#PTonICE Daily Show

Dr. Mark Gallant, a clinician specializing in fitness and health, discusses the shift towards a holistic fitness-focused approach in physical therapy. Topics include metabolic wellness, balancing fitness coaching with physical therapy for highly fit individuals, and tailoring fitness programs for fitter clients.

In this episode, Dr. April Dominick from ICEPelvic discusses a unique case of an OBGYN client with lumbar radiculopathy. She shares insights on a specialized core training approach that helped the client tolerate sustained positions with less pain in the OR. The podcast also covers strategies to reduce physical strain during C-sections and core rehab routines for surgical staff.

Dr. Zach Long, Fitness Athlete lead faculty, shares tips on increasing PT income by understanding current earnings, negotiating higher revenue percentages, and offering specialized services for fitness athletes. Learn how to maximize income through strategic negotiations and post-discharge programming.

Alan Fredendall // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Chief Operating Officer Alan Fredendall discusses the concept of poise, poise gone wrong, and poise gone right. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course 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 INTRODUCTIONHey everybody, Alan here, Chief Operating Officer at ICE. Thanks for listening to the P-10 ICE Daily Show. Before we jump into today's episode, let's give a big shout out to our show sponsor, Jane. in online clinic management software and EMR. The Jane team understands that getting started with new software can be overwhelming, but they want you to know that you're not alone. To ensure the onboarding process goes smoothly, Jane offers free data imports, personalized calls to set up your account, and unlimited phone, email, and chat support. With a transparent monthly subscription, you'll never be locked into a contract with Jane. If you're interested in learning more about Jane or you want to book a personalized demo, head on over to jane.app.switch. And if you do decide to make the switch, don't forget to use our code ICEPT1MO at sign up to receive a one month free grace period on your new Jane account. ALAN FREDENDALLAll right, good morning, PT on ICE Daily Show. Happy Thursday morning, hope your day is off to a great start. My name is Alan, I'm happy to be your host today. Currently have the pleasure of serving as our Chief Operating Officer here at Ice, and the lead faculty in our fitness, athlete, and practice management divisions. Leadership Thursday, we talk all things business ownership, practice management. Leadership Thursday also means it is Gut Check Thursday. So this week's Gut Check Thursday, we have a partner workout. We're working our way with a partner through five rounds, 20 or 15 calories on that rower. Ideally, that's together, side by side, two different rowers. Coming off the rower, moving through 15 synchro toes-to-bar, and then finishing with a little you-go, I-go, working our way through 10 total sandbag cleans. I do one, you do one, until we've done 10. and then resting a minute after each round. That's gonna feel a little bit like anaerobic intervals, a little bit like maybe doing 400 meter repeats on the old cardiovascular system. Our goal there is two to three minutes per round, a minute per rest, get done with all of that work right around the 20 minute mark. I tested that yesterday in the garage, was able to hang with about 230 to 245 per round. My toes to bar are not the best, but a really nice workout, very simple, very easy to warm up. So that is Gut Check Thursday. Speaking of working out, May is Mental Health Awareness Month. We're happy to be partnered with Forging Youth Resilience. You may have seen at the Ice Sampler a couple weeks ago, we did the Ignite workout, a fundraising workout designed to support FIRE and support Mental Health Awareness Month. So all throughout the month of May, you still have time to donate to our campaign, which is for Forging Youth Resilience. We're trying to raise $10,000 to help some of those kids go to camp this summer in July up outside of Boulder, Colorado. So you can find more information about that on our link tree on Instagram. Find all about Forging Youth Resilience. Find all about the Ignite Workout and our fundraising campaign for FIRE. EMOTION CAN SPREAD LIKE A DISEASE Today we're talking about the concept of poise, the definition of poise, of staying in balance or staying in equilibrium. And in the context of today, we're really talking about staying balanced, staying composed, representing poise as it relates both to leadership within the clinic, you and your colleagues and your teammates, but also poise in front of our patients. So the idea of this topic came upon me actually several years ago. Two years ago in June, I had the pleasure of watching Dustin Jones and Jeff Musgrave teach Older Adult Live. down in Kingman, Arizona, and then we took a trip up to the Grand Canyon to do a rim-to-rim hike. So if you have never heard about that, you've never done it, rim-to-rim is half of the hardest thing you can do there, the other being rim-to-rim-to-rim. So starting at the top of the Grand Canyon, hiking down to the base of the Colorado River, and then hiking back up. Some individuals hiking south rim to north rim and then coming back. So many, many miles of hiking, very rough terrain, And this time of the year, spring, summer, very, very, very hot. So stepping off around 4 a.m., hiking down to the Colorado River. If you don't know anything about the Grand Canyon, it's really mentally defeating. It can be because as you come down in elevation, the heat actually goes up, which is not something our bodies are used to happening. So as you get closer to the river, it actually gets very, very hot, sometimes approaching 120 degrees. And then at the hottest point of the hike, at the hottest part of the day, you turn around and hike back up the Grand Canyon. So very, very tough, both physically and mentally. And as Jeff and Dustin and I were making our way back up the Bright Angel Trail, very wide trail, very exposed trail, sandy, not a lot of shade, very hot, very dry. And again, you're already halfway through the hike, so you are already pretty fatigued. And overall, I think it's fair to say that coming back up to the rim to finish the hike, most people are just trying to finish. They're looking forward to being done. And along the Bright Angel Trail, as you come back up, what you encounter along the trail are these things called rest houses. These are just little brick houses for shade that have a well pump nearby so that you can top your water off. And so, Jeff and Dustin and I, coming back up from the base of the river, making our way back out of the canyon, about halfway up, passed by one of these rest houses, decided to stop, take a break, top off our water. And we walked in this rest house, It was packed full every every inch of space had somebody sitting and hiding in the shade. And as we looked around, we realized a lot of these people probably had no business doing that hike. If you've never done the Grand Canyon hike, what you experience when you start the hike is signs everywhere. telling you, asking you, begging you not to do that hike, warning you that usually somebody dies every day hiking the Grand Canyon. It's very tough. It's very hot. And so as we're sitting in this rest house, we were sitting among some folks who maybe should not have been out on that trail. who were in a really tough spot physically and mentally. And unfortunately, on that hike, you're not really in a position where you can give much help to people. You certainly could not throw somebody on your back and carry them out. You're really not in a place where you could afford to give somebody any of your water or your food. Those folks, unfortunately, are just gonna have to wait until the sun goes down, until their body has recovered enough to hike back out of the canyon. And so my first experience with poise and with negative emotions was in that rest house, watching all those people really, really suffering and the three of us kind of sitting down, not as deep in our tank as some of those folks. But really, the longer we sat there, the more we realized kind of how quiet, how defeated those people were, and how that negative emotion, those feelings of maybe hopelessness, of extreme physical and mental fatigue, were actually starting to get into us. The longer we sat there, the longer we rested, the more we kind of let the whole vibe bring us down, even though when we walked into that rest house, we were definitely not in the same mood. And I'll never forget Dustin standing up and saying, okay, let's go. We have to get out of here. It smells like death in here. And what he was saying was, hey, we're actually not as bad off as these people, but if we sit among them for too long, we will convince ourselves that we are. So let's get going. Let's keep making our way Kback out of the canyon. We don't need to sit and rest here and feel bad about ourselves and how tired we are and how much we just want to be done. we can't let those negative emotions affect us. So, realizing that our poise, our balance, our equilibrium, our confidence can rub off on other people near us, and especially the larger group of people that is around, the more people feel a certain way, we can almost palpate those emotions, right? We've all felt that at a concert, or maybe you felt that at church during worship or something, you can feel kind of positive and negative emotions start to infect you almost like a disease. And so recognizing that is a concept that can happen and that we ourselves are in charge of not only how we pick up on other people's poise, but how we demonstrate our poise to someone else. KEEP YOUR POISE: GRIPES GO UP THE CHAIN OF COMMAND And so my second point today is learning a little bit about leadership in the military, going to non-commissioned officer academy, and really learning a foundational leadership concept that when you are frustrated, when you are upset, when you have suggestions, when you don't like the way things are going, your suggestions, your feedback, your complaints, your gripes, call them whatever you want. should always move up the chain of command, they should never move down the chain of command. And very similar to the Grand Canyon story, the idea behind that in the military is poise, is confidence, of we don't want to mislead people, we don't want to lie to them about the current situation, but at the same time, complaining to people beneath us about how tough our job is, or how bad things are going, especially if they think things are going well, and otherwise putting a damper on the situation again, can really bring in those negative emotions, can really start to fester, and really start to spread and infect almost like a disease. That if we're not careful, that if we complain too much about our business, about our clinic, about our patient caseload, about financials, about taxes, about any of the different things that we can have suggestions to improve, that we can have wishes that they were better, that we can have complaints about why they're not better. All of those things When we voice those things, especially to people in leadership positions beneath us, we need to recognize that we're just fostering that environment of negative emotion. And my final point is, why does this really matter? Even if you don't consider yourself in a leadership position, even if you're not in a leadership position in your business, in your clinic, you are in a leadership position with your patients. And just like complaining downstream can really have a lot of negative effects on a whole organization, having that same mindset individually with a patient about your business, about your clinic, about how busy you are, all of those things are concepts, are thoughts, are emotions that our patients are very easily able to pick up on. POISE WITH PATIENTS So my third point is, your poise matters probably the most with the patient in front of you. I truly believe it's our job to make that person feel welcome, to make them feel like their concerns are valid, and that we do have a way to help them, and probably most importantly, our poise is that we are excited about helping them. Not every patient that walks in is a high-level athlete and it's really fun to help them improve their snatch or their clean and jerk or something like that. Some folks come in and we know those patients. They are very deconditioned. Their therapy protocol can look very low-level to us, but it is our poise. It is how much We make it seem exciting to do things like sets of sit-to-stands, and one-pound dumbbell bent-over rows, and really partial range of motion burpees, and that we clap it up the first time that person's able to transfer on and off a bike for the first time, for an example. and that our poise, our balance, is always, if not neutral, erring on the side of positive. And when we really step back and question what are the benefits to having negative poise, to letting this person know how busy we are, how many patients we have on our schedule, how far away we think they are from the finish line, that really does not do anything to meaningfully move that person closer to their goals. If anything, it might keep them or slow them down from their goals if they pick up on the idea that they are not doing well, that their function is not great, that they are maybe making slower progress than we'd like to see. If they're able to perceive that, then we know those emotions can spread and those emotions can become reality. So being very careful with our own poise, making sure that when we have complaints about what's going on in the clinic, what's going on with our schedule, whatever is happening in our life, that those complaints go up the chain of command, that our patients don't hear them, that folks who work with us in leadership positions beneath or to the side of us don't hear about them, that those gripes, those complaints, those suggestions, those feedback things go up the chain of command so that the poise of the organization at least again stays neutral, ideally trending towards positive. Knowing the effect that those negative emotions can have. Despair, bad mood can really spread like wildfire if we're not careful to control it. And so recognizing when you show up for that patient your poise really, really matters. How steady you seem, how confident you seem, even how confident you seem and maybe not knowing something plays a big role into your poise. Hey, you know what? I don't know the answer to that question at all, but I'm going to look into that and as soon as I find out the answer or I find out somebody who maybe has the answer, I'm going to put you into contact with that person. So just trust me, that even if I don't know, it's okay that I don't know, and I'm going to help you find a solution. Just that poise, that level of confidence that we display, can go a really long way in patient buy-in. That if they leave the clinic and they feel like, man, my therapist knows what's going on, they know what I need to work on, they're happy, they're excited, they're stoked, they're measuring my progress, they're letting me know how I'm doing towards working towards my goals, and that overall it feels like a really positive environment, It's no surprise that those patients tend to show up for more therapy, they tend to do better in their plan of care, and even when their plan of care is done, they tend to be the folks that recommend new patients for us. And so, in those cases, having a really strong, confident, positive poise rewards everybody. SUMMARY So think about that the next time you're getting ready to stand up from your desk, you're getting ready to start your day, you're getting ready to restart your day after lunch break or something like that. Check your poise. Are you excited to work with this patient? Are you gonna clap it up that they do that one pound strict press, that they get eight cals done in a minute on the rower? No matter how low level it seems, no matter how basic it seems to you, maybe compared to your normal clientele, check your poise. I promise, the more you work on this, The more folks will have fun, the more you will have fun, and not surprising, you'll find yourself having more patients wanting to see you, then you have time on your schedule as well. So poise, think about it a little bit. That's it for today. I hope you have a fantastic Thursday. Happy Mother's Day to all those moms out there. Mother's Day, if you didn't know, is coming up Sunday. Still time to go get a gift if this is brand new to you. And then we're happy to restart live courses after a little bit break next weekend. So check out ptinice.com for all the live courses coming your way throughout the summer and into the fall. Have a great Thursday. Have a great weekend. Bye everybody. 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. Jeff Musgrave, specializing in geriatric fitness, discusses the significance of developing fitness programs for older adults, preventing chronic diseases through targeted exercise, building an older adult fitness class, optimizing fitness class space, and strategies for business success and financial planning

Dr. Paul Killoren // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling division lead Paul Killoren describes his ideal setup to travel with all the supplies & equipment needed to perform dry needling on at least 2 individuals. Take a listen to the podcast episode 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 dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling. EPISODE TRANSCRIPTION INTRODUCTIONHey everybody, Alan here, Chief Operating Officer at ICE. Thanks for listening to the P-10 ICE Daily Show. Before we jump into today's episode, let's give a big shout out to our show sponsor, Jane. in online clinic management software and EMR. The Jane team understands that getting started with new software can be overwhelming, but they want you to know that you're not alone. To ensure the onboarding process goes smoothly, Jane offers free data imports, personalized calls to set up your account, and unlimited phone, email, and chat support. With a transparent monthly subscription, you'll never be locked into a contract with Jane. If you're interested in learning more about Jane, or you want to book a personalized demo, head on over to jane.app.switch. And if you do decide to make the switch, don't forget to use our code ICEPT1MO at sign up to receive a one month free grace period on your new Jane account. PAUL KILLORENAnd good morning, Instagram. Paul Killoren here going live broadcasting worldwide PT on Ice daily show. If we haven't met before, I am the current division lead for dry needling division. And today I want to tackle a big FAQ, one of the top frequently asked questions. It comes up almost every course. It comes up during holiday season and travel season. And really any time that someone says, here is a box of needles and you're flying anywhere. So we're talking travel guide for dry needling. And to give you some background on myself, I had a brick and mortar clinic cash pay for almost 5 years, many years ago. Since that clinic closed, I have more or less been mobile, and mobile really means getting on airplanes to treat pro athletes. And that brings up a lot of questions. So whether you are truly traveling with needles, we'll talk TSA, baggage, all of that stuff, or you're just more of a mobile setup and you're looking for some solutions that maybe aren't your typical, like you don't have a cabinet, you don't have places, brick and mortar in a clinic. So we're gonna talk the travel guide to dry needling today. And first of all, I get zero kickback, zero financial incentive, but what I'm wearing here is actually the Go Rucksack, the GR1. I've actually traveled with this heavily teaching for a long time, almost nine years, and this thing has held up. So it gets my stamp of approval. It is an expensive bag, but for me, it has been more than valuable, and this is traveling consistently across the country. So this bag is, is just your standard backpack. And if you are traveling, let's say getting on a plane to see a, uh, an athlete, or if you're traveling for vacation to see family members, that bag is large enough that I have my laptop, all my normal personal travel carry on stuff. Um, but that is where I put a lot of my non needling supplies. So, I mean, if you're doing cupping or scraping or taping, any of your other things, that GoRuck gives me plenty of space to stick stuff in. But today, this is the pack that I think most people have questions about and will talk about the most. So this is my travel kit for dry needling. You can see the logo there, Instagram, YouTube. Medpack is the name of this company. Again, I have no financial incentives. Honestly, I've been wanting to carry their stuff for a long time, and I dry needle, but it's been just a tough distribution setup. But I do give this my endorsement, and the pack I'll show you today is actually the one I've had the longest, it's the smallest, and actually the least expensive. meaning if you go to Medpack site there are lots of different options and really they're kind of EMT or athletic trainer quality bags meaning they are durable, they do have nice sturdy locks and straps and holding longer straps I guess for carrying but they are high quality and they are medical grade bags. This bag specifically is their 300 series bag. It's their cheapest one. It's less than 100 bucks right now. And honestly, I like this better than some of the larger bags that I've used. And I'll show you everything this can fit in a moment. The larger bag has enough, it has more space, it has enough space really for more needles, but for two of the ES-160 e-stim units, which is nice. Larger means it doesn't always fit as easily in the overhead bins of some of the regional jets that I've been on or underneath the seat. And if anything makes me more uncomfortable and nervous on a plane, it's watching Bob try and cram his carry-on bag right next to my med pack that has two ES-160s. You know, you picture them spinning it around, cramming it in, doesn't fit, doesn't fit. There's been a few times where I'm just like, it's made me nervous enough that I prefer to travel with the smaller bag because it fits better, at the very least, underneath the seat in front of me. So this is the Medpack bag. Again, no financial affiliation by me. This is the one I've liked the best. The 300 series is less than 100 bucks. So let me walk you through it. And I've got Instagram here, YouTube over here. Try to give you the best angle. So again, what I like about this is it has sturdy straps. And you see big pocket one side, other side, these outer pockets. One is where I have my new gloves. So it's full of gloves that are unused, will be used. And the other side is my garbage. So during a treatment session, I travel to an athlete's home, I have gloves, I have swabs, I have all the needle debris. I'm sticking all of that in my garbage pocket during the session. I mean, really, I'm not trying to leave any waste or trash, even those tiny little shims, at a patient's home. So I'm constantly sticking that in here. Those are the two outer pockets. If we unclip here. First of all, I just have your standard cord pouch, I guess. Nothing fancy to this, but this is where I keep all of my lead wires for the ES160. And I will say that it's worth having extra of everything when you travel. That's batteries, that's lead wires, that's almost have a second everything, because what you wouldn't want to do is travel to a client and not have a functioning unit for whatever reason. So here are my lead wires, including a few extra and some extra batteries for my e-stim unit. If we take that out, another clip here you can see, here you go, inside of the purse. I'll try not to dump it out entirely, but what you see is that there are little compartments for almost everything. This middle one is actually customizable, meaning there's Velcro that I can make this smaller or larger. So I made it perfectly sized to actually have a pretty secure hold on a quart-sized sharps container. And then there's my needle, the main needle compartment. So I have 105-75s, and if you want a pro tip, I mean I'm biased, I use iDryNeedle, Needles, which means they have a shim tab. I really like having max packs for being in a patient's home Again, if the goal is not to leave any of the shims or any garbage much less clutter with the multi pack I like having those and then let's see if I can tilt this up even further two front pockets have my swabs so my skin prep swabs and You saw there a little gel electrode. If you know, you know that it's kind of nice to have one of these with the metal button. You can put it on a patient's skin, clip up an alligator clip to that metal button and then to a needle. So it's nice to have a few of those handy. And then in this front pocket is just more needles, smaller individual size needles. So needles, sharps, kind of cleanliness, skin swab stuff, more needles. And in the back, this is really why I like this bag specifically, is almost a perfect size compartment for the ES-160. So there is my 6-channel e-stim unit, slides right in back. Behind there you see that there's a little pocket or another compartment where I have the e-stim 2, so a smaller e-stim unit back there. There's a larger pocket where you can fit more supplies there if you need. That's where I used to keep my extra batteries, but then I kind of got the cord carrier. And then up top you have a zipped pocket, I guess. And I guess since real early on, like the first year that I started needling, Someone terrified me into carrying a hemostat just in case a needle would ever fracture. So that's what's in there right now. I've never used it, never had to use it, but a zipped pouch for whatever you'd like to put up there. So again, that is the Medpack 300 series bag that I travel with. Again, there are larger ones. If you're not getting on a plane, there are roller bags and backpack bags like there are MedPak makes a nice, again, more durable, more resilient, and almost healthcare grade pack, kind of EMT, ATC bag quality. So that's me getting on a plane. I have my GORUCK, I have my Carry-On. So let's talk plane travel specifically, because again, this commonly comes up. First of all, whether you've heard or not, you are allowed to carry on needles. They can be in a closed box. They can be in their loose sleeves. They can be in a sharps container. You are allowed to have needles. I know that from experience and also from Delta Airlines policy. So again, that bag I just showed you, I'm going through TSA pre-check goes through there. I will admit that 50% of the time it gets kicked to the side. So you're sitting there waiting for your bag. The person is going to ask, like, whose bag is this? Is there anything sharp or that's going to poke me? And that's when I say, yep, it's full of needles. Ha ha. And they don't believe me until they open it up. But once they do, there's been no issue. They basically say, like, oh, are you a health care provider? Are you an acupuncturist? And you say, I'm a physical therapist. It might be worth carrying or having a copy of your license should there be more questions, but me doing this for several years, there's never been more questions. They basically nod along. Honestly, why my kit gets kicked to the side half the time is either a hand sanitizer that I carry with me or a cleaning, like a table cleaning bottle, basically a fluid that's more than three ounces. They actually let you keep both of those after they test them. So even if your hand sanitizer or your cleaner is larger than three ounces, they will run a little swab test on it. Typically they give it back. I'm not sure if that's because we are health care providers or because there's some exclusion for sanitizer, but that is why it gets kicked to the side or it does look a little suspicious to have all sorts of wires and batteries under x-ray so half the time they don't even realize or care or know that your bag is full of needles they see eight nine volt batteries or eight c batteries with a bunch of wires and that looks kind of suspicious. So every once in a while, you'll get questions on what is that unit? And I say electrotherapy device, electro stim device, therapeutic device, whatever answer you want to say, but that is why half the time when I'm carrying through that pack, it gets kicked to the side. But honestly, never had any issues from there. Again, I travel pretty frequently. So those are the common frequently asked questions. I already gave you the pro tip that if you are traveling two clients on a plane or even driving, you should have extra everything. And that's needles, batteries, lead wires. Learning over the years only from one or two failures, but it is pretty embarrassing to show up and not have extra batteries. You're basically asking your patients if they have batteries. So just have extra batteries, have extra lead wires. Unfortunately, if you do travel or you are mobile for your treatments, It puts a little more wear and tear on your stuff. As far as stem units go, I actually haven't had any issues durability wise with the ES160. Aside from the wires, I've replaced a couple over the years. The E-stem 2 is one of the smaller, cheaper units that holds up really well. The Pointer XL and the E-stem, sorry, the ITO ES130, the 3-channel unit, do not hold up as well. So as far as the plastic inputs on the ES-130 or the wires, if you're looking for more durable units that really don't wear as quickly with travel, I like the eStim 2 and 3 and the ES-130. But that's what I got for you supply-wise. Again, no issue with TSA or otherwise with needles or sharps containers or e-stim. Really, I'd just be prepared for maybe one or two follow-up questions, but there's never been an issue. Other things that are worth having if you're just more of a mobile setup or if you are getting on a plane, I would always have extra consent forms or maybe a one pager for what is dry needling. You'd be amazed if you are mobile how it's not even a word of mouth referral. You're traveling to see one person or a mobile session with one person and they have a friend or a family member that just happens to be there during your session. Whether it was planned or unplanned, they just want to watch it, ask you all the questions while you're working with Gladys in her living room. So I would just have some reading material for that person First of all, to avoid distractions from them, but also to answer their questions, potentially gain a new client. Otherwise, consent forms, same thing. You find the opportunity to potentially do a trial treatment. I would always have extra consent forms with you, or just have an electronic version that's easy to pull up. I still do the paper. I have extra ones with me. I do scan it with a PDF scanner and can send it to the patient right away. But otherwise, I do the old school consent forms. But that is what I have for traveling with needles. Once this episode drops on Instagram, I'll drop some links for the bags. If you have any questions on travel, I think I hit the big ones. I think one other question that comes up, um, less so for the more formal like mobile or travel client, but more frequently with I'm at home at Christmas with uncle or grandma. Um, some other questions that come up are, is there kind of a less formal way to dispose of sharp needle or dispose of sharps? Um, and the answer is yes. And even depending on the state you live in, some states would say this is entirely legal, which is you should just put them in a water bottle with a cap that you can twist, and then dispose of it in recycling. Maybe put duct tape over the top of it. But maybe if you're at home on the holidays, you have a few needles in your bag, whether you are going to do gloved clean needle technique on family, that's up to you, like whether you have those sorts of supplies, but I would certainly dispose of the needles semi-properly, which might just be a water bottle and some tape. SUMMARY All right, team. So that's what I hope that answers some of the main questions you have. I know summer means you're going to be traveling a little more. Um, we're coming right off of sampler and honestly, the number of folks that came up to me and ask questions about treating athletes or, or travel treatments or mobile treatments were high. I think it's just becoming a model that even healthcare consumers are more intrigued by, you know, having the option of us driving to them, even if we charge them a premium. So when it comes to needling, there are some pretty nice setups. Again, I like this bag. If you want to know some of my failed or my less desired travel tips, I kind of went through the plastic tote phase that had a snap-on cover. I tried kind of, I guess, a makeup kit or a taco box. Nothing really seemed to fit quite as well as what I just showed you, which is the Medpack bag. But there are other options out there. So if you have questions on travel tips for needling, drop them once this goes live. Again, I'm Paul Cloran. I'm the division lead for dry needling. If you're trying to catch a course with us on the road, May we actually only have two courses and they're both the weekend of the 18th and 19th. Ellie will be in Virginia Beach. I'll be out here in Seattle. And really throughout the summer, we have some big courses, but we have a lot, we have fewer courses throughout the summer. We just know that you all are out there being active, friends, family, a vacation. We want our faculty to kind of decompress a little bit, but if you're trying to find courses throughout the summer, they are there. If you want more options or you're looking for something more convenient, check out our summer, but also our fall options for needling. All right team, thanks for tuning in. Drop any questions you have on traveling with needles. Signing off. 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. Jessica Gingerich // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Jessica Gingerich discusses two different presentations of pelvic floor patients who may present to the clinic. 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 INTROHey everyone, Alan here, Chief Operating Officer here at ICE. Before we get into today's episode, I'd like to introduce our sponsor, Jane, a clinic management software and EMR with a human touch. Whether you're switching your software or going paperless for the first time ever, the Jane team knows that the onboarding process can feel a little overwhelming. That's why with Jane, you don't just get software, you get a whole team. Including in every Jane subscription is their new award-winning customer support available by phone, email, or chat whenever you need it, even on Saturdays. You can also book a free account setup consultation to review your account and ensure that you feel confident about going live with your switch. And if you'd like some extra advice along the way, you can tap into a lovely community of practitioners, clinic owners, and front desk staff through Jane's community Facebook group. If you're interested in making the switch to Jane, head on over to jane.app.switch to book a one-on-one demo with a member of Jane's support team. Don't forget to mention code IcePT1MO at the time of sign up for a one month free grace period on your new Jane account. JESSICA GINGERICH Good morning, PT on ICE Daily Show. I hope everyone had a great weekend. It is Monday, so that means that you are live with the pelvic division. My name is Dr. Jessica Gingrich, and today we are going to talk about the most bang for your buck pelvic floor addition. So I'm going to present today two separate presentations. So I don't want to talk about necessarily a case study or two separate case studies, just different presentations that you may see in the clinic. if you are a newer pelvic floor clinician, you may feel stuck. You may feel, oh, I haven't seen this or haven't seen this many combinations of things. Where do I start? And so, that's what I want to talk about today. So, the first thing or the first patient we have is going to be the person that has pain. That could be back pain, that could be hip pain, SI joint pain, tailbone pain, pain with penetration, and that may be during intercourse, during a vaginal exam, whether that is a speculum or digital exam. They may even have a history of this with tampon use. Even bedroom toys can be an issue. They may also say that they have issues with bowel movements. They have difficulty emptying or they do have a bowel movement, but when they're done, they don't feel quite empty. From the urinary standpoint, they may feel like they pee all the time, so they have frequency. Or when they get the urge to pee, they really have to go, so more like urgency. And then this also may present with or without urinary incontinence. On the flip side of that, we have the weaker pelvic floor. And so this is someone that comes in and maybe when you're talking to them about their activity level, Well, I haven't worked out all that much or I like to walk. I don't really lift weights. I haven't done it in years. And they may also present with leakage. They may even have heaviness in their vagina or dragging sensation. All of these presentations may come with, um, babies or, or no babies, right? Back to our first presentation, that person also may have that type A personality, where they like structure, and they feel like they have to work out all the time. I wanna kinda go off on a little bit of a tangent about that personality. We tend to say that, oh, well, they have that type A personality, and that's not a bad thing, right? If we didn't have that personality, what would our world look like? What we wanna do is we want to help that person Um, lean in to how they can best just function, right? And so when it comes to working out for a type a person, it may be a lot of education, right? You don't need to work out seven days a week, but this is what it can look like. Here's what programming looks like to really maximize things. There's a great book that I'm currently reading. It's called A Guide to Losing Control or Type A, I'll have to post it in here. I can't remember the title of it. But it's a really great book around just the structured Type A personality and how to really lean into that and help that person just feel better and function better, really optimizing recovery, stuff like that. So I'll drop that in the comments here when I'm done. So what I wanna talk about is where can we start with both of these presentations if we don't know where to go? So with that weaker person, they need to be loaded, right? They need to get stronger. So that's the first and foremost. But maybe they're not ready for that. So what we're gonna talk about, there's a thousand different ways to do this, but we're gonna talk about relaxing, okay? This is not the, well, you need to just relax your pelvic floor. You need to just relax. No, it's more about knowing how to relax. So, the first thing that I want to talk about, and I know this is everywhere, but is the squatty potty or getting your feet elevated to some capacity. What this does from a mechanical reason, and I love talking about this in the clinic, is give them the reason why they're doing it. Don't just say, hey, when you go to the bathroom, elevate your feet. Okay, see you later. Tell them why. So what this does is it decreases that anorectal angle. So when that angle decreases, now we're not having to fight against natural angles in our rectum to help keep us continent. The other thing that it does is it allows that puborectalis muscle to relax, to just unkink the base of the rectum. So two biomechanical reasons as to why we are suggesting that they get their feet up. Now you may be asking yourself, why are we talking about a squatty potty to relax the pelvic floor? Cause that's maybe one or two times in a day, depending on the patient in front of you. So that is going to allow the pelvic floor to just work optimally, right? You're getting the pelvic floor. When the pelvic floor needs to be off, you are helping that to be off rather than sitting and without your feet elevated and your pelvic floor might be on a little bit, or if you're bearing down, maybe your pelvic floor reflexively kicks on. And so that's just optimizing your pelvic floor on day-to-day functions. that need to happen, right? Now, I will say that some people don't feel great with having their feet elevated, and that's okay. Also, the angle of which their hips are is different per person. Also, I feel like you guys can hear my dogs barking. They're making their PT on Ice daily show debut. Sorry about that. The second one is a diaphragmatic breath. And we hear this one all the time too. Well, let's just teach our patients how to diaphragmatically breathe. Yes, that's a really important thing, really for anyone, but we need to teach this well, right? We can't just say, here's how you breathe. Okay, go do it. We need to have them focus on what they are trying to feel. And so when we are diaphragmatically breathing, when we inhale, our pelvic floor should descend. Have them focus on that. Where does your pelvic floor go when you inhale? Focus on that movement. And also just… and have them do this in different positions. You know, they may be on all fours doing it. They may be in a deep squat. They may be sitting on the floor. And this is likely going to be a static thing that we're doing. So, having them be still really focusing on it. Don't watch Netflix and do this as you're starting to learn. Now, different cues that I like to use around where your pelvic floor is, it looks different for everyone. So, does your pelvic floor descend? Some people, they're like, yeah, it does. They kind of understand that they are aware enough about that. Sometimes people aren't, and so you have to give them one structure to focus on. One of my favorites, and I know you guys have heard me say this a thousand times, is feeling your butthole open. We know where that is most of the time, right? When we have to go to the bathroom and we are not by a toilet, we know where that muscle is because we squeeze it. That's certainly not everyone, but it's a good place to start, okay? Now, the third thing is incorporating that diaphragmatic breath that we talked about after a workout or even before intimacy. And that can be a really powerful thing if someone is having pain with insertion, painful orgasms, painful arousal. And that could work for people who own a vagina and for people who own a penis. So give those three things a shot. But remember, we always want the end of that plan of care to look like that person lifting weights. They also may be doing Kegels, right? They may need to have that base strength of where, or I say strength, Kegels can increase strength for someone, but it's probably going to be short-lived, right? Because A, it's really kind of body weight, and B, we don't function just under body weight, we function under load. And so, ending with your plan of care of teaching this person basic barbell movements, dumbbell movements, Kettlebell movements, maybe that's where they're starting and encouraging them to lift weights. This looks different per generation, right? We may have to convince some people that this is a really good thing. And then other times we may not need to, right? People are going to be a little more into it. So, go out and try these three things. We've got the Squatty Potty, we've got Diaphragmatic Breathing, and we've got Diaphragmatic Breathing following a workout or before intimacy. Give those a shot and let me know how they go. I will see you in a couple of Mondays. 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. Joe Hanisko, Fitness Athlete lead faculty, discusses grip endurance vs maximal grip strength, programming examples for clinicians, and strategies for enhancing grip strength in fitness athletes. Topics include the impact of grip strength in CrossFit, improving gymnastics grip strength with drop sets, and specific training approaches for enhancing grip strength for endurance and maximum weight.

Dr. Ellison Melrose, Dry Needling lead faculty, discusses using dry needling for recovery and e-stim parameters. Topics include recovery mechanisms, muscle selection for a recovery circuit, and optimizing muscle pump for recovery. Explore the benefits of dry needling for muscle recovery and fatigue relief, alongside insights on dry needling technique for muscles.

Dr. Julie Brauer shares insights from training for a 50k run and how it applies to working with older adults. Topics include embracing life's journey, enduring pain with community support, progression in patient exercises, and the power of saying yes and moving forward.