#PTonICE Daily Show

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Julie Brauer discusses the ins & outs of daily life as an acute care physical therapist. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JULIE BRAUERWelcome to the PT on ICE Show brought to you by the Institute of Clinical Excellence. My name is Julie. I am a member of the older adult division. Thank you for spending some time on your Wednesday morning with me. Let's dive right in. So one of the most common questions that I receive from students and clinicians is is asking me about acute care. Should I go into acute care? Should I choose home health over acute care? And I'm having a lot of conversations with folks about pros and cons. and sharing my reflections from having been in acute care and home health and inpatient rehab and outpatient and private and home with older adults. So I figured I would do a podcast and bring all these thoughts that I've been having in these individual discussions to all of you. Okay, so what I'm going to do is I'm gonna go through a list of five to seven things that I believe are the most important characteristics of acute care and will help you decide if acute care is the right setting for you and if you are going to thrive in that setting. Okay, so number one, this is what I believe is the most important characteristic that sets acute care apart and will be the biggest factor in helping you determine if you are going to thrive in this setting. All right, number one is that in acute care you have complete autonomy over your day. You have complete autonomy over your schedule. This ended up being The reason why I feel like I thrived the most in acute care is because I wanted full autonomy over how I structured my day. So let me explain what that means. So when I was working in the hospital, I would walk into work, you clock in, and you are more than likely going to be given a list of patients. It is then up to you to decide which of those patients you're going to see. Are they appropriate to be seen? So you're doing some triaging there and you have autonomy to make that choice. And then you get to decide, most importantly, what your day looks like. When do you go see those patients? And this was so key for me. I don't like to be in a box. I don't like to be back to back all day. I like to create my own day. And so I would look at my list and depending on how intense or complex the patients were, depending on my energy levels for the day, I would decide, like, okay, I'm going to knock out a bunch of my patients in the morning. Back to back to back, get it done, and then go eat lunch, and then in the afternoon when my energy stores are down, that's when I do the majority of my documentation. So my afternoon, I wouldn't really have to see any patients, maybe one, and the majority of it was documenting. Or if sitting around and documenting for a long time is something that fatigues you, you can do a system where you go see a patient, then you document. You see a patient, then you document. So if you are someone who really needs that energy reset after pouring into a human, typically one that's very sick and there's lots of complexities and you need a little bit of a break and a breather, you can set your day up so that you get that break after every single patient or perhaps after two patients. So you really have a lot of flexibility there. I remember I was the type of person who I would love to knock everyone out in the morning. I would go find a quiet room or a room that was near some natural light. I would put my music on and I would just sit there and document. So you have full flexibility there. When you look at other settings like inpatient rehab, you are back to back to back to back. It's one of the things that I liked the least about the setting is that I did not feel like I had autonomy over my day. And I realized that that was professionally a big core value of mine. And then if we think about home health, you do have a lot of flexibility. You schedule all of your patients yourself. However, I learned my experience was that that was a big burden for me and I never really knew what I was walking into. I didn't get the choice of who was on my schedule. Scheduling patients was typically fairly time-consuming and frustrating when you're trying to reach out to all these people and they may not be answering and you're trying to very efficiently, Tetris them into your schedule so that you're not driving all around your region. Trying to schedule patients became just this extra task that really stole a lot of my energy. So after having been in multiple settings, I think that was the biggest plus to acute care. And if you are someone who likes to have that flexibility and you feel you can be efficient and effective and productive by making your own schedule, then acute care may be the setting for you over other settings. Okay, that's the biggest one. Number two, When you work in acute care, you learn how to be a master of scale. You have to learn how to come up with unique and creative loading strategies because you are in an environment where you don't have weights. You are in an environment where maybe you are just stationed to the edge of the bed because your patient is, they have tons of lines and tubes attached to them. So you have to figure out how to do a lot with a little. And that skill right there has become, it became my superpower going forward into every other setting. I never encounter a time where I'm with a challenging patient, they're complex, or we are in a less than ideal setting, for example, someone's home, and I have never felt I'm stumped. I don't know how to bring a fitness forward approach to this person. I can't come up with an idea. I don't have weights, and so I just don't know what to do. That has never happened. And the reason for that is because over several years, I learned how to get incredibly creative. So in the acute care setting, that could be as easy. I carry around dumbbells in my backpack. and I'm like rucking through the hospital, I bring my own equipment. We paused, we paused, we're back. That could also look like the, this is my favorite hack, the toiletry buckets that are typically filled with shampoos and soaps. I dump those out, roll up towels, soak them in water, put them in the toiletry bucket, and now that becomes a little bit of load, I would have folks deadlift that toiletry bucket, press it over their head. That was one of my favorites. I would use the tray table for a sled push. I would turn the hospital bed into a total gym and put it at an incline and have them reach at the bar above their head and they're doing pull-ups or I'm having them basically do a leg press with the hospital bed. I just was able to always find a way to bring that fitness forward approach and the acute care setting really forces you to get creative. And that was just such an amazing skill that has carried me through every single setting with every single patient that I've had throughout my career. So that's number two. Okay, number three. You do not, for the most part, have to take any work home with you. Yes. How nice does that sound? So for a lot of you who are in other settings and you typically at night, you get home from work, you maybe go to the gym, you eat your dinner and then you're like, well, here's my glass of wine and I'm going to sit down and I have one to two hours of documentation to do. That is not something that is typically happening when you are in acute care. Now in the very beginning as a new grad, a hundred percent, I was taking documentation home for me. But the vast majority after that learning curve, you know, after I got through that steep learning curve, I was not taking any work home from me. With me. You actually get to leave work at work. The administrative burden is very, very low. The EMR is very easy. It's a very low, low, low documentation burden. Something that I didn't know and I learned when I went into home health is that my god, documentation burden was enough for me to, was a big reason why I quit home health. I truly was so frustrated and cognitively overloaded by how extensive the documentation was that I could not even be present or enjoy the time with my patients. And for me, that was enough to say this setting is absolutely not for me. So if you are someone who you're really trying to create a barrier of when I'm at work, I do my work and I do a fantastic job. And then when I'm out, I'm off, I'm done. You go home and your energy stores go to your partner, they go to your friends, they go to your family. Acute care is definitely a setting where you can more easily create those boundaries. Okay, documentation burden low, that's number three. Number four, you are gonna do a lot of things in acute care that don't look like traditional therapy. Okay, so what I mean by this is that your role beyond improving someone's mobility and getting those sick patients, those, you know, individuals who need to get out of that bed and trying to start to get them stronger. Beyond that, I would say The majority of my time was actually spent being a fierce patient advocate, a fierce patient advocate. That is truly what my role became. And I actually evolved to loving that part of the role even more sometimes than going in and doing the functional mobility strengthening stuff. I thought it was such a beautiful opportunity to be able to advocate hard for my patients. So in MMOA, we call that significance over sexiness. You're not always going to get this patient doing squats or deadlifts or bringing in weights, but what you can do is you can fight to the end so that your patient can get over to inpatient rehab. I will never forget one of my first patients that I experienced working on the trauma floor was an individual who had a spinal cord injury. He fell down the stairs, ended up in the hospital. He did not have insurance. And he worked hard every single day with us. I worked with him for months. But because he didn't have insurance, acute rehab was saying, no, no, no, we're not going to take him. Even though everything else made him the perfect candidate to go to rehab. And we know that his outcomes were going to be so much better if he was able to go over and get that intensive rehab. So me and my colleagues were able to just hammer on that goal and we brought it up to the physicians and we got them to do an appeal and face-to-face peer review and we worked closely with case management and we were able to get him over to rehab because we went after that so hard. and that was more beneficial than probably anything we could have done in a more traditional therapy sense. So you have this awesome ability to really dictate the outcome of these folks and it doesn't look anything like PT. Another example is if you have an interest in working in the ICU you have an amazing role there to advocate. Meaning you're going around with the physicians and case management and the nurse manager and sometimes higher up execs in the hospital and you're looking at these folks who are on sedation and on the vent and you know that you want to get that sedation down so you can get these people up and start that early mobility. and you get to look at their settings and look at what's going on and say, look, can we get this person off Propofol and put them on Propofol? Or sorry, the opposite, take them off Propofol and put them on Procedix so that we can try and decrease the sedation burden that's going on with our patients and get them mobilizing faster. That is so cool. I thought that was amazing. I loved feeling like I was like this mama bear trying to protect all of my patients and get them to the next best. setting and really improve their outcomes. And much of that did not look like teaching them how to do sit to stands or deadlifts. So if that's something that you feel you would love to do, acute care is a really wonderful setting for that. Conversely, if you are an individual who, you know, I talk to a lot of clinicians and students who love the fitness part, like their core values when it comes to their professional career are that They want to be able to work with someone when they are in the stage of being able to load them up. That's what brings them value. They want to work more from a sports performance perspective. And they want them to be at a level where they're able to do all the exercise. Like that's what you love to treat. And so I give them the, you know, I let them know, acute care may not be the setting for you. You really may belong more in outpatient instead. So something to think about just the how dynamic of the role can be in acute care. Okay next you learn how to communicate and you learn how to be on a team. All right you will hear all the time that in acute care you have to have really solid interprofessional communication. 100%, you've heard that word over and over again. But what does interprofessional collaboration actually mean? You learn very quickly that the world does not revolve around you and your therapy plans. These patients are so complex. They have so much going on with them. You are one small piece of the puzzle that actually helps them move on to the next level of care, or helps them get home and be safe. You learn it really quick. You cannot operate in a silo. You start to learn what the nurse's roles are, what the nurse tech's role are, truly what your OT partners and your speech partners can do. And you learn how to work with case management. You learn how to have conversations with physicians. They're all right there, and you have to figure out You have your patient's health and mobility, and you want them to get stronger. That's the forefront of your mind. But you've got to deal with all of these other individuals who have their own priorities when it comes to the patient. the physicians or the surgeons, like I'm trying to keep the lungs and the heart alive, or I'm just trying to keep that brain alive. Like that's what their focus is. You know, the nurses are, Hey, I got to get these meds into my patients and they're overloaded. And you start to learn to have grace for people when maybe they're not fitting the idea of what you think should be done for the patient because you're thinking about your bias of mobilization and strengthening. So you start to understand, how to create allies with individuals who have various priorities when it comes to your patient case. You learn how to argue, you learn how to be direct, but you learn how to respect everyone else's role and everyone else's time. And that can become a really beautiful collaborative effort where you can work together and move people forward. And you just don't get that opportunity in other settings. When I went into home health, I really missed the fact that I could easily collaborate with my OT partners or my speech partners, or I could easily, you know, talk to a physician. In home health, a lot of the time it feels a lot more siloed and My goodness, if I was able to get even just a PA on the phone to tell them about a concern I had with a patient, that was a big win. So if you are someone who values and loves the fact that you're surrounded by a team constantly, acute care may be the setting for you there. Okay, only a few more, I promise. Let's do two more. Okay, next, the emotional toll slash connection is very high in acute care. Now, every single setting you are going to be emotionally connected to your patients, right? You could be in very vulnerable situations with the patient. However, I do believe acute care has the highest amount of emotional connection and along with that emotional toll because you are with folks that are dying, that have been through catastrophic accidents, that are, you know, I will never forget the day where I was working in trauma and a patient came in, terrible car accident. That individual lived, but her spouse died. And you are pouring into this human, they don't even know that their spouse is dead yet. I mean, you are going to face these situations so often, especially if you work more in the ICUs. You are surrounded by death quite frequently, and you're surrounded by a lot of sadness and loss and grief. And that can take a significant toll on you. I think it's beautiful that you are able to be someone who can support your patient, your patient's family during an incredibly tough time. But that can also be something if you are, um, if you are an empathetic person to a fault, sometimes like I am, that you can take on a lot of that grief and that can end up being incredibly heavy for you. So something to consider if you love to be in those vulnerable positions with your patient and you want to help them through dying and sickness and grief and loss, it may be a great setting for you. And that's not to say you don't experience intense joy as well. You can. see folks who were minimally conscious after a stroke or traumatic brain injury, and you can see them, you know, spontaneously start to recover. And that's absolutely incredible as well. But the emotional roller coaster is incredibly high. So if you are prone to taking on a lot of energy and emotion, and that's something that you know is not necessarily a positive for you, then maybe acute care isn't the place for you. Okay, last one here, last one. you do not get to see the sexy outcome. You do not get to see the sexy outcome. In acute care, you truly have to be okay with being the person who sees this person once, you plant a seed and you hope that that grows and that ends up changing this person's trajectory. But you don't get to see that outcome most of the time. And that's really hard for individuals. Many clinicians, they want to build that relationship and go along that journey with someone and see discharge day, see how far they've come from the amount of effort and work and progress that you've been making together. That longer term relationship is so important. This is one of the, um, this is definitely one thing that I didn't like about acute care as much is that I didn't have the ability to see this see this outcome. On the flip side of that, I definitely adopted the perspective that, hey, I've got maybe one or two chances to work with this patient. I'm going to do everything possible to set them down the right path. I'm going to pour into this human 200% to try and make sure that I can hand off the baton to the next person and it's a fitness forward individual and I can continue to keep them in that lane. And I was okay with that. I loved knowing that as a fitness forward professional, when I walked in those doors of my patients' hospital rooms, I knew, I just felt that their outcome was going to be different because I was coming into their room. And I loved being able, I loved being able to have that impact with them, even if it's for a very short amount of time. If that is something that you feel like you can get on board with and you can really learn to value and you can be okay with planting the seed and not seeing the outcome, acute care could be a really wonderful setting for you. If you are someone who knows that they want to go along the journey over a long period of time, they want to see discharge day and know what those efforts look like at the end and what the outcome was, probably not the setting for you. Okay, all, that's my list. It's not an exhaustive list by any means. I would love for you all to add to this list to kind of let more folks know some pros, some cons, some other considerations. Please add to this. Put it in the comments. Send me a message. I'd love to post other thoughts about all the things that go into acute care and whether it is going to be the right setting for you. Okay. So I will end with talking to you all about what we have coming up in the older adult division. So in August we, Oh, first let's talk about July. My goodness. So this coming weekend, we, uh, the whole team is in Littleton, Colorado. And then once we go into August, we are in California, Salt Lake city. in Alaska, as well as our Level 1 online course, that starts August 14th as well. PTINice.com, that's where you can find all of that info. If you're not on the app already, make sure you get on there and get into our community. We're on the app so much more now, so if you have questions or comments, find us in there. All right, team, have a wonderful rest of your Wednesday. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you’re interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you’re there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Miller Armstrong discusses the key factors that set the top 5% of physical therapists apart. He emphasizes the importance of making one crucial choice for clinical success. The podcast also highlights the inspiring story of Coach Seriki Diabate and upcoming spine management courses.

Dr. Jessica Gingerich // #ICEPevic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Jessica Gingerich discusses pushing strategy during labor. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION JESSICA GINGERICH Good morning, PT on ICE podcast. My name is Dr. Jessica Gingerich and I am on faculty with the pelvic division. Today's Monday, so you know that we are kicking off our week with some pelvic content. So today I'm going to talk about a question that I got from a client. So I wrote this down because I didn't want to get it messed up. And so She asked me, she said, if my uterus contracts to push my baby out during birth, then why do we as women feel or need to push during that second phase of labor? And I love this question because she has, she's done her research, right? She read that the uterus contracts to help push her baby out. And sometimes there are some nuances to our patients that we want to make sure that we clear and explain, and especially around birth, because we can decrease that fear around birth. Or if she wasn't having fear, at least empower her. So the uterus plays a key role during labor. So it expands during pregnancy to accommodate the growth of the fetus. There's also a thick muscle called the myometrium that expands to hold the baby, but it also contracts during labor, um, in this wave like pattern, starting from the top of the uterus down towards the cervix. And it helps to open or dilate the cervix. And it helps to thin or efface the cervix to allow the baby to move towards the birth canal. The contractions become stronger, more regular and more frequent as labor continues. So that is the role of the uterus. The pelvic floor's role is to be in a relaxed position. I like to think holes open, and I even say that to my clients. So it gives this really nice kind of internal cue. Now, while the uterus has a lot of work to do during labor, the role of pushing just helps descend the baby towards the birth canal. So it's just something that helps. And that's all we can that's what we can explain to our patients if they have this question. Now, this is kind of outside of the scope of this podcast, but I want to mention this is Because we do push during labor, we can imagine that the stronger our cores are, and really from an endurance and aerobic capacity, this can be a huge advantage, right? The stronger we go into labor can be a huge advantage to help with this. And so we want to make sure we're encouraging exercise in specifically core work, and even programming that as accessory work for our clients. So let's get into pushing. And there's two specific ways to push, and I'm going to talk about those today. This happens during the second phase of labor. I want to also mention that when we talk about pushing, we've got an open glottis and a closed glottis. The closed glottis is very similar to what athletes do when they are lifting weights. And so we really want them to practice how to push, especially those athletes that when they hold their breath, down below there are holes closed. And so as we talk about these strategies, I want you to be thinking about your clients who would really, really benefit from this. So the first one we're going to talk about is the closed glottis push. This, you think about your canister, so you've got your diaphragm at the top, your abs at the bottom, or excuse me, in the front, you've got your pelvic floor at the bottom and your back muscles in the back. You've got holes in the top and you've got holes in the bottom. And so as we create that intra-abdominal pressure by either tensing our core and holding our breath or tensing our core and exhaling, these are different strategies that create a different amount of force with each. So the first one is closed glottis or closed glottis pushing. This is going to be where we close our mouth, we close our nose and we bear down or strain putting the base or putting the pelvic floor in the basement or in that descended position. This creates a lot of force. This is going to be very helpful if mom is right at the end of that finish line and she can feel maybe she reaches down and she can feel the baby's head. or she, um, someone's telling her that her baby's crowning. She can close her mouth, close her nose and push. The second one is going to be an open glottis push. And so you can imagine we are creating a force through our abdominal muscles as air is coming out of our mouth and our noses. This is typically going to be really noisy and really loud. Maybe mom's screaming, maybe she's, making some really loud mooing faces, maybe noises, or maybe she's cussing because it hurts and that's okay. So this is gonna be a little less powerful, but it can be a really wonderful technique to help control their heart rate and help mom hold on longer, especially if she's got that marathon birth going on. Both of these pushing strategies can be influenced whether mom has an epidural or not. There's going to be less likely them to feel what they're doing. And so they're going to need coached pushing. That's going to be a nurse telling mom when to push. This is important to talk about because they need to practice. Practicing these birthing these pushing strategies for birth prior to birth can help mom come back to that and remember, Oh, this is what I did. This is what I did to prepare for this. I had a client tell me that she was in her second phase of labor. So she was pushing, she was so confused because she could not figure it out. She also had had an epidural. And then she remembered, she was like, wait, I remember that we practiced this, that you, you had me every day practicing how to do this. And so she went back to what she had been doing and she ended up being really, really proud and really, um, happy with how her birth went. But it took her a minute to like, remember, Oh wait, I did this. I knew going into my birth, how to do this. So she came out of that. She was really empowered, felt really good. So that is what I've got for you today. Um, we have our last cohorts coming up. So if you head over to ptonice.com, our last L one is kicking off on September 9th and our last L two of this year is going to be kicking off on September 15th. So head over there, snag your spots. Um, we'd love to have you have a great Monday. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Matt Koester // #FitnessAthleteFriday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Endurance Athlete faculty member Matt Koester discusses the differences between front and rear mount bike trainers, which is preferred for different bike types, as well as budget options.  Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn from our Endurance Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION MATT KOESTERWhat's up everybody? Good morning and welcome to another episode of the PT on ICE Daily Show. Today I'm going to be your host. I'm Dr. Matthew Koester. I'm one of the lead faculty in the endurance athlete division with a specialty in bike fitting. I am super stoked to hop on here today and talk about probably the most popular question that we get in every live course and one of the most important things when you're getting into fitting for the first time as far as equipment goes. But before we dive into those topics, I want to talk about the opportunities that y'all are going to have to come and find us on the road. with number one being in Denver next weekend. We've only got four seats available for that course, so if you're interested in popping in, it's gonna be in South Denver in the Denver Tech Center area. We are really, really stoked to be heading out there soon, but if that's not gonna work out for you, we have another option, which is gonna be in Bellingham, Washington again, because the last time we were out there, it was completely sold out, the wait list was filling up, and we decided we'd run it back and set up a second course in Bellingham, Washington later this fall. There's gonna be another opportunity as well to see Jason London, who's the original content creator for this course, which is an absolute opportunity in Park City. That's a really cool location. We're gonna be out there in October as well for that course. So if you're looking to get a jump on some of this education and use this stuff in the clinic, the live course is the best way to get through it. So by all means, come find us on the road and check out one of those course options. Now, I said I was gonna talk about probably the biggest question in the course. The biggest one is really the thing that gets you into this. And it's what type of trainer do I need? We have two options in most cases. So to my left and behind me here, we have a front mount trainer, which offers a whole lot of options as far as what bikes can go on. And then we have the tried and true rear mount trainer. And what I want to do today is talk about probably like the biggest pros and cons of each. I want to talk about which one is probably the most appropriate for you and your clinic, depending on what type of bikes you're typically seeing. And then the ones that kind of have, I'd say, more budgetary constraints and or are just limited in availability sometimes. So, to start off first, I want to talk about the rear mount trainer because that is the one that is tried and true. That is going to be, in most cases for us, this green guy here. This is the Curt Kinetic trainer. Now, if I slide that thing forward, You'll see we've got the rear roller, which is basically what compresses the tire and allows you to kind of go through resistance while you're pedaling. You've got this rear cup that basically compresses the back axle of the bike and allows you to keep the bike nice and steady. And then we typically put something underneath the front wheel. Sometimes it's a custom wheel block. Sometimes it's an adjustable wheel block that allows you to lift that thing up and down and change the positions. But with this trainer, one of the things that people really, really love about it is that it's been around forever. They're used to it. When somebody comes into your clinic for a bike fit and they see something like this, they're like, ah, I know what this is. This makes perfect sense to me. I even brought my training skewer, which is typically the axle that they have to replace in the back of the bike if they're going to get on this bike. Because these metal cups here that compress the rear axle when they're tightened up are gonna basically act to lock the bike in place only on the contact points they get to touch. So if those contact points are plastic, which is pretty common as a way to save weight, save money on a bike, you have to replace that either with a training skewer, which just has metal cups on the sides, or in many cases nowadays with how bikes have gotten, these new through axle skewers. So the through axle skewer is typically a lot thicker, it's a lot more robust. It's common on bikes that allows them to put disc brakes on the bikes, which is really more and more ubiquitous these days. So having these options for different through axle skewers allows you to put metal on metal and compress it in the rear end of the trainer. Now depending on what types of bikes or what brands of bikes you're seeing more in the clinic, the skewers that you're going to need are going to change. So they all have various thread types that go on them. Some are very fine, some are medium, some are coarse. Now the Other kicker to this is that even though you might have the thread type dialed in, the distance, so the width of the actual screw itself might change. Last time I checked on the Kirk Kinetic website, which is the name brand for these guys, they had somewhere between, I think, five different options. I think it was like five different ones, three that were the different thread types, and then two more that were XLs for different distances. And each one was running about 50 bucks. So there's a bit of a financial investment to have all the options so that folks can come to see you and have all the options available to them. If you don't have one of these available to you and their bike doesn't have that, you're going to be kind of stuck in a place where you don't have an option with this style of rear mount trainer to throw them on and do the fit appropriately. That could be a bummer. got to have all the pieces. I'll say there's one other option out there, or not one, but two other like styles of these that are completely adjustable. CycleOps makes one, and I'm forgetting the other brand right now, but they basically have plugs and things that you can change in and out to put on. In my experience, they can be a little challenging to work with. They don't always match up exactly the way that I want them to distance wise. I like the tried and true nature of these ones from Kure Kinetic, but if you're in a bind, and you can only afford to grab like one adjustable through axle, I think you can figure it out. You just have to spend more time with it and go through the trials and tribulations of working through it. So, to recap real quick. This guy, tried and true, everybody knows it, everybody's used to it. It's a trainer they spend their entire winter on. The adjustability in terms of having different through axles is definitely a key. You gotta have them, especially nowadays as bikes have gotten more and more modern, going to disc brakes. These through axles are just like almost a non-negotiable So you gotta have all the different types so you can match the different brands and the different bikes that they come in. So, tried and true. Now, we step into one thing that Jason and I have been seeing over probably the last few years that's really become more popular is this front mount trainer. It really started to make its way in probably like a couple years ago in staging areas or like warm up areas for cross country cycling and downhill cycling. Specifically in downhill cycling, you'll see these guys everywhere when it comes to just getting through warmups. What this guy has to offer is two pieces that basically slide together. These two pieces include the front end triangle here, which allows me to remove and add the front fork of the bike. So we take the front wheel off, slide the forks over top of this guy, and snug it up nice and tight. The next piece from there is the rear rollers, where we have to get the tires centered in the rollers so they can smoothly pass back and forth as it's rolling. Cool part about this, they only have one adjustable piece as far as the actual front axle goes. So, and they send it with them. So when you buy this piece, you have everything that you need in order to do the fit. You can put any bike on here, because the front mount options will work for a standard fork, so they'll work for through axles. You can often put their own through axle back into the same bike. When you're talking about the distances here, there's a little track here that allows you to work with different size bikes so that when you overcome that issue, you can even separate them or buy the extenders. It just has to get, you have to make sure they're nice and perfectly aligned. Otherwise the back wheel might want to roll off one side or the other as you get started. So the rear trainer here offers a whole lot of options for being able to just throw a bike on quick. Now, the challenge that comes with that, as you start to get into like, oh, this thing works for everything, is that it kind of has that jack of all trades where it's not quite really any good at one thing. The challenge behind this thing is that it's not near as stable. It kind of sacrifices the stability and the tried and true nature of the rear mount for something that can be a little bit tippy if your patient or client gets on it and you're not paying attention. If they just throw a leg over it, it can kind of pull the weight with it, I'll say I've never had anybody fall off one. I've never had an actual incident, but I can definitely tell you that when I am with a client in the clinic and we're setting up to do a bike fit, I talk to them about getting on and off the bike carefully. I talk to them about how, like, when they're going to transition on, I'm going to grab ahold of the bars just to create that element of stability. But then even once they're up and on, an experienced rider, so I would say a good example of this would be a triathlon athlete. So somebody who's in the Madison area for me, who's doing Ironman Wisconsin and is coming in for a fit, If I throw them on this guy, it will work, and it will be fast to throw it on, but it lacks some of the stability and control that they're used to having when they're on the rear mount trainer that they spend all their time on. So they might hop on this, and they might notice that they just don't feel as confident. They don't feel as great. So they're more thinking about the experience of being on the trainer than they actually are thinking about the fit as they're going through it, which can be a negative. Okay. So there's the negatives to it, and there's the positives to it. From a financial standpoint here, if you were in a clinic where you were going to have to buy things new, and I'm going to kind of make that a subject for a moment, you can't just go on Facebook Marketplace and buy new stuff and throw it in at your organization. This guy's going to run you somewhere between $400 to $500, but it's kind of that jack of all trades. You can put anything on it. There's no bike you need. There's no custom pieces that you have to go through. You can just get any bike on here. The rear mount trainer, gonna be a similar ballpark. In many cases, it'd be like 250 to 450, depending on how nice you go, you can certainly spend more. It's gonna be limited in some ways because you're gonna have to have all of the different through axles to accommodate any different bike that walks in the clinic, but you're gonna have that stability and just steadiness that people really rely on and like when they're riding a trainer at home. So it's familiar, so that's kind of a nice option. If we take a step away from the idea of having to buy new, and you're like, okay, I'm going to budget my way through this in my clinic. And I know that if I buy something used, I can just make sure that it's good quality and it's broken. We started to get changed the tone here a little bit. These are harder to find use, but they are definitely. Hmm. They're harder to find used, you can get a hold of them, but they definitely have deals all the time on new ones. So you can find the ballpark, if you go on Amazon or various websites, you can get anywhere between that $400 to $500 mark. And this is where I would spend the bulk of the money, because you're going to have almost no scenarios in which you can't get the person's bike on the trainer. That is going to get you through more fits, even if it's a little bit less ideal of a setup. On the flip side, if I've invested in this one right here and I've got the money spent, I'm probably going to start looking at Facebook Marketplace because these guys are a dime a dozen. There were so many folks during COVID that were buying up bike trainers and they were going to spend more time on them at home. We saw the same thing with Pelotons and indoor bikes. These things are on Facebook Marketplace, Craigslist if you still go down that rabbit hole. They're everywhere for sometimes like under 100 bucks, maybe 50 bucks sometimes. And then from there, most of your investment on this guy goes towards the actual, through actual skewers that allow you to get all the bikes on. So your investments kind of change a little bit as you go through this. This guy's going to be the most money up front. This guy's definitely going to be cheaper as you go through it. But you got to get more components, more pieces. If I only had one in the clinic, which is kind of the question that people boil it down to, if I only had one, it would be the front mount trainer. and that comes with one more layer to it. I love the ability for a private practice or a clinic to be able to get out in the community and showcase the things that we do on a high level. If I want to go out to our local high schools here and go talk with them about mountain bike fits and making sure they get the best performance, injury rate reduction, all of those things, I can pop out to the local high school on one of their opening practices, which is actually coming up in a few weeks. I can throw up the front mount trainer, and in a very short time, take out their front wheel, put that thing right over top of this guy, pull the back up, and go right through things like seat height, have a quick look at their reach. I can make adjustments to small things on the bike very fast and make quick transitions to the next bike and not have to fiddle around with various components and other changes. So the, not only in the clinic does this kind of become the absolute jack of all trades, getting it on, It also makes some of those like community events that much more approachable and that much easier to go through. So I am always going to lean on this guy, but I will tell you it's nice having both for that occasion when somebody comes in and I'm like, Ooh, I really want the stability of the rear mount trainer for this person to throw it on. But I would say nowadays as I've gotten more and more comfortable with this, those things are few and far between. There are a few more nuances that would definitely go into this. There's more questions that surround them about the live courses. but deciding between which one is right for you. Hopefully this is a helpful conversation, a helpful talk to get you through that decision. Feel free to drop a comment, ask us questions here, send me a DM, but we will be in Denver next weekend. If you're ready to join us, we'll talk this stuff through even more. Thanks, y'all. OUTRO Hey, thanks for tuning in to the PT on ICE daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you’re interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you’re there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

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