#PTonICE Podcast

Today's episode of the PT on ICE Daily Show discusses the recent cuts to Medicare reimbursements and potential fixes to the American healthcare system. They explore the division and future of Medicare, the financial challenges faced by the program, and the role of rehabilitation in decreasing healthcare consumption. They also address the urgent need to lower healthcare costs, potential changes in Medicare eligibility age, and the importance of individual responsibility in healthcare.

The podcast discusses the top 4 'ins' and 'outs' to geriatric practice in 2024, including high intensity training, patient first language, personalized rehabilitation, and collaboration among healthcare professionals.

This podcast discusses the concept of fitness forward physical therapy, overcoming doubt as a physical therapist, shifting approach to acute neck and back pain, the importance of fitness forward care, and dealing with doubt by focusing on patient improvement rather than searching for the perfect treatment.

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan defines interrectus distance and how to measure it, how to functionally measure core strength, and the limitations of focusing on interrectus distance with patients. 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 INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today’s episode, I want to talk to you about VersaLifts. Today’s episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today’s show notes to get your VersaLifts today. ALEXIS MORGAN Good morning, PT on Ice. Getting both our cameras going here. Good morning, PT on Ice Daily Show. My name is Dr. Alexis Morgan, and I am excited to be with you on this morning, this new year. Happy New Year, everyone. And let's talk about measuring IRD or inter rectus distance versus measuring strength. Which one matters more? So to jump right into the topic here, Interrectus distance is a common measurement that individuals are going to be taking in pelvic health. WHAT IS INTERRECTUS DISTANCE (IRD)? So interrectus distance is the distance or the measurement of the linea alba width. It's that linea alba between the rectus abdominis on the left compared to on the right. What is that distance between? That's our interrectus distance. Many people advocate for measuring interrectus distance. Number one, it's measured in a lot of our scientific studies that is looking at diastasis recti. There's a lot of studies that are looking at it. And so if they're looking at it in the studies, well, maybe we should be looking at it in clinic as well. It's also repeatable. We can measure it the exact same way and we can see if there is change. And we like data that we can measure and we can see if there is change. So people are definitely advocating for its use. There are some benefits from measuring change. Obviously, you're here at ICE, you know that we are recommending to be able to test and retest to see those differences in all aspects of care. So, of course, we should be recommending that here, right? Well, we do recommend testing and retesting in this space. MEASURING STRENGTH However, we recommend measuring strength. So, measuring strength entails getting functional with your clients. One of our favorite tests is the sit-up test. We talk about it in our online course, and it is a way in which you can measure how strong an individual's rectus abdominis is. So they're sitting up. How much support do they need from their legs? How much support do they need from their arms? Do they need to whip themselves up or can they control themselves up? Do you need to hold onto their feet or not? This gives you a score. And with that score, we can then track change over time. It's extremely functional. This is what individuals are doing when they're getting out of bed or when they're getting up out of the floor with their little ones. This is also very functional for all populations. So not just the postpartum individual, but this is also helpful for individuals who are post hernia surgery or pre-hernia surgery. This is great for individuals with varying levels of adiposity. You don't have to measure, you don't have to assess something and be distracted or be, oh, I don't really know what I'm looking at because there's adiposity. We're just measuring strength. We're just testing the functionality. LIMITATIONS OF IRD When we think about the limitations of measuring the interrectus distance, Really, I could go on for a long time here. There's actually no known pathological number or centimeter or measurement. There's no known measurement that we all are in agreeance of like, yes, that number is pathological. We don't have that. In 2021, a recent paper came out and actually I believe Rachel did a podcast on this exact paper. So I'm not going to go into all of the details. You can search back to listen to this, but in 2021, a paper came out looking at individuals ages 20 to 90 males and females of all BMI sizes, looking at their CT scans and they measured the interrectus distance. With all of these people, 57% had greater than two centimeters in that interrectus distance. Now for reference, over the last 70 years, much of the data, much of the science that is looking at diastasis is using measurements, oftentimes in centimeters, and they vary. There's no agreeance in these studies. So sometimes there are two, sometimes it's 2.2, sometimes it's 2.5, that that one particular study calls pathological because there's no known pathological. But around that two centimeter mark, Well, now we have this study just in 2021, looking at what is normal. And we see that 57, so over half of the individuals actually had greater than two centimeters. So there's a problem here. We can't call this pathological of more than half of the individuals of all ages, of all BMIs, parity being one risk factor, but BMI and age also being risk factors. We can't use that. Not to mention in all these studies there's a variety of tools that are being used. So measuring with just fingers, measuring with calipers, measuring using a ultrasound machine. There's a lot of different ways to measure and of course those are going to be different between different tools. We don't have any standards. We don't know where exactly should we measure. In all of these studies, sometimes it's a couple centimeters above the belly button, sometimes it's more, sometimes it's less, sometimes it's right at, sometimes they avoid. There is no absolute on where we should measure, nor the type. It's all over the place. And one of the aspects that I think is the most concerning here is that, well, I've just laid out one, the fact that we don't have any agreement on any of this. Why are we doing, why are we measuring? FOCUS ON FUNCTION AND NOT APPEARANCE But number two, when we're measuring, we are perpetuating this focus on the looks. We're focused on what they look like and what that measurement is has nothing to do with their function. We talk a lot in our level one course on diastasis and a big aspect that I'll have to leave for another podcast on another day, or you can join us in our course, but another aspect of this is body image. And many individuals are very concerned and have body image dissatisfaction. If we can help them by shifting the focus to function in our little space, absolutely we recommend referring out to mental health professionals to help with that. But in our little space that is the physical world, If we can help by shifting the focus to physical and to function, then why would we not do that? Especially when there's a lack of evidence for clarity on measuring that inter-rectus distance. Our newest research in this space in the last handful of years, our newest research has shifted in this direction. it shifted in measuring abdominal torque. the rotational torque that is that one can generate power. Why? Because that's functional. Or that sit-up test, like I mentioned, it's functional. Our newest evidence is heading in this direction. Let's not wait 20 years. Let's go ahead and jump on this train and let's start measuring function today, this year, for 2024. Let's measure function and let's focus on what matters. for our clients, and let's follow this research. And when we do that, we know we can absolutely help them increase in their function. We've got no doubt about it. I know for sure if you can't do a full setup, I'm gonna give you the modifications and I'm gonna give you that home exercise program that will allow you to do a full setup in due time. I have no doubt about it. I can sell that so easily and I would hope that you can too. So let's stop focusing on interrectus distance. Let's start focusing on function. Our recommendation is that if somebody comes in and asks for an interrectus distance measurement, if they're asking you to measure, and they fully believe in its importance in their rehab, that would be the only time in which you would use measurement. Other than that, other than they're asking for it and there is a significant belief in its importance, If those two things are not both on the table, then we need to set the measuring IRD aside and focus in on strength. Thank you so much for joining me this morning. I hope it made you think. It's something we've been thinking a lot about, both in reading the evidence and in practicing clinically. And I hope it helps you focus in on what matters this year for your patients. This material and a whole lot more is in our online level one course. Our course starts next week. It's absolutely sold out. We are closing, we will be selling out for the March cohort well before March as well. So if you are wanting to get into this level one course, it's been revamped, all brand new. If you want in, you should go ahead and register for that March cohort. If you've taken our online courses before, online level one before, then you will be interested in our online level two course. And that is a brand new course, which starts April 30th. If you want to catch us live, we're going to be on the road a lot in 2024. All of that's on the website. You can see it. I'll just mention the few that are coming up in January and February. We are going to be in Raleigh, North Carolina, January 13th and 14th, Hendersonville, Tennessee, January 28th and 29th, and Bellingham, Washington, February 3rd and 4th. We are so excited to see you all out on the road in 2024 and can't wait to see you all online as well. Have a great day. Happy New Year. And we'll catch you next time. 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.

The podcast discusses the assessment and treatment of shoulder internal rotation and extension limitations in fitness athletes. It explores the significance of the subscapularis muscle in shoulder mobility and discusses various assessment techniques. The podcast also analyzes subscapularis muscle activation and teases a follow-up episode on treatment for fitness athletes.

Balancing consumption with creation, the illusion of consumption as productivity, and the need to be authentic. Importance of balancing consumption and creation by committing to create something after acquiring knowledge. Rebalancing consumption and creation for a more meaningful online presence by sharing one's uniqueness on social media platforms.

Discussion on the effects of high-velocity resistance training for adults 50 and above, including benefits for bone density. Emphasis on maintaining results, incorporating power training and explosive movements, and the positive effects on bone health. Also mentioned upcoming training sessions and certifications.

Dr. Lindsey Hughey // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Extremity Division Leader Lindsey Hughey discusses the need to assess beyond the physical properties of a scar. Scars can have deep meaning to our patients, and learning the human story behind the scar can help with better understanding a patient. Whether the scar was planned or not, the story behind the scar has value. 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 more about our Extremity Management course 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 INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today’s episode, I want to talk to you about VersaLifts. Today’s episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today’s show notes to get your VersaLifts today. LINDSEY HUGHEY Good morning, PT on Ice Daily Show. How's it going? My name is Dr. Lindsey Hughey. I am extremity faculty, and I'm delighted to be with you here the day after Christmas. For those that are on YouTube Live, unfortunately, that is not working. So I'm just gonna have to send it via Instagram. Today, I'm gonna chat with you all about how scars, and I promised a month ago that I'd be chatting about actual scar management. THE HUMAN SIDE OF SCAR MANAGEMENT But what I didn't tell you last time was that we're gonna focus on the more human side of scar management for our post-op folks. So after surgery, no matter what extremity is involved, whether it's shoulder, maybe it's elbow, maybe it's hip, knee, ankle, maybe it's even back surgery, right, there is a scar that comes along with it. And as physical therapists, we tend to focus on the more physical part of managing that scar. And so what I mean by that is we focus mechanically, right? How's it moving? What's its pliability like? What's the elasticity surrounding that tissue, right? Is it moving well with the fascia? Are there any adhesions? Our scar tissue buildup. We are looking at the pain response of the patient, right? To show if there are any signs of infection. Think red, hot, tenderness, or spreading redness, right? We're looking for the management and guiding education accordingly. In addition, we're looking for any excessive swelling, right? Is the scar raised? Is it flat? And then we're really focusing our efforts on educating, mediating, against infection and then how to keep that scar moving. We aren't often focused on what that scar might represent from the patient. And what I mean by that is some intangible and unquantifiable measures like their emotional and their mental and their social response to having that scar. I wanna share two personal anecdotal experiences with scars that I've had myself to try to illuminate that part that's more unquantifiable, right? That emotional, social, mental piece in our scar management. So I have three kiddos, 13, 12, and seven. Some of you that know me already know this. And they were all born via C-section. C-section was not what I wanted. I had this whole natural birth plan written out, and it didn't really go according to plan. For that first one, it was emergent, and the second one was planned, and then third one was also planned, but there were some complications with actually having Luke, where he needed to be rushed off to the NICU, actually, because of some breathing issues. And I'll tell you, in general, the scar, I focus a lot on its appearance, right? That it's ugly. For those C-section mamas you know, there's like often this like shelf or invagination where that scar is and so tissue hangs over it. And besides it not being kind of the birth plan that I wanted, that appearance part of the scar really bothered me. So it represented kind of two things. Something that I didn't really want to have or how I wanted my birth experience to go and then also just the appearance like that there's this lingering scar that has now like affected my body makeup and how I'm presented to the world and The reason I share that is I don't think we think about that with our patients, right the connotation with the scar. We're again always thinking about physicality. How's it moving and is there any signs of infection and giving them tools to manage that. THE STORY OF THE SCAR IS IMPORTANT Well, when I realized the story is important, I want to share one particular moment that I had with my scar and the management of it. And it actually happened with my third c-section. So About a year after having Luke, I started having like spasms in my rectus when I would laugh and or when I was doing gymnastics work. So not only was the appearance kind of bothering me, it was starting to become painful because I would get these spasms that would double me over into trunk flexion. And so it made me talk with a colleague at the time I was working at Baylor and Dr. Jen Stone actually is a pelvic floor therapist and she offered to take a look at it and literally we're like in between teaching classes um on a break and she's like yeah lay down and i'll assess it and she starts assessing um the scar mobility and i was not a good pt patient and i hadn't done much scar work and so she starts you know telling me it's hypertonic and not moving well and more on that left side and she's just palpating and then she just offhandedly says what was your birth um experience like and I'm starting to tell her the story and I just start weeping. And it was so unexpected because I started telling her, basically, I'm on this OR table, in this Vitruvian man position, you can't get up. And I look over and Luke, you can see his red flashing lights. and his pulse ox was low. And the nurses were kind of telling me like, Oh, he's fine. And kind of pretending like he's fine, but really he couldn't breathe. He was having transient tachypnea, which is come to find out normal after C-section in many babies, because they don't get that birth canal squeeze. So fluid sits around their lungs, but I had never experienced that with the other two C-sections. And so like emergently he's wheeled away from me and I'm still like open on the OR table and so I start telling her this and like I'm crying as I'm telling her this and I get to kind of the end of the story how I never got to hold him like you know that first hour of nurturing time I didn't get and I didn't actually hold him for like 12 hours and we're like when I'm waiting post-operatively to see what's going on they don't really they didn't tell us much so I'm like in limbo thinking like is he gonna die but again Turns out to just be the transient tachypnea, not a really big deal. And I'm recounting this whole story to her how it was like tough. I didn't get to hold him. I didn't get the skin to skin time. And, you know, we're literally were afraid he was going to die. You know, he only needed two to three days in the NICU, it turned out, and he was all good. But in that moment, I realized like Jen gave me permission to tell my story and really unpack it because I'm kind of like a power through type of human, got through that last C-section and went back to CrossFit and thought I was fine and dandy. And it was in that moment where she just, you know, was palpating the scar and took the time to like understand the story behind it. And so it makes me pause and Consider maybe all of the folks that I kind of bypassed thinking like total knee replacement, total hip replacement, and what those scars might have meant. Or someone after trauma think ACL or getting that triad where they have this surgery where it takes them out of their season, right? It's out of their control. Those are two different kind of scenarios, right? I didn't want the C-section, right, in any of the cases. but the C-section kind of chose me. In that case of like a total knee replacement or a total hip replacement, something where we get gradual worsening pain and function and we have to elect to have the surgery. SCARS TELL A STORY OF RELINQUISHING CONTROL I have another personal story to share where even when you elect, so like those three sections not really in my control, There are surgeries we have to choose sometimes because of pain worsening function and or failure of our tissues. And so the second scenario, I want us to appreciate too, because both involve a little bit of relinquishing control, which is tough for our patients. So my second scenario is also another personal story. Having had the three C-sections, right? And we fast forward seven years to the present, I, in this last year, started experiencing a supra-intra-abdominal hernia. So I noticed this mass above my belly button to the left. So because it's asymmetrical, it wasn't like the Linnea Alba issues. It literally, or Diastasis Recti, it literally is a hernia because of that asymmetry. throughout the year kind of started getting bigger. And I consulted with some pelvic floor PTs, and they're like, that's not necessarily pelvic floor, right? Start working on your intra-abdominal pressure to help. But you should get that checked out, because the mass on your stomach is kind of concerning. And come to find out, I put it off for quite some time, at least six months, and I go to this intra-abdominal specialist, and he does, in fact, confirm that it is a supra-abdominal hernia, and that there's subcutaneous fat, and that, right, if you ignore it long enough, this can turn into an issue where there's strangulation, which then can become like an emergent issue if you become sepsis, if it were to triangulate and cut off blood flow or like your intestines, right? The reason I share this story with you is the second part is this was a surgery that I had to opt for, kind of like when someone has to choose that total knee replacement or total hip replacement. I was starting to have some pain associated with eating big meals, and then some exercise-induced nausea with high intensity. It was only intermittent, right? Sometimes, so for at least a year-ish, I had been putting it off. I've since had the surgery, right? December 13th, I had it. And now I'm in this new zone. You can't actually even see the scar, right? Because it's under steri-strips. But what I want you to think about and what has me pausing and thinking from my own personal experiences, this scar, although a little bit out of my control, right? It's abdominal wall failure due to intra-abdominal pressure issues, due to that history of C-sections. It's not really something I wanted to do. I don't want the downtime of not lifting heavy things with my friends. I don't wanna build my gymnastics from the beginning. I don't want this break of time where I'm not lifting heavy and I'm not working intensely, right? It's this forced slowdown. But in a lot of ways, like I chose this, right? I chose to schedule this surgery due to some failure in the tissue and some worsening pain and weakness. The scar, once it heals, it'll represent a pause in my story. But it also represents an opportunity, if I'll reframe it that way, right? An opportunity to work on my intra-abdominal pressure from the start, now that I don't have a 1.5 by one centimeter hole in my fascia, right? And now there's no longer subcutaneous perineal tissue sticking out. SCARS REPRESENT A SLOW DOWN Our patients, no matter their surgery, whether they had you know, a history of various surgeries like I had and have had to have subsequent surgeries like I just needed to have because of those, they are coming to you and they are in a time where there is some uncertainty on board, where they have to slow down in their story, right? Which affects them mentally, socially, emotionally and spiritually, like when they're not involved in the activities that like bring them joy in their life. And They have to give up some things for a time and that can be really hard. And so scars, let's approach them. Let's take the opportunity to not only obviously address that physicality piece, right? and safety about infection, and make sure the scar is moving well, but take the opportunity to understand the story behind maybe why they chose that surgery, or were advised to have that surgery, or maybe why it was emergently, right? If there's some trauma associated around having to have the surgery, that can be tough, and they've maybe never been asked to share that story, and maybe they'll have that kind of emotional release unexpectedly when you ask them that question. What I want you to reflect on is, have you even thought of the human in front of you and the story behind the incision and what that might mean to the patient? Can you take the time to give them permission to tell that story? And it may unlock some sadness and fear and angst. But if you don't invite that opportunity, then you miss the opportunity to help them reframe that experience for the better. you miss the opportunity to deliver control to their story right where they're the heroine of that story. So two real action items today is learn the story behind their scar and their incision from the beginning and then of course create a complimentary rehab program that makes their extremities, their spine, robust and that makes that scar just be in a badge of honor, right? And just a reminder of a moment to get after resilience in their story. A lot of times in our extremity management course, we can't dive into postoperative care. We speak a ton about upper quarter and lower quarter extremity resilience and how you can get after that with your patients. We have so many offerings to dive into that in January. And so if you'd love to learn more about extremity care and resilience, we would love to have you at one of our upcoming courses. We are literally stacked in January, January 13th, 14th. We are not only in Richmond, Virginia, but we are also in Greta, Louisiana, and we are also in Fayetteville, North Carolina. So all of our extremity faculty will be out on the road teaching that weekend. be there at one of those locations. In addition, January 27th, excuse me, I already said that, January 13th and 14th, we also have opportunity. I kind of flipped that actually. Check us out on btoknights.com. The 13th, 14th is when we're in Virginia and Louisiana, and then the 27th is when we have three opportunities. Forgive me for that. Fayetteville, North Carolina, Athens, Georgia, and then Burlington, New Jersey. And then literally most months of 2024, we are somewhere in a city near you. I thank you for taking the time to listen to my story today. And I hope again, that you will consider the patient's story behind their scar. Have a great day, everyone. 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.

Unpack the underutilized emotion of 'awe' in physical therapy sessions. Explore the concept and expressions of awe, along with its mental and physical benefits. Learn how to create an awe-inspiring environment and incorporate awe in PT sessions for enhanced emotional well-being and client-therapist connection.

This podcast discusses the benefits of high-intensity interval training for athletes and the physiological effects it has on the body. It explores different types of training and the specific adaptations that occur. The importance of combining work and rest for performance improvement is highlighted, along with the significance of intensity in interval training for runners. The podcast also mentions programming interval-based training and upcoming courses and events.