#PTonICE Podcast

In this episode, the state of physical therapy in 2023 is discussed, specifically focusing on the pay and financial investment required. The episode addresses concerns about the return on investment for education and training, suggesting alternative routes to becoming a physical therapist. It emphasizes the need for better guidance for future physical therapists in terms of education and career choices. The hosts highlight the importance of providing information to students considering the profession and those already practicing. They also discuss the state of pay in physical therapy, including stagnant or declining wages, and the financial implications of pursuing a career in the field.

Dr. Lindsey Hughey // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Extremity Division Leader Lindsey Hughey discusses carrying as a valuable skill unique to humans as hunter-gatherers. She points out that humans, with their opposable thumbs, are well-suited to carry objects for long distances and extended periods. However, Lindsey also notes that this skill is being lost in modern society due to sedentary lifestyles and technological advancements. Lindsey references Michael Easter's book, "Comfort Crisis," which challenges readers to step outside their comfort zones and recognize the importance of carrying as a skill. She suggests that carrying should be trained and incorporated into various healthcare professions, regardless of the specific patient population being treated. The episode highlights the benefits of training carries. It mentions that carrying trains aerobic tolerance and grip strength, and it is a primary functional skill for picking up and transporting objects over long distances. Lindsey encourages listeners to consider how incorporating carries into their practice can lead to long-lasting functional changes for their patients, enabling them to carry objects without assistance and without needing frequent breaks. Additionally, the episode emphasizes that training carries not only benefits specific body parts like the trunk, shoulders, and spine but also the entire system. The act of walking while carrying is described as the "magic" of training carries, as it trains the cardiovascular system, respiratory system, and central nervous system. The episode concludes by stating that not training carries means missing out on a unique opportunity, regardless of the specific issue being treated (upper quarter, spine, or lower quarter). Take a listen or check out the episode transcription below. 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 00:00 LINDSEY HUGHEY Good morning, PT on Ice Daily Show. How is it going? I am Dr. Lindsay Hughey. I will be your host this morning. We are going to chat all things Cary today. But before I do, I would love to just tell you a little bit about some courses that the Extremity Management Division has coming up. There are a host of opportunities. So just this upcoming weekend, I'll be in Madison right before the CrossFit Games. We're so excited to cheer Kelly on and her team, representing her team this morning. My shirt just came in. We're so pumped for that. But if there are a couple spots, like one or two left, so if you're on the fence, sign up now because those spots will probably go. But moving throughout the summer, we have lots of opportunity. So the next opportunity will be August 12 and 13, Rochester Hills, Michigan. There's lots of spots left in there. That's one of our more empty courses. So sign up for that. Because we're not in Nebraska, the following weekend, the 19th and 20th, is actually almost stacked. I don't think there are any spots left, maybe just a couple. So then your next opportunity would be in September with Mark. And there's lots of opportunities to jump in there in Amarillo, Texas. And that is September 9 and 10. He would love to see you there. And then September 16, 17. So we're moving more into the fall season. Cincinnati, Ohio. Mark has some spots there. Take a look on PT on ICE.com. If you're looking for a little bit later in the year, there are opportunities through the winter to join us. But we're not putting any more courses on the books for this year. So 2023. So opportunities are dwindling. But if you want to learn about met best management in your dosage strategies and about tendinopathy and how to load the upper and lower quarter, we would love to have you join us. All right. Today's topic I mentioned is carrying, right? And if you've been to our extrogyn management course, you know that carry lab is a big fun part of the end of day one. And then if you've been to MMOA, you know, carries are really important there as well. And most of our divisions at some point probably talk about the value of carrying. And a little bit about the background that got me inspired to chat about the value of training carries in our patient. It's really from a book I just recently read by Michael Easter Comfort Crisis. It's really challenged me to think about kind of how the evolution of technology and advancement in our society has really evolved away some of our valuable apex predator skills because we have more sedentary lifestyles and just our job demands and our ability to do that. And so we're losing a skill that's really unique to us as hunter gatherers. And because we have the opposable thumb, we are like the prime species to carry objects for long distances for a long time. And we aren't training ourselves in that way, even though we are the most well suited species to do so. And that book, dive into that if you're interested in it because it really challenged my thinking about everything we do in our world today is pretty comfortable. And the book really challenges you to get outside of your comfort. I'd love us to challenge us as a profession, no matter if you treat pediatrics, older adults, summer and summer. In the middle, treat in acute care, treat in home care, treat in outpatient orthopedics, training fitness athletes that carry is a skill that needs to be trained no matter what whether you're seeing upper or lower quarter, or whether you're seeing someone with a spine condition. Let's not keep losing this skill. Even I want you to think before I kind of dive into the three reasons why I think we don't want to lose training carries and their importance is you can even see it in the objects we do carry right like our book bag. Even I want you to think before I kind of dive into the three reasons why I think we don't want to lose training carries and their importance is you can even see it in the objects we do carry right like our book bags, or if you travel a lot your suitcases we even have roller apparatuses to make carrying easier. In our clinics, we need to make carrying harder. One of the three things and value that carries bring our number one from an extremity management perspective is it trains the shoulder elbow wrist hand, right, to be functional to work in this locked out engaged fashion. We have tons of evidence in the relationship between grip strength and mortality. If you have a weak grip, your mortality is poor. We even see it likened to associations with tons of metabolic diseases, and specifically frailty in our older adults. We need to train grip strength, because of that strength that it gives our grip, but that it trains our shoulder elbow wrist hand as well. But not only does it just train the upper quarter. We are actually training the spine, we are training the spine to hold the line as Mitch Babcock would say, right, because it's not just about locking out and training our shoulder elbow wrist hand in a stacked fashion, but we're actually challenging the trunk for those watching on YouTube or on Instagram I'm kind of, if we do this lateral lean we're not getting the benefit right, it's a stack trunk the whole time right while we load. This helps to be not only train the spine to take on load and asymmetrical load right if we're holding it in one side. But it also can be protective of our spine because we teach our spine how to light up right all of our lumbar stabilizers. And if you were to pick up an object that was pretty heavy right now, you will notice that it actually trains the lower body as well right it demands that the glutes the quads the hamstrings all kick in rather than this lazy like me unlocked position you have to actually stack not only the trunk, but your lower body to hold and carry well. It trains the entire system, the whole system gets the goods when we train carries. But guess what the magic isn't just in training shoulder elbow wrist hand and in training the spine. The magic is in the walk, so we don't just have someone carry and stand there. Right. If we think back to hunter gatherer we would carry over long long distances right to bring that meat back home. We need to train folks to carry and hold an object locked out and move and walk so the magic is actually getting our folks moving with weight. This trains our cardiovascular system. This trains our respiratory system and even our CNS right to take on load and be able to go for long durations. If you aren't draining carries you are missing out on a unique opportunity. It doesn't matter if it's an upper quarter issue a spine issue even a lower quarter issue. You need to be training your carries in your folks that are in your clinic or in the hospital, because this is a primary functional skill to be able to pick up objects and carry them for long distances. It trains aerobic tolerance, it trains grip strength and ability. Let's not let this skill be lost to our species. Let's not let this one evolve out. I want you to think about today how you can use carries in the clinic and kind of reflect on what if we got our humans, our patients carrying more for longer. Think of the healthy long lasting functional changes we could make, but not just functional in the ability to carry their objects without needing help from a family member, right or needing to take multiple respites. But I want you to think about mortality, right. We need clear links to grip strength and mortality. Offensive extremity care across the lifespan, young to old requires carries. I hope you'll consider putting this in your plan of care this week. Thank you for your time to join me on this short and sweet PT on Ice. Take care folks. Happy Tuesday. 08:40 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 CU's from home, check out our virtual ice online mentorship program at PT on Ice dot 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 PT on Ice dot com and scroll to the bottom of the page to sign up.

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses that PTs need to be aware of the signs and symptoms of preeclampsia in pregnant women. Preeclampsia is a high blood pressure-related condition that typically occurs after the 20th week of pregnancy. It can also manifest during delivery and postpartum, although it is less common in the postpartum period. The three main symptoms of preeclampsia are swelling of the face and hands, persistent headaches, and pain in the upper right abdomen or right shoulder. PTs should be familiar with these symptoms and know when to refer their patients for further evaluation or treatment. It is crucial for PTs to monitor vital signs, especially in the postpartum period, as they may be the first healthcare professionals to detect an increase in blood pressure. Preeclampsia is the leading cause of mortality in pregnant women, so early detection and management are essential to prevent it from progressing into a life-threatening condition. While PTs may not be responsible for ordering tests or directly managing preeclampsia, they should be aware of the condition and its potential impact on their patients. Take a listen to learn how to better serve this population of patients & athletes. 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. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody? We are back with another episode of the PT on Ice Daily Show. Before we jump in, let's chat about Jane for a moment as they are our sure sponsor and they make this thing possible. The team at Jane understands that payment processing can be complex, so they built in an integrated payment solution called Jane Payments to help make things as simple as possible so you can get paid. If you're looking for an easy way to navigate payments, here's what we recommend. Head over to jane.app slash payments, book a one-on-one demo with a member of Jane's support team. This can give you a better sense of how Jane Payments can integrate with your practice several other popular features that Jane Payments supports, like memberships with the option to automatically invoice and process your membership payments online. If you know you're ready to get started, you can sign up for Jane and make sure when you do, you use the code ICEPT1MO as that gives you a one-month grace period while you settle in. Once you're in your new Jane account, you can flip the switch for Jane Payments at any time. Let the Jane team know if you need a hand with anything. They offer unlimited support and are always happy to jump in. Thanks everybody. Enjoy today's PT on ICE Daily Show. 01:27 RACHEL MOORE All right. Good morning, PT on ICE Daily Show. It is Monday morning. I am here with the ICE Pelvic Division here to chat with you guys this morning about preeclampsia. This is a topic that is actually really near and dear to my own heart because I had preeclampsia with both of my pregnancies. So it's a really interesting topic. There's been a lot of kind of conversation about this topic in the prenatal space lately because there's a new test that just came out recently. We're going to chat about that here in a bit. Before we dive in, I want to kick this off going over our upcoming courses for the pelvic division. We've got two live courses coming up soon. We've got Denver, Colorado this upcoming weekend with Alexis Morgan and April Dominic. That is the 29th, 30th, and 31st, Friday to Sunday, this upcoming weekend. And then we also have in September in Scottsdale, Arizona, a live course coming up as well. Our live courses are two-day courses. We talk about all kinds of stuff from pregnancy to postpartum. We are in lab a majority of the time. We're practicing skills. We're going over these movements. We're talking about scaling and modifying. We also do the internal assessment and we do the internal assessment not only in supine but also in standing. So it's a really great way to dive into the internal side of pelvic floor if that's not something you're already doing or maybe learn a new way to do pelvic floor assessments if you are already a pelvic floor PT. It's a super fun course. Hop in one of those courses coming up. We've got several other ones listed online on the website. We've got at least one a month until the end of the year. So we're going to be cruising through. Hope to see you guys on the road. Let's talk about preeclampsia. So what is preeclampsia first? That's kind of the first thing we need to talk about. Preeclampsia is a high blood pressure related condition that typically begins any time after the 20th week of pregnancy. It can happen in pregnancy. It can happen during delivery and it can also happen postpartum. It is less common to happen postpartum, but just because it is less common does not mean that it doesn't happen and that is something we need to be aware of, especially if you're in the prenatal space seeing postpartum women. Personally, before we dive in, my story, I had postpartum preeclampsia with my daughter and it wasn't caught until I was two weeks postpartum and I say wasn't caught until I was really fortunate that it even was because I went to a midwife for my delivery and I had a two week postpartum visit and when I went in my blood pressure was like 198 over 110 and she immediately sent me downstairs to the emergency room and I had no idea that there was even anything wrong. I didn't know that I was feeling bad. I thought that it was just kind of the norm for being postpartum and so that's how we caught it in the first pregnancy. And then my second kiddo, we knew that it was something to be on the lookout for and sure enough within 72 hours of my delivery, I was fine and then it was like a truck hit and I had high blood pressure. So something to keep on your radar. It can develop into a life threatening condition. So preeclampsia itself is not necessarily life threatening. What is life threatening is eclampsia, which is the progression of preeclampsia and that is a condition that is characterized by seizures and strokes and it can also progress into help syndrome, which means the abbreviation is hemolysis, elevated liver enzymes and low platelet count. Essentially this is a condition where your red blood cells are damaged and interferes with blood clotting and typically your liver is involved as well. So your liver starts kind of going into failure essentially. Eclampsia and help are both medical emergencies. So we want to be catching preeclampsia when we can so that we can prevent that sequelae into these life threatening conditions. The way that preeclampsia is diagnosed is typically with repeat high blood pressure readings and there's also a urine test that can be done to check for protein in the urine. However, you don't have to have protein in the urine in order to be diagnosed. So this is something that used to be kind of together that you had to have both, but what things have kind of shaken out over the years is that you can have preeclampsia, you can have the high blood pressures, but not necessarily progress to the high protein in the urine. So it's not necessarily something that is utilized as a gold standard. You have to have this thing in order to be diagnosed anymore. Typically if somebody is diagnosed with preeclampsia or they're in their second pregnancy or subsequent pregnancies and they know that they had preeclampsia earlier on, a lot of OBs will prescribe taking baby aspirin during pregnancy. That's not obviously within our scope to suggest, but just something to kind of keep in mind that there are things that can be done quote unquote. Statistically this preeclampsia affects one in 25 pregnancies. It is the leading cause of maternal mortality worldwide and along with a lot of other prenatal health conditions. This affects women of color, particularly black women, significantly more than white women, 60% more likely to develop preeclampsia and that is largely due to the disparities in healthcare for women of color. It's really unclear who gets preeclampsia. So there's a long list of risk factors which we'll chat through, but you can have none of these and you can still get preeclampsia. You can have all of these and not get preeclampsia. You can do all the right things and still get preeclampsia and that's something that can be really tough, particularly if you're treating athletes or people who are in a more healthy lifestyle who are saying like, well I exercised, I ate healthy, I did all of these things and then I still got it, can feel like I did something wrong or like a failure almost. But preeclampsia is a condition that's really not well understood. We're learning a lot more about it as time has gone on. However, there's just not a lot of like real true understanding about what is the cause of preeclampsia. So some of the things that put you in the higher risk category would be having a previous pregnancy with preeclampsia, carrying multiples, so twins, triplets, so on and so forth, chronic hypertension prior to pregnancy, having kidney disease or diabetes, and then any autoimmune condition. All of those are going to put you in the higher risk category for developing preeclampsia, not to say that yes, you are going to get it, but a higher risk. Moderate risk for developing preeclampsia would be a first time pregnancy. So either first time pregnancy puts you moderate risk, previous pregnancy with preeclampsia puts you high risk. BMI over 30, family history of preeclampsia, maternal age advanced quote unquote, so above 35 years of age. IVF can also increase the risk of preeclampsia development and then complications in previous pregnancies. Not even necessarily just preeclampsia, but just complications in general. There's a lot of discussion about what is the reason people get preeclampsia and what it's really boiled down to based on what we know and what we've learned about preeclampsia over the years is that it's most likely related to the structure of the placenta and the creation of blood vessels in early pregnancy. So there's not a lot that quote unquote can be done later in pregnancy necessarily. It's something that is kind of determined and laid out earlier on and then presents itself later in pregnancy. There's really no great way to prevent it. Like I said, you can do all the right things. You can check all the boxes and it can still come up at that later or at those later stages of pregnancy. We really advocate at ICE for getting our postpartum patients in early postpartum for that first visit. So within like two weeks of delivery, kind of touching base, being that healthcare checkpoint because a lot of women aren't getting that from their healthcare providers potentially. And this is a really important thing for us to keep in mind when we're screening our patients postpartum. Typically blood pressure is going to peak within three to six days after delivery. So if you're seeing your patient within the first week, that would be fantastic. It is so important to take vitals. It's always important to take vitals, but especially in the postpartum client, they may have no idea that they're feeling bad or that their blood pressure is high. You might be the first person that watches or sees this upwards trend of blood pressure. So something that's really important. We can be the first touch point within the healthcare system of picking this up if they're not going to a physician earlier on or a birth care provider earlier on in that postpartum period. So what are the biggest signs and symptoms of preeclampsia and how does it relate to our job as PTs? There's three big symptoms that I see with preeclampsia that really kind of like light up. So that could be something musculoskeletal or it could be something that we could have our hands on the pot and correcting or it could not. The top three that I'm thinking are going to be swelling of face and hands or swelling in general. A lot of times we see it in the lower legs in pregnancy, a headache that won't go away and then pain in the upper right abdomen or in the upper or the right shoulder. So that's going to be up in this area here. If you're not, if you're listening, it's kind of the bottom side under part of rib cage, right upper quadrant pain and referring up into the shoulder. The other three symptoms that are really larger for symptoms are going to be nausea and vomiting, especially in later pregnancy. So if there's somebody that didn't have nausea and vomiting and then all of a sudden they're developing it, that would be kind of a red flag. A sudden weight gain. Same thing we know in the third trimester, baby is growing rapidly and as such mom is going to be gaining weight, but a significant sudden weight gain would be a big red flag there. Difficulty breathing is always going to be something that we want to kick our moms over to their healthcare providers for sure. If it's just like I'm out of breath when I stand up and then it goes away, that's one thing. But if it's like a significant shortness of breath, that's a problem. And then vision changes. Vision changes are going to be one of the biggest things to help differentiate for sure. Are these quote unquote normal pregnancy changes or is this something different? Because typically we don't see people seeing floaters or seeing spots or having major vision changes in any other situation in pregnancy. Whereas we could maybe see them having some discomfort in their abdomen or maybe see them having headaches. That's one factor that is really going to point us towards like, okay, you have this thing and vision changes, it's time to go to your doctor and get looked at. So let's talk about those big three things that I said at the beginning. Swelling, headaches and upper abdomen pain. Our job as PTs, right, is to help with musculoskeletal problems. We see people with swelling. We help people manage inflammation and swelling. Even in the pregnancy space when we have patients coming in with a lot of like leg swelling and things like that or varicosities, we help a lot with that. We talk to people about that muscle pumping action and utilizing the muscles around their cardio or their venous system to help facilitate that upwards flow of blood and fluid. And so we know that we can impact this. However, if we're seeing this progress into like hands and face, that would be a sign that that might not be your typical prenatal swelling. And that's something that needs to be referred out. That upper abdominal pain, if you have somebody come in and tell you like, oh, I have, like baby's just growing a lot. I've had, I have pain in my upper abdomen. Typically they're not going to tell you I have right upper quadrant pain. A lot of the times they think it's a rib. So they'll say like, oh yeah, my rib hurts really bad or oh, it's my like my ligaments or my abs are hurting really bad. We want to follow that up with a lot of questions. Some of the biggest questions that we want to know, is it both sides or is it just the right side? So if it's both sides, that doesn't necessarily mean that there might not be something going on, but it's less likely if it versus if it's purely just that right side consistently. We want to know if it's related to anything timing wise. So is it worse after you eat? Is it worse or better after you exercise? Is it relieved by exercise or stretching? So maybe you're a little uncomfortable and then you start moving and your tissues start warming up and then you feel better versus I work out and nothing changes at all. I stretch and nothing changes at all. No position that I get into makes this better or worse. True musculoskeletal pain is going to behave differently than pain that is created by a referred pain from an organ, which is what that right upper quadrant pain in preeclampsia is. So those are some big follow up questions we need to be asking. A lot of pregnant women, especially later in pregnancy, just assume that aches and pains and stretching discomfort and things like that are normal. And to an extent we expect it, but if we hear that right upper quadrant or like my shoulder, my right shoulder, my right neck area, that should be a sign for us to start looking at these other factors as well and just make sure that nothing is being missed. On the flip side of pregnancy, in the postpartum timeline, a lot of the signs of preeclampsia can be brushed aside because of that like fatigue and exhaustion, lack of sleep, all of the things that come along with having a newborn. So I see this a lot, especially in first time moms where any type of symptom for maybe not necessarily even just preeclampsia, but symptoms of anything are just brushed under the rug as normal because they know like, well, I know I'm not going to feel 100%. And so it's probably fine or it's probably normal. We want to make sure that we're educating our patients of red flags to look for when we're seeing them prenatally so that when they're in their early postpartum period, they know what to look for and what they need to be calling their doctors about or following up on to make sure that things don't progress into more serious situations and conditions. Things like blurred vision or maybe not seeing spots, but just like feeling a little foggy headaches or just like that general feeling of like unwell can really be brushed aside. And so we want to make sure we're telling them if you're seeing vision changes, call your doctor. If your headache is there and it's just not going away, no matter how much water you drink, if you take a nap, if you stretch, none of that's helping it. Just go ahead and check in and see how that's going. The education that we can provide prenatally to make sure that our patients are empowered in the postpartum period can be incredibly important in making sure that things are caught, especially in that timeline because we know in pregnancy, especially later pregnancy, mom is going to be going in for frequent visits to their birth care provider, especially like 35, 36 weeks on those are weekly visits. It's pretty easy, quote unquote, to catch things that are changing. In this case, a lot of women are only seeing their physicians or their OBs or their midwives at that six week point. Maybe they have a telehealth visit touch point in there in the middle, but most cases people are not going to their doctor until after that six week point. And we need to make sure that they know what the red flags are, not just for preeclampsia, really for all of the things, but especially for this episode for preeclampsia so that they know if they need to go in and be seen for sure. Most women are not taking their blood pressure at home every day. And so that's something that we can really talk to them about ahead of time. Like, hey, just in the morning when you wake up, take your blood pressure, throw a cuff on and just track it for the first couple of weeks and see if there's any changes. That information can be really valuable if she is also feeling kind of crummy. There's a new test that just came out. The FDA just approved it recently. It's been pretty highly talked about for some pluses and minuses. It's a blood test that measures protein, two proteins that are put out in the case of preeclampsia. And it's essentially a predictive test. So this test is done between 25 to 23 to 35 weeks pregnancy. And it's job is 96% validity of predicting if somebody is going to develop into severe preeclampsia. So the test that was done in order for this test to get preapproval was taking women that already had hypertension or had low severity, quote unquote, preeclampsia, and they followed them and the test could predict within two weeks if they were going to progress into severe preeclampsia. There's some discussion about this test because on one hand, people that are criticizing it are saying it's just another test that costs money, right? That could be fear inducing in people potentially. It's not 100% guarantee that you're going to get severe preeclampsia. And the biggest discussion about this is what are you going to change clinically that you weren't already doing? So if you have somebody who's coming in, they have high blood pressure already, which would be an indication that they could benefit from this test to know, you're probably already keeping an eye and managing that patient a certain way and knowing whether or not they're going to progress to severe preeclampsia within two weeks isn't necessarily going to change the protocols that you're already doing for that hypertension. Same thing with a low severity preeclampsia. If you know somebody has low severity preeclampsia, it's likely not going to change anything other than you're going to be on the lookout regardless, which you would have been anyway. On the flip side, people that are really excited about this test are really talking a lot about the benefits of it clinically, especially in areas with disparities in healthcare. So again, we talked earlier about black women being 60% more likely to develop preeclampsia and a lot of times that comes from poor care and not being believed when they're talking about their symptoms. And so this test gives the opportunity to show like, this is a real pain, this is a real thing and it could be developing into a life threatening condition and it needs to be addressed. So that's one benefit. Another benefit is if you are somebody that's in like a rural area or an area that doesn't have great access to resources that maybe could be life saving for mom or baby, it's an opportunity to transfer somebody to a hospital system that is better equipped to handle a more severe preeclampsia patient rather than a smaller hospital that maybe doesn't have like a NICU or maybe doesn't have the type of care level that somebody with a more severe medical condition would potentially need. The other thing in the prenatal space is women that are coming in with some symptoms or discomfort potentially shortening their hospital stay. If the physicians know, okay, they have low severity preeclampsia, we did this test, they're not likely to progress into severe preeclampsia. They don't need high doses of steroids for baby's lungs to be developed in order for an early delivery. They're probably going to be fine just continuing on their pregnancy with close monitoring. And so that's something that hopefully could impact shorter hospital stays, allowing mom to get moving going from there as far as the impact on their health and their outcomes in the hospital. So there's some pluses and minuses. It's a new test. It was just approved by the FDA recently. So it's something that we're going to see kind of shake out across the prenatal and postpartum space. It'll be interesting to see how much it is offered and if it becomes kind of like a standard of care versus if it is something that people just pay extra and go above and beyond for. It'll be really interesting. Doesn't necessarily affect our role as PTs in the sense that we're not the ones that are going to be ordering that test clearly. But it's just something that we need to keep an eye on and be aware of as something that can be potentially done for our patients or something that our patients may be having. To wrap things up, preeclampsia, number one mortality or highest cause of mortality in pregnant women, high blood pressure condition that can progress into a life threatening condition if not addressed and caught early or addressed and caught whether or not that is through delivery or whatever other ways that they manage it. As PTs, our job is going to be to know what the signs and symptoms are and know when it is a time to send out to be done a more close workup on those symptoms. Those are going to be things like swelling of the hands and face, right upper quadrant pain, a headache that won't go away with any type of our typical quote unquote management of those symptoms, nausea and vomiting that comes out of nowhere in that third trimester, sudden weight gain, difficulty breathing and seeing spots. If your patients are talking to you about these symptoms, tell them to go follow up with their provider. And on the flip side of that, you talk to your patients about those symptoms if you're seeing them prenatally so they know what the red flags are for postpartum, they know what to look for so that in that six weeks that they are potentially not having a visit with a healthcare provider, they're not alone on an island, give them that buoy of information so that they know if they need to address it. That's all I have for you guys today on the postpartum and prenatal preeclampsia episode of Ice Pelvic. This is a topic that we do talk a little bit about in our courses. So if you want to learn more, dive into our courses, we talk about when maybe exercise is indicated or contraindicated. There's a lot of new information about that where some of the old school things that we thought maybe are not actually accurate or don't benefit our patients to put them on restrictions. We can absolutely dive into that more in our courses. So sign up for our online course, sign up for our live course, come hang out with us on the road. I hope you guys have a fantastic Monday and I will see you guys around. 25:08 OUTRO Hey, thanks for tuning into 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 CU's 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.  Zach Long // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Fitness Athlete faculty member Zach Long. In today's episode, Zach shares his favorite exercises for low back strengthening, including the reverse hyperextension, heavy horizontal rowing, and Jefferson curls. Take a listen to learn how to discuss cold plunging with your patients or athletes. If you're looking to learn from our Clinical Management of the Fitness 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 00:00 INTROWhat's up everybody? Before we get rolling, I'd love to share a bit about Jane, the practice management software that we love and use here at ICE who are also our show sponsor. Jane knows that collecting new patient info, their consent, and signatures can be a time consuming process, but with their automated forms, it does not have to be. With Jane, you can assign intake forms to specific treatments or practitioners, and Jane takes care of sending the correct form out to your patients. Save even more time by requesting a credit card on file through your intake forms with the help of Jane Payments, their integrated PCI compliant payment solution. Conveniently, Jane will actually prompt your patients to fill out their intake form 24 hours before their appointment if they have not done so already. If you're looking to streamline your intake form collection, head over to jane.app slash physical therapy, book a one-on-one demo with a member of the Jane team. They'll be able to show you the features I just mentioned and answer any other questions you may have. Don't forget, if you do sign up, use the code ICEPT1MO for a one month grace period applied to your new account. Thanks everybody, enjoy the show.  01:25 ZACH LONG Welcome to the PT on ICE Daily Show here on the Best Day of the Week on the podcast. It is Fitness Athlete Friday. I'm excited to be with you here today. I'm Zach Long. I'm one of the lead faculty members inside of our fitness athlete division. And today we're going to talk about a few of my favorite exercises for low back strength. Before we do that, two pieces to get out of the way. Number one, congratulations Joe Hanisko, one of our faculty members here inside the fitness athlete division. He and his wife Aubrey just had their first child, so congrats Joe. Second, upcoming courses we have inside the fitness athlete division. Advanced Concepts, eight weeks online, starts up September 17th. That always sells out, so if you've already taken essentials and you want to move on and take advance, you need to go sign up for that really soon because it will sell out several weeks in advance. Upcoming live courses we have September, we're in Bismarck, North Dakota, as well as Newark, California. October, just outside of Seattle. In November, we're in Hoover, so look forward to seeing you on the road. Or in Advanced Concepts. So let's jump into today's topic and that's bulletproof back exercises. So one thing that we talk about a lot in so many of our courses, but especially in Fitness Athlete Live, is that there's just this principle of rehabilitation. Like when a tissue is injured, what do we strengthen? We strengthen that tissue, right? If you're dealing with Achilles tendinopathy, we're doing Achilles tendon loading. If you're dealing with patellofemoral pain, we're getting your quads and your glutes really strong. We strengthen the tissues around what is injured. That's a principle of rehab. But all of a sudden when we start talking about low back pain, that principle like goes out of the window. And so much of our profession then says, no, we're not going to get the back strong. Instead, we're going to worry about the glutes not activating. We're going to worry about psoas tightness. We're going to worry about transversus abdominis activation. And while I'm not saying any of that is not completely irrelevant, I'm just saying that a principle of rehab is that we strengthen the area that is injured. So when somebody has back pain, we should probably make that back a little bit stronger. And so I want to share five of my favorite exercises for doing that today. And number one for back strength is going to be the reverse hyperextension. So this is a piece of equipment that you don't see a lot of physical therapy clinics. So I'm going to describe it for those of you that aren't familiar. Imagine you have a high-low table that goes up about five feet off the ground. And it's got this nice cushiony pad on top of the table. And you lay your torso on that with your legs hanging vertically off of that. And then you lift your legs up. So it's essentially just doing like a Romanian deadlift, except your upper body's horizontal to the ground and locked in place, and you're lifting your legs up. So there's reverse hyper machines, but this can also be done a number of different ways. I have patients doing it off of beds, off of incline benches, over exercise balls, over a barbell in J-cups on a rack, over a glute ham developer. A lot of different ways to do reverse hypers. But they are a phenomenal exercise for building a little bit of low back strength and endurance. And I'd say this is probably one of my most frequently prescribed low back exercises, because it works so well, even on your highly irritable patients, so frequently they can do this and get a huge pump into those muscles around their lower back, which of course is going to help tremendously out with pain and with working through a little bit of inflammation and getting fluids moving a little bit. So really make sure you check out reverse hypers. If you've never done those before, I would highly encourage you to take a look at different reverse hyper variations. You can find some videos of that on my YouTube or my Instagram if you need some ideas on how to do that, or you can just shoot me a message and I'll send you that video. But it is a great exercise to start with. Exercise number two, any form of heavy rows. I think we very frequently think of bent over rows and other movements like that as an upper back or mid back exercise, but they're so underrated in terms of what the low back has to do in terms of holding an isometric contraction. So I love really heavy rows. So bent over rows or really, really, really love pin lay rows. So if you're not familiar with pin lay rows, here's another great exercise for you to go train and explore within your own personal fitness journey. So barbells on the ground with bumper plates on it, you hinge over quite a bit to grab the bar and you're doing a row with every time the bar goes all the way back down to the ground. And what I really focus on with my pin lay rows is that my lumbar spine stays locked in place. I let my thoracic spine round and extend a little bit as I row. And that's just a phenomenal exercise to build total spine strength. So really for sure, check out pin lay rows if you've never done those before. Next movement is a series of movements actually. So that's anything off of a glute ham developer. Not very many physical therapy clinics have a glute ham developer, but a lot of gyms do. And so a glute ham developer is an exercise, a piece of exercise equipment that has a lot of different potential variations that you can do. But really I like to do tons of isometric holds off of the glute ham developer. So the glute ham developer has this little foot plate. So you lock your feet in place and then your thighs into this other pad. And then your upper body is free hanging out here. So you can hold your upper body parallel to the ground and you're now going to do a really good isometric of your low back, your glutes, your hamstrings to hold that global extension position. But you can then do different things like hold some light dumbbells and do rows to make that a little bit more challenging. You could turn it into a hinge movement by doing back or hip extensions, either loaded or unloaded, but so many different variations of exercises that can be done off a glute ham developer to load the post of your chain and the back specifically that you really want to make sure you check those things out. Up next, Jefferson curls. So Jefferson curls tend to get physical therapists a little bit fired up because everybody seems to be on one side of the equation or the other. So Jefferson curls, where we work on segmentally flexing the spine and taking the spine from an upright position, going into global flexion with light load behind it. I love Jefferson curls because so frequently in our culture, people are absolutely terrified of flexing their spine, especially with any load. And so the lightly load that and make people feel more confident that their back can get out of neutral position and not explode. Like we see Instagram infographics happen all the time by unfortunate influencers. The Jefferson curl is a great way to build confidence that the spine can be flexed. I love this to build a little bit of submaximal strength out of positioning. I love it also for my athletes that have some neural tension. We've worked through so much of that neural tension, but I know they're going back to a sport like CrossFit where they're going to be doing a ton of hinging motion. I like to use the Jefferson curl as the in range, make sure we completely clear out any of that stiffness that might be remaining. So that's exercise number four. And you all know exercise number five, last exercise. If you've been to an ice course, whether this is total spine thrust, modern management of older adult, lumbar spine management, or fitness athlete, you know what the next exercise is. And that is the freaking dead left because that is the best exercise that has ever been invented to build low back strength as well as human's confidence in their body. It is shocking and amazing how often somebody pulls a weight off the ground that they didn't know that they could do. They didn't know that they were strong enough to do it, or they didn't know that their back wasn't so fragile that they couldn't pick up that 95 pound bar, that 125 pound bar, that 225 pound bar. They pick it up and all of a sudden, their chest pops up a little bit. They walk out of the clinic a couple inches taller because they're so much more confident in their body when they learn how to pull a heavy weight off the ground. And it's something that they weren't expecting. Dead lifts can be conventional dead lifts, sumo dead lifts. They can be kettlebell dead lifts, so many different options for it, but get your people pulling heavy weights off the ground because that builds a lot of confidence in the human body. One of our favorite research articles from that comes out from Taglia Theory and colleagues in 2020. So they looked at individuals doing low load motor control exercises and manual therapy compared to a group that did heavy loading. So they're doing squats and dead lifts and a ton of other exercises that load the spine heavy. And what they actually found was that the heavy group, the group that were getting after it lifting heavy loads, had significantly reduced levels of kinesiophobia, which when it comes to low back pain, we all know that's the key. Our patients, after they've had an experience of low back pain, are terrified of their backs. And anything we can do that reduces kinesiophobia and makes them feel more confident is really important. And in that Taglia Theory and colleagues article in 2020, low load motor control exercises, your bird dogs, your clam shells, those sorts of movements, they don't make people less fearful of their back, although they do help with their pain. Heavy loading helps with pain and makes people more confident in their body. And that's what it's all about. So five different exercises there. We've got reverse hypers, we've got heavy rows, we've got glute ham developer work, Jefferson curls, and the greatest exercise of all, the dead lift to make your patients stronger in their low back, more confident in their low back, and getting back to doing the things that they love. So I hope you enjoy this episode. As always, reach out to us if you have ideas for future topics you'd love to hear of, and we look forward to seeing you on the road. Have a great weekend, everybody. 11:12 OUTROHey, 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.    

Alan Fredendall // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE COO Alan Fredendall introduces the concept of servant leadership in the workplace, discusses the four main characteristics of servant leaders, research supporting the use of servant leadersihp at work, and the intersection of "burnout" & lack of servant leadership at work. Take a listen to today's episode or check out the transcription below. 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 00:00 ALAN FREDENDALL Good morning, PT on ICE Daily Show. Happy Thursday morning. I hope your morning is off to a great start. My name is Alan. I'm happy to be your host today here on the Daily Show here on Leadership Thursday. We talk all things leadership, small business management, practice ownership, that sort of thing. Leadership Thursday also means it is Gut Check Thursday. This week's Gut Check Thursday. I tested this this past Tuesday. Pretty simple, but doesn't mean it's easy. Ten rounds for time, ten calories on a fan bike, that assault bike or eco bike for gentlemen and seven calories for ladies, followed by ten pull ups. So the challenge here is going to be to keep that bike as fast as you can while trying as big of a sets of pull ups as you possibly can. Just a warning, that's a lot of pull ups. If you're not used to that much pull up volume, surely you can grind through this and get through that many pull ups, but it's probably going to leave you quite beat up. I know myself today, my lats, my biceps a little bit are sore. So if you're not used to that kind of volume, maybe scale that down, maybe eight rounds for time, maybe seven rounds for time, maybe even five or six rounds for time. Maybe keep the calories on the bike, but cut the pull ups in half, maybe ten, seven cows on the bike, five pull ups, ten rounds, something like that. And overall, try to keep it between 15 to 20 minutes aiming for maybe a minute to two minutes per round or faster. So again, pretty simple. Get off the bike, do some pull ups, go back to the bike. You're going to hit a wall on the pull ups eventually, just a matter of how long you can hang on before those start to fall apart. Some courses coming your way next weekend, the weekend of July 29th and July 30th. We have upper body dry needling down in Dallas, Fort Worth area. That course has two seats left out in Denver. We have Alexis with our ice, ice, ice pelvic live course that same weekend, two chances to catch older adult live either with Alex Germano up in Boise, Idaho, or with Christina Prevot down in Watkinsville, Georgia. That's about 90 minutes east of Atlanta out towards the Athens area. And then extremity management will be in Madison, Wisconsin that weekend with Lindsay. The weekend of August 5th and 6th, again, dry needling will be out on the road with Paul, this time lower body in Greenville, South Carolina at Onward Greenville. Older adult live will again be on the road with Alex Germano, this time in Frederick, Maryland. The weekend of August 12th and 13th, dry needling will again be out on the road, this time lower body with Paul out in Salt Lake City. Extremity with Lindsay on the road again, this time in Rochester Hills, Michigan. Total spine thrust will be up in Bellingham, Washington with Justin Dunaway. And then you have another chance at older adult live, this time with all of the faculty and teaching assistants at the older adult live summit that will be in Lexington, Kentucky at Stronger Life. I will be there for that one. That's going to be a great weekend. So if you can make it down to Lexington that weekend, you should. Finally, the weekend of August 19th and 20th, again, dry needling will be on the road with Paul, lower body in Phoenix. Extremity will again be on the road with Lindsay, this time in Fremont, Nebraska. That's right outside of Omaha. Older adult live will be in Bedford, Texas right outside of Dallas or up in Minnetonka, Minnesota. That will be right outside of the Minneapolis area. So those are the courses coming your way in the next month from ICE. Today's topic, servant leadership. We have touched on this a little bit before, but we're going to get really nitty gritty today and we're going to more importantly talk about some of the research supporting the use of servant leadership in practice. So servant leadership, what is it, how to get better at it. We're going to define it. We're going to list the characteristics. We're going to give some examples of high quality servant leadership and talk about the research supporting the use of servant leadership. So first things first, what is servant leadership? You may have heard of this. You may have seen some books maybe in the airport, in the business section or something like that about servant leadership. It is a leadership principle founded in 1970 by a gentleman by the name of Robert Greenleaf. And it was an essay basically published called The Servant as Leader. And the idea behind servant leadership is leaders are essentially individuals that look and act no different than any other member of the work team of no matter what you're doing, you are hauling garbage away. You are a physical therapist. You work on a computer doing data entry or software development or something that servant leaders, true servant leaders are yes, maybe the owner of the company. Yes, in charge of a team of people, but they're also on the ground still doing the day to that composes the work of whatever the business is trying to accomplish, whatever product or service they are trying to offer. Team members then should be easily relatable to the leader because they are essentially doing the same thing. Maybe the servant leader is not doing as much of it, but they have certainly started in whatever work they are now leading and they are still doing some or most parts of it day to day. The whole idea here is that when someone is not a servant leader, we don't necessarily notice when someone is a servant leader, but we certainly notice when someone is not a servant leader that when their fellow servant, when their fellow teammates, employee, colleague, however you want to define yourself is absent, when that person is gone, the team itself, the work that the team does overall feels less organized, less functional. That day to day looking at a group of people, you might not be able to figure out who the leader is because again, they are doing the day to day work of the organization much like everybody else that works there, but when they are not on the job, things just don't function as well. They keep things organized, they understand a lot more details of the work to be done because usually they are people who have spent a lot of their time doing it. They may have been, for example, physical therapists in practice for 5, 10, 15, 20 years. They may have all of the knowledge of the back end work of the business and when they are not there, yes, work continues, but it's just not as productive. Work gets a little bit slower, it gets a little bit harder to do and overall the idea behind servant leadership is that having the servant leader there makes everyone else's job just a little bit easier, not only by performing their share of the work, but by helping everybody else stay organized and on task as well. This is in stark contrast to almost every other business philosophy and leadership philosophy Most businesses are running kind of a leader first mindset where the goal of the leader is to squeeze productivity out of people. This is obviously very common in physical therapy, but it's common across business in general of oftentimes the leader of a physical therapy clinic of a large company may not even be a physical therapist or may not even know the work that happens at that organization. They are just there to essentially be a boss, to crack the whip, to squeeze productivity out of people, to make sure deadlines get met and things like deliverables get delivered and otherwise kind of push the organization along even if it's not functioning well and even if the people in the trenches doing the work may think, boy, what would really help right now is an extra set of hands. That doesn't happen in a leader first culture, but it does happen in a servant leadership culture. So let's talk about characteristics of servant leadership. So there are four main characteristics. The first is that a servant leader always approaches work with an unselfish mindset. That is to say, there is no task beneath a servant leader. If the leader expects the toilets to be cleaned at the start of each day, if it's not done, it is not beneath the servant leader to go in and clean the toilets themselves. They still practice whatever profession they are leading. They are still a practicing physical therapist, a practicing software developer, whatever. And they still perform a lot of the mundane day to day tasks that not only do they expect of others, but are necessary for the organization to function and thrive. You will find these people still cleaning windows, cleaning up those tiny little pieces of toilet paper that get ripped off the roll and in bathrooms. You will still find them treating patients. You will still find them doing their documentation. You will still find them doing all the things that they expect the people that work for them to do on a daily basis. I think often here at ICE of I'm very familiar with what it's like to spend an entire day or maybe multiple days with a delayed flight or a canceled flight or trying to drive across the country to make it to teach to a course of understanding what it's like to do the really boring, mundane, kind of agonizing tasks day to day of a job, of driving across the country to bring equipment to make a course happen. That is stuff that I have done in the past. That is stuff that I still do. And I am able to relate to when that happens to others who work here at ICE because I have done it myself. Again, that is in stark contrast to the way that a lot of organizations are run where the person in charge may not have any idea of the actual work that goes on in the company. They are just there to boss people around and ask for reports and that sort of thing. Essentially, approaching work with an unselfish mindset is saying that I know exactly what it's like to do your job and I'm also not above doing it and I probably still do a lot of it. The second main characteristic of a servant leader is that they encourage diversity of thought. That the leader's ideas aren't necessarily best just because they are the leader's ideas, but because they come from the leader after that they have incorporated everybody else's thoughts, feedback, and opinions of everybody on the team. That large decisions should be team decisions. Large decisions should be team decisions. The third characteristic of a servant leader is that they create a culture of trust. That they are not some lofty, unapproachable individual that maybe works in a different state that maybe now works in the Caribbean from some island or something because they're so rich and they jet in every now and again to collect their checks or yell at some people or fire somebody or something like that. That they are just a regular person that still comes to work every day, that still gets up, still gets their kids breakfast and gets them on the bus to school and still comes in to work just like everybody else on the job site. They don't just come to work to boss people around, they come to work to work and to guide others to be more productive in their work, not to just come and make new rules and punish people and then go hit the golf course. The last and maybe the most important characteristic of servant leadership is that servant leaders foster leadership in other people. That they recognize that true long-term success, true long-term sustainability at a job, true long-term productive, profitable work comes from building a successful, often multi-generational team of yes, in the moment I'm thinking of tasks that need to be accomplished and deadlines that need to be met and costs and expenses, but I'm also in the back of my mind thinking who here is next going to sit in my seat and I'm trying to give that person advice and guidance and mentorship so that someday they can also be a leader within the company and that treating everybody within the company as a potential leader not only empowers them, builds a culture of trust, but really fosters leadership in them in a way that when the leader happens to not be there, things don't fall apart of like oops, we can't even unlock the door to let patients in for the day because the boss is out of town today until noon, of fostering leadership in others and having others take over some of the leadership tasks of the job. Most businesses are only created with the goal of growing them big enough to sell them and essentially just to acquire wealth, to be sold at some point for a profit. There is often not a lot that goes into the fostering of other leaders to take over the company to keep the company continuing running. It's often thought of I hope I can make this go long enough so that I can sell it someday and get a big golden paycheck and then it's somebody else's problem. Not many people approach work with the mindset of who's going to take over my position after me and continue to grow this thing into a successful multi-generational business. So that's what servant leadership is. The characteristics of a servant leader. What is some really nice research that supports the incorporation of servant leadership in the workforce? So none of these papers are going to be found in physical therapy journals or fitness journals. These are all going to be from managerial science journals. Really really interesting stuff that you really you can't put down that you can't keep flipping the page. But I want to share three articles with you that I hope hit home. The first is research on reduced employee turnover nutrition. This comes from a paper from Cash App and rang rang a car. Sorry if I butchered that. This is from the Journal of the Reviews of managerial science. Thrilling. This is from 2014 looking at servant leadership in the workforce and finding that when servant leadership was put into place the direct effects of servant leadership on employee perception results in reduced job turnover. That employees report that the workplace is seen as a positive place to be. That employees report having higher levels of pride in the work that they perform when they're on the job. That they feel they are rewarded accordingly and that they genuinely this is a direct quote generally enjoy the company of the people that they work with. It's a fun enjoyable place to be. It's great when there's a lot of synergy between coworkers and it's not just a place where you clock in and you clock out. Servant leaders model the behavior expected of others and that is very rewarding to everybody else that works there and to the organization as a whole. The second paper I want to cite is on life improvements outside of the workforce. So everything that's not work what changes in somebody's life when they work in a job where the leader is a servant leader. This is from Zimmerle, Holzinger and Richter from 2007 from the Journal of Corporate Ethics and Corporate Governance. Again another page turner. This paper reported overall reduced levels of stress and an improved ability to spend time with friends and family and meet the needs of the family unit at home outside of the workplace when the workplace was run by a servant leader. Subject reported that when their work needs felt met they had more bandwidth, more mental energy to support others outside of work, to support their spouse, to support their children, to support other members of their family and friends outside of the workforce. And just concluding that when a servant leader is in charge work is not this kind of hellacious place where all we're trying to do is make it to the end of the day. That it's just this block of time on the calendar that we have to grind through and suffer through and it's really kind of this hellacious experience. Subject reported that we leave work feeling maybe at least not as drained as maybe other positions but maybe even leaving work for the day feeling energized, having more time, more energy to go do other more enjoyable stuff. Again spend time with friends, spend time with family members that when work itself is enjoyable and rewarding it's a sustainable pace that allows both work life and family and outside work life to really function and thrive. Our last paper here is that servant led workplaces are sustainable workplaces. This is from Chukotai and colleagues in 2017 from the Journal of Applied Research in Qualities of Life and finding that servant leaders carefully manage work with the use of deadlines but also with rewards and even distribution of work allocation and regular performance evaluations so people have an idea of how they're doing, how to get better and they don't feel like they're doing an uneven amount of work for less than their fair share of pay. There's a lot on social media now about burnout and imposter syndrome and all this stuff and how to just get through your work day and the truth of the matter is most of us feel burned out, most of us feel overwhelmed because we're able to perceive that we're doing an uneven amount of work for an uneven amount of pay right. We are doing more work than our bosses do for less money than they make. As soon as your brain perceives that you start to get a really disgruntled feeling in your mind and that is the nucleus that turns into burnout, that turns into maybe I don't want to be a physical therapist anymore, maybe I want to sell real estate. That is palpable in the workplace. As soon as you walk into a business you can tell when the people there are kind of just staring straight forward, they have that dead look in their eyes and you can tell that they are not happy to be there, they are not thriving. That servant led workplaces are focused on the results, not the effort of telling people to get all of their work, get X amount of work done immediately and the rationale is because I said so. For example, very common in physical therapy right, get all of your documentation done by the end of the day. Why? Well because I said so and I'm in charge. Maybe the biller has already gone home for the day and there's no way that that documentation is going to turn into claims anyways. So what the hell does it matter that I get this done by 6pm if it's not going to be looked at until tomorrow morning or if it's Friday it's not going to be looked at until Monday? Why am I at work until 8pm or 10pm at home doing my notes when they're just going to sit unaddressed for a day, two days, three days? That is kind of a boss led work environment versus a servant led work environment that says hey, get X amount of work done by Y date and you will get Z reward right? Get all of your documentation by the next pay period and that's it right? I don't care when you do it, I don't care if you do it a little bit every day, I don't care if you wait until Sunday night and do all of it at once. Like I literally don't care about the effort that it takes to get the work done, I just care about the results of the work, that the work is high quality and then it gets done. I don't care how you practice physical therapy, as long as patients get better, they leave physical therapy feeling better, they are healthier, fitter, stronger people leaving physical therapy, I don't care how you got there right? So servant led workplaces are focused on results and not just doing effort to say that effort has been done. This is objective, measurable and repeatable led work. We can track this stuff, yes, if we care about data and reports, but ultimately again we care about the results and not the effort. And so ask yourself, am I burned out because I believe that I'm not skilled enough, that I'm not competent enough as a clinician or am I really burned out because I work in a boss led workplace and not a servant led workplace? And I think you'll find that most of you considering leaving the profession, considering changing jobs are really aware in the back of your head that you are not working for a servant leader. You may be working for somebody who doesn't even live in your state, right? You may be working for somebody who's not even a physical therapist. The owners of your company may be investment bankers from New York City or Chicago or LA and you are just going to work to generate money so they can go on really nice vacations and have a cabin and a yacht. And again, the moment your brain starts to perceive that, that's really where kind of that disgruntled feeling comes in. And I would urge you to look around that there are many clinics out there, there are many workplaces out there that are led by servant leaders and you really just need to tell yourself that you're not going to settle until you find that place where you come in, work is maybe not necessarily overly energizing, but it certainly doesn't take so much out of you that you feel drained for the day, that you have to go home at 5 p.m. and go to bed for the day and all you can do is lay on the couch and watch TV until you fall asleep. A really high quality workplace led by a servant leader can be a fun environment, it can be an energizing environment, it can leave you with enough energy in the tank to where you can go home and do whatever you want with the rest of your day and the rest of your life and that you don't feel like you're just doing work to get work done, to check the box on things like reports and to produce data for somebody to look at and rubber stamp it. So again, don't settle until you find that nice servant led workplace. So servant leadership, what is it? It is a servant mindset, it is somebody who comes to work with the mindset of they have done that job before, they're likely still doing that job, they're able to help you get better at doing it so you don't have to spend as much physical and mental energy doing it as well, right? They are often great mentors, they lead their workplace in a way that makes it more organized, that makes it easier to work at and maybe even makes it a fun energizing place to work at. They embody four main characteristics, they approach work with an unselfish mindset, no task is beneath them, they encourage diversity of thought, they have meetings where they ask for your thoughts and opinions on decisions, again large decisions are team decisions, they create a large culture of trust, they're not this lofty individual living in Costa Rica, they are standing next to you, they are in the other room treating a patient and that they foster leadership in others, they challenge you to take over some of the reins the whole idea is creating a sustainable multi-generational business. Know that there's a lot of research supporting this, that it often leads to less turnover, it leads to higher quality of life outside of work for employees and then overall it leads to a sustainable work environment where people don't feel that quote unquote burnout feeling. And recognize that burnout is often not remedied by taking more vacations or reading more It's found by working for people who are servant leaders, of not being afraid to move yourself in a position or maybe even move yourself geographically to find a really high quality servant led workplace. They are out there, you just need to tell yourself that you're not going to settle until you find it. So servant leadership, I hope that was helpful, I hope you have fun with Gut Check Thursday, if you're going to be at a live course this weekend I hope you have a fantastic time, have a great Thursday, have a great weekend, bye everybody. 22:20 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. Dustin Jones // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Dustin Jones explores the concept of creating impactful memories for customers and how it can enhance business success through word-of-mouth marketing. He shares examples from the restaurant industry, illustrating how exceeding customer expectations can cultivate lifelong customers and improve business growth through positive word-of-mouth.  Dustin emphasizes the significance of creating "legends," which are memorable experiences that surprise and make customers feel special. These legends become synonymous with the business and leave a lasting impression on customers. When businesses go above and beyond to provide such memorable experiences, it not only fulfills the customers but also benefits the business owners. Dustin encourages listeners to consider what legends they can create in their own businesses. It could be as simple as acknowledging a customer's birthday with a card or text, or going the extra mile by taking a discharged patient to play pickleball or organizing a group trip. The possibilities are endless, and creating legends can have a positive impact on the business, the community, and the overall satisfaction of everyone involved. Take a listen to learn how to better serve this population of patients & athletes. 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 00:00 INTRO What's up everybody? Welcome back to the PT on ICE Show. Before we jump into today's episode, let's chat about Jane, our show sponsor. Jane makes the Daily Show possible and is the practice management software that so many folks here at ICE utilize. The team at Jane knows how important it is for your patients to get the care they need. And with this in mind, they've made it really easy and convenient for patients to book online. One tip that has worked well for a lot of practices is to make the booking button on your website prominent so patients can't miss it. Once clicked, they get redirected to a beautifully branded online booking site. And from there, the entire booking process only takes around two minutes. After booking an appointment, patients get access to a secure portal where they can conveniently manage their appointments and payment details, add themselves to a waitlist, opt in to text and email reminders, and fill out their intake form. If you all are curious to learn more about online booking with Jane, head over to jane.app slash physical therapy. Book their one-on-one demo with a member of their team. And if you're ready to get started, make sure to use the code ICEPT1MO. When you sign up, that gives you a one-month grace period that gets applied to your new account. Thanks, everybody. Enjoy today's show. 01:43 DUSTIN JONES PT on ICE Daily Show. It's Dustin Jones here. It is Wednesday. We're going to be talking about making legends. What, how, and then the why behind this. Making legends is going to be about how to create memorable, impactful experiences for your patients and why it's good for them, it's good for you from your professional standpoint, and good for your business. All right. So what I want to talk about first before we get into this are the modern management of the older adult courses that are coming up. We are picking back up. We usually kind of take a little break during the summer, regroup, do our revamps, update all the literature and the slides, and we're hitting the ground running. So we're going to be in Boise, Idaho, in Watkinsville, Georgia at the end of July 29th and 30th, and August 5th we'll be in Frederick, Maryland. And then on August 12th, we will be in Lexington for the MMOA Summit where all the MMOA faculty are going to come together and deliver the brand new revamp of MMOA Live. We're super pumped about that. And then we have Essential Foundations, our online course starting August 9th. All right. Legends. Let's talk about this. I'm really excited about this topic. This has been something I've been thinking about since about February when I read the book Unreasonable Hospitality. So this is a book that you probably heard some of the ICE faculty talk about that Jeff Moore recommended. Anytime Jeff Moore recommends a book, you should probably check it out. The guy doesn't recommend a lot of books, but when he is very critical of a lot of books, so when he says, hey, this is worth reading, you probably should add that to your list. And this definitely proved to be true with this book. So Unreasonable Hospitality, I'll just give you the 30,000 foot view. Will Guderia is a restaurateur, very successful in that business or that industry. And he kind of talks about some of the principles that he used to create such impactful businesses, restaurants in particular, and how a lot of those principles that he used also translate over to business in general. And just so many different industries can benefit from kind of that hospitality mindset. And so he talks about a lot of different practical strategies that all of us can use in the rehab and the fitness profession. But he speaks to one particular of how we try to create legends. And when he says the word legends, what he's really talking about is creating impactful memories for folks where they are surprised, they feel special, and they will never forget. That moment and the business that is associated with that moment. He's got all kinds of crazy examples from the restaurant business, where he just went above and beyond what people were expecting and thus created customers for life. And that really improved his business, word of mouth marketing, and a lot of different things that made their job more fulfilling. And so he speaks about that concept of legends a lot in the book. And I walked away from that book just thinking about, man, we have such a huge opportunity to create legends in the rehab space, in the fitness space. And I'm going to talk through, you know, just through that of why we may want to do that, and then particularly the how and give you some examples. So in terms of the why, the first thing that I want to acknowledge is that when we go above and beyond and provide a memorable experience for folks and do it in the mirror, that they're kind of surprised and taken back. That is very fulfilling for us. I'll give you one example. Ellen Sefi. So she teaches with MOA. She has created lots of legends for a lot of her patients. She had one patient in particular that she was treating in a more acute setting. I forget the exact situation, but she this this patient had a long road to recovery. And Ellen ended up switching jobs into outpatient as that that patient was kind of leaving that acute setting and going into outpatient. So Ellen was able to treat her in that setting. This is a long road road to recovery for that individual. And Ellen worked with this person to help her get back to being able to hike. That was a big goal for this patient. And I think this is where a lot of us kind of stop, right, is we get people to the point where they can do the thing, right? Whatever that particular goal is for this patient, it was hiking. So she worked on her lower extremity strength. She worked on her dynamic balance. She worked on her endurance and she checked the box of all the kind of prereqs to be able to go on a hike in Colorado. And that's where we stop. And that's where we have such a huge opportunity to take a one step further and create a legend. And what Ellen did is she actually organized a hike and did a 14 or with this patient, right? She gave her the prerequisite skills and abilities required to achieve that goal. But then she facilitated that goal to actually happen. And she went on that journey with that patient that for Ellen, that's one of the most memorable professional moments for her. The fulfillment of being able to see of all your hard work and time that you have invested in this person, that they're able to do something epic like that. That is so fulfilling. So it's good for you. It's also good for your business because that happens. What do you think that patient is going to tell all their friends and their whole networks? Do you think she took a thousand selfies on the top of that summit and posted it all over social media? And guess how many patients Ellen probably had from that word of mouth, from impacting that patient on such a big level that it really sets you apart from a lot of your competition that aren't doing that. They're just checking the box. They're just improving strength, improving endurance. And you're actually facilitating your patients climbing 14 years, right? That has a compounding effect over time. It's going to be good for your business. All right. So that's the what of the legends. That's the why. It's good for you, for your fulfillment, for your career. It's also good for your clinic, your business as well. And so I want to get kind of dive into some practical examples of how we can create legends in the context of rehab and or fitness. I think we can do this in very simple manners and we can do this in kind of big, big, monumentous events as well. On the small side of things, just think about how you can surprise your patients, make them feel special. This is could be as simple as acknowledging someone's birthday. You have their date of birth that you send them a card, a gift card, whatever that just that simple act kind of puts you above them. Beyond most clinics and in gyms, for that matter, it could be that easy. It could be that simple. It could be more like what Ellen did, where she worked on building physical capacity with a patient, which is usually the case in our plans of care. Right. We're trying to get them stronger, improving their endurance, improving their balance, all that fun stuff that is tied to a patient centered goal. Right. We're already asking a lot of those things. What if you take it another step further to facilitate them being able to participate in whatever that activity is? Right. I'm not saying you got to climb a 14 or like Ellen did, but what if you proactively, you know, organize the hike that they could go on? What if you address the barriers that they may have on going on that hike, like going ahead and printing out directions of going ahead and planning out the day, recommending restaurants to hit up after the hike, just reducing barriers and facilitating that or even connecting them with a local hiking group that's going to increase their odds of actually doing the thing that you help them be able to do. Right. We could do it in that manner. Ellen took someone up a 14 or for me, especially in the context of home health, this happened a good bit where it was usually something a lot simpler than going to climb in a 14000 foot mountain. It was, you know, once that person was discharged from homebound status that we would go and do something in the community that they loved about. One in particular, I will never forget this. Me and my wife went on a double date on Valentine's Day at Waffle House with Walton Peony Smith in Columbus, Ohio, that I was discharged in Peony. She was no longer considered to be homebound. And it was right around Valentine's Day. And she had just regained the ability to navigate her community safely and efficiently. And so we crushed the All-Star Special. I still remember that meal. It was absolutely amazing. A double date on Valentine's Day at Waffle House. Something like that is just takes things to the whole another level that I will never forget. Very fulfilling from the professional standpoint. Peony will never forget. And then all of her friends, her family won't forget either. And when they want PT, guess who they're going to be calling. Right. We could take it up another notch. And this is something that we have been trying to do more at Stronger Life. We have a couple examples of this recently, which has really fueled me wanting to talk about this. One is that we had four individuals compete at the National Senior Games. These four women have basically never ran their life before, about 12 months ago. They qualified at the state games last year and then went to Pittsburgh last week to compete in the National Senior Games. And one of our athletes, Carolyn Holmes, 89 year old woman, got third in the 5K. And her whole family, three kids from all across the country, their kids, and then she had a couple of great grandkids were all there to witness this. And I will never forget this. Carolyn Holmes, 89 years old, running across the finish line with her eight year old great granddaughter. We got Carolyn stronger. We improved her endurance. We improved her balance. We checked all those boxes. But we created the opportunity for them to really flex their muscles and really pursue something that they had never even thought that they would be able to do. And then to do that in front of their community, in front of their family and then the whole Stronger Life community watching this from afar. Those are potent moments. Those are legends that I will never forget. Hands down, my most fulfilling professional moment. Carolyn will never forget that. And anybody watching that story will never forget what happened on that day. It's good for me. It's good for Stronger Life. This is good for our communities. It's a win win win for everybody involved. All right. We've got another one coming up this winter where we're taking 25 of our members to Costa Rica in an all inclusive adventure retreat where we work on their balance, their strength, all this stuff inside the gym. And then we create the opportunity for them to use those skills and do things that they never thought were possible. Right. These are legends. They're good for you. They're good for your business. They're good for your community. So I want you to think what legends can you create in the context of your own business? Some of you, it may be, all right, I need to acknowledge that someone had a birthday and just write a card and send it or send the text or whatever it may be. Some of you may think, oh, man, I may end up taking that patient that I just discharged actually to go to the pickleball court and play some pickleball with them or connect them with that pickleball group. And some of y'all may climb a 14 or some of y'all may organize a group trip to the Caribbean. I don't know. But there's so many opportunities for us to take things to that next level to create legends. I've really enjoyed this. I think you will as well. And I know your business will benefit, too. All right. Let me know your thoughts in the comments. If you have any legendary stories or any ideas, I would love to hear what you're going to do. We'll get lots of ideas in the comments, which will be very helpful to make this more practical. All right. You have a good rest of your Wednesday. I'll talk to you all soon. 13:24 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 PT on Ice dot 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 PT on Ice dot com and scroll to the bottom of the page to sign up.    

Dr. Dave Finkelstein // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Spine Division faculty member Dave Finkelstein makes his debut on the podcast to discuss the importance of asking patients if there is anything important they want to cover or do in their session. This question is often overlooked by therapists, but it is seen as one of the most important questions they can ask. By asking this question, therapists are allowing their patients to take control of their care and be in the driver's seat. The aim is to promote a sense of self-efficacy in the patients' care and give them the opportunity to express what is truly important to them. The episode highlights that therapists may be surprised by their patients' responses to this question. While some patients may be open to whatever the therapist suggests for the session, others may have specific concerns or topics they want to address. It is crucial for therapists to listen to these concerns and not dismiss them for their own predetermined plans. By addressing what is important to the patients, therapists can alleviate their fears and concerns and demonstrate that they are truly listening and invested in their well-being. Furthermore, the episode emphasizes that asking this question helps to strengthen the therapeutic alliance between the therapist and the patient. By showing attentiveness to the patients' needs and concerns, it enhances the trust and rapport between them. This, in turn, can lead to better treatment outcomes and a more positive therapeutic experience for the patient. In this episode, the host discusses the importance of asking specific questions to patients in order to determine the direction of their care. The host shares five specific questions that can be asked to gather important information from patients. The first question is, "How did you feel after the last session?" This question allows healthcare providers to understand how their intervention or treatment has affected the patient's symptoms. By knowing how the patient felt after the previous session, healthcare providers can make informed decisions about the next steps in their care. The second question is, "How are you progressing with your goal?" This question helps healthcare providers assess the patient's progress towards a specific goal. It allows them to gauge whether the current treatment plan is effective or if adjustments need to be made. The third question is about the patient's adherence to their exercise program. The question is, "How often are you keeping up with your exercises?" This question helps healthcare providers identify any barriers the patient may be facing in following their exercise program. It also allows them to assess the effectiveness of the home exercise program. The fourth question is, "How are you feeling today?" This question helps establish a baseline for the patient's current condition. By understanding how the patient is feeling at the start of the session, healthcare providers can evaluate the impact of their intervention or treatment. The fifth and final question is, "Is there anything specific you would like to discuss or address today?" This question gives the patient an opportunity to express their concerns, priorities, or any specific topics they would like to discuss during the session. It allows the patient to take an active role in their care and helps build a sense of self-efficacy. Overall, these five questions provide valuable information for healthcare providers to determine the direction of a patient's care. By asking these questions, healthcare providers can gather subjective information, assess progress, identify barriers, evaluate the effectiveness of interventions, and address the patient's priorities and concerns. Take a listen or check out the episode transcription below. If you're looking to learn more about our Lumbar Spine 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 00:00 DAVE FINKELSTEIN Alright, good morning to the PT on ICE Daily Show. I am your host today. My name is Dr. David Finkelstein and I have the pleasure of serving as a TA in the spine division. I am a TA in the cervical and lumbar spine management courses. The topic today is ask for directions. But before we jump into the topic for today, I wanted to highlight a few of the upcoming courses that we have in the spine management division. So on September 23rd, we actually have all three of our lead faculty leading courses that weekend. Zach is going to be in Henrico, Virginia at Onward Richmond. Jordan is going to be in Baton Rouge, Louisiana at Delta Physical Therapy. And Brian is going to be in Parker, Colorado at Onward Denver. So if you're looking to hop into a lumbar spine management courses, all three of those gentlemen are going to be running courses on September 23rd. If you're looking to jump into a cervical spine management course, Jordan is going to be in Brookfield, Wisconsin on July 22nd at Onward Milwaukee. Jordan will also be in Charlotte, North Carolina, August 26th at his home base of Onward Charlotte. And then Zach on September 9th is going to be in Roswell, Georgia at Onward Atlanta. So looking to jump into a cervical spine management course, those are going to be your next few opportunities in the coming months. All right, so let's jump in the topic today. The topic is called Ask for Directions. And the idea came from a conversation that I had with one of my coworkers. She was talking about one of her patients that seemed to plateau in their care, and she didn't know which direction to go in terms of directing her care. So when we're working with our patients, they're going to be giving us a lot of subjective information as the weeks go on. And my hope with today's podcast is to give you all some specific questions to ask your patients to know which direction that you want to go with their care. Right. So I have five questions that I want you to consider, and there were more prompts. So that way you can dive a little bit more into those questions as you ask them. All right. So question number one, how did you feel after last time? I love starting with this question because it helps us know how the patient felt with our intervention after our last session. Right. Usually our patients will say something along the lines of, I felt good. Don't accept that as your answer and then type into your documentation system and then move on. Right. We want to know how our intervention affected them. So you want to dive into that a little bit more. So when the patient says good, ask them, what does good mean? How good did you feel after last session? How long did that good feel for? Right. So that way we know how effective our intervention was. And if they did feel good after last time, that might be something along the lines of you want to increase the vigor, continue on with the dosage of, of what you did last time to help prolong that good sensation that they felt. Conversely, if they didn't feel good after last time, if they tell you, you know what, Dave, I actually didn't feel so hot after last time. I felt quite a bit worse. Don't panic. That's actually good news in a way because it helps you know that you were in the right place, but maybe your vigor was a little bit too much or maybe your dosage was a little bit too much. Right. Because if you weren't in the right place, their symptoms wouldn't have changed. Or conversely, they might've done something between the last session and your current session that also could have flared up their symptoms, unpacking it a bit more. Maybe John said, you know, I felt pretty good after last time, but then I mowed the lawn and then picked up a few boxes and then I did X, Y, Z. And then after that, I felt a little bit worse. So it helps you know exactly if it was your intervention or if it was something that they did afterwards. Right. It also helps you know if you establish their irritability correctly after the initial evaluation. So if you did your particular intervention, you thought they were low irritability and you intervene in an area and nothing really changed, you might want to consider going a little bit more vigorous into your examination or into your vigor to see if you can really elicit their symptoms. And then conversely, if they felt like really flared up after last time, maybe your vigor was a little bit too much and you overestimated their irritability. Right. So in both ways, that's a really good starting place when you ask the patient. So that first question is how did you feel after last time? Question number two, how did you progress towards X goal in our cervical and lumbar spine management courses? We talk about obtaining a subjective asterisk. Basically, that's something that the patient that's important to the patient that you want to measure, but you can't measure in the clinic. So what that looks like is how many times someone woke up in there in the night because of their pain or how long into their commute they're able to sit for before they have an onset of symptoms. Right. So if you ask them, John, how did you feel after or how are you progressing with your commute? And John tells you, you know what, Dave, actually, it's a little bit better because I was sitting for 30 minutes and then my symptoms came on and now I'm sitting for 45. So now you know that your intervention was effective because their commute increased. Right. Whereas conversely, if they say, you know what, Dave, after last time I was in my commute and I was only able to tolerate 15 minutes of sitting before my symptoms really started to act up a bit, then you know, once again, maybe it was that bigger or maybe it was that particular intervention that you did that was a little bit too much that that might have increased their symptoms a bit. So asking them how they felt with that specific goal, with their subjective asterisks that you obtained in the initial evaluation, seeing how they progressed with that. And also keeps those goals that are salient to the patient in the back of your mind that you continue to ask them in those follow up sessions. Right. So that's question number two. How are you progressing with X goal? Question number three, how often are you able to keep up with your exercises? I love asking this for a home exercise question as opposed to are you doing your home exercises? Because it's a little less judgmental. Right. If the patient didn't get to do their exercises, you're asking them from a place of curiosity as opposed to did you do your exercises? So when you ask the patient how often are they doing their exercises, it gives the patient opportunity to even tell you, you know what, Dave, I actually didn't. Wasn't able to keep up with those exercises. Don't judge them for not doing their exercises, but look at that as an opportunity to examine barriers to their adherence to their home exercise program. Right. So you can tell John, like John was up. How come you weren't able to do those banded external rotations? And they tell you, you know what, Dave, I just didn't have an opportunity to go out and buy the bands because I'm a little short on time and it did help after last time, but I just I wasn't able to go on by the band. So that way you now have the idea that the barrier was purchasing the bands. Right. So then you can change that exercise to a sidelined external rotation. We're holding a can of tomato sauce there. You're kind of taking out that barrier of buying a band. You got the stimulus that you wanted. And then you also taught John a way of creating a weight in his house using a can of tomato sauce. Right. So using that as an opportunity to identify a barrier. And then also, if your intervention was effective as far as a home exercise program. So take, for example, a patient with low back pain radiating down their leg. They say, you know, Dave, doing those prone press ups that you gave me, I felt pretty good for about an hour after you gave me that exercise. But then it kind of went back to baseline afterwards. And then you realize that you dose that out three times a day. You might consider asking John, hey, John, you know, you felt pretty good for about an hour after you did those exercises. What are your thoughts on maybe increasing that from three times a day to six times a day? You know, it might sound kind of aggressive, but in that way, you're increasing that dosage of that thing that was helping John. So now you're getting a good idea of how your home exercises are affecting your patient and then playing around with that dosage or that particular intervention. Right. So that question, once again, is how are you how often are you keeping up with those exercises? Question number four, how are you feeling today? Seems like a very basic question that we ask all of our patients. But I want you to think about why we're asking our patients that. We're asking that question to establish a baseline, how they feel right now. So that way, if we do some sort of intervention, that we know how it's changing their baseline symptoms. This is another opportunity that the patient might say, good, don't take that good as a as your answer. Tell them, like, can you unpack that for me a little bit? Tell me what what good means and then start to trace out their symptoms. See exactly where their symptoms are, how intense are their symptoms? So that way, when you establish that baseline, you feel really confident about the intervention that you did, whether or not it changed their symptoms for the better or it did. Right. Establishing that baseline. All right. So question number four, how are you feeling today? Question number five, I think, is one of the most important questions that we can ask our patients, but is often overlooked. So question number five is, is there anything you want to cover today? Talk about do that's really important to you. In that question, we're taking our hands off the steering wheel and allowing our patients to be in the driver's seat. We want our patients to feel a sense of self-efficacy in their care. And this is the best question to open that opportunity to know what's really important to them. Right. Maybe our patients will say, you know what, Dave, whatever you want to do today, I'm game for, which is fine. And then you continue on with that plan that you had. But your patients might surprise you and say something on the lines of, you know, Dave, I was actually thinking about it the other day that I don't really know how to get off the ground if I were to fall. And that's kind of in the back of my mind for a while. In that the patients opening up to being vulnerable and saying, hey, this thing is really important to me. What you don't want to do is ignore that and be like, well, sorry, John, you know, I had this other plan and I just want to proceed with it. We'll cover that in the next session. You want to cover the thing that's most important to your patient because it's going to help take that kind of fear, that concern out of the back of their mind. And then in addition to that, you're helping boost that therapeutic alliance by addressing that thing that's really important to them. Right. Nothing is going to tell your patient more that you're listening to them, that you're concerned about them than intervening in that thing that's really important to them that day. Right. So that question is, is there anything that you want to talk about or do today that's really important to cover in our session today? So those are the five questions I'm going to give you a quick recap. Question number one is, how did you feel after last time to know how your intervention affected their particular symptoms? Question number two is, how are you progressing with X goal? Recapping back to their subjective asterisk, making sure that you know exactly what's important to them and how that's progressing or not. Question number three is, how often are you keeping up with those exercises so that way you can identify barriers to their adherence to their exercise program in addition to knowing how effective your home exercise program actually is? Question number four is, how are you feeling today? Knowing the back of your mind that you want to establish a baseline so that way you know how your intervention is affecting the patient. And then question number five, once again, really important to ask our patient, is there anything important that you want to cover, talk about, do today that would be beneficial? Right. So give those questions a thought. Try that out. Keep in the back of your mind why you're asking these questions and then diving a little bit more. Let me know how it goes. Shoot me a message in the comments section. I love talking about this stuff. I love the conversational piece and the Therapeutic Alliance piece of patient care. If you're looking for more opportunities to jump to some courses or see some of our free resources, go to PTNICE.com. Check us out. Everyone, thanks for giving me some of your time and have a wonderful morning. 14:07 OUTROHey, 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 PT on ICE dot 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 PT on ICE dot com and scroll to the bottom of the page to sign up.  

Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today’s episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick discusses the obturator internus muscle and its role in pelvic floor and hip conditions. She highlights the importance of understanding and addressing this muscle for effective treatment. Take a listen to learn how to better serve this population of patients & athletes. 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. EPISODE TRANSCRIPTION 00:00 INTRO What’s up everybody? We are back with another episode of the PT on Ice Daily Show. Before we jump in, let’s chat about Jane for a moment as they are our sure sponsor and they make this thing possible. The team at Jane understands that payment processing can be complex, so they built in an integrated payment solution called Jane Payments to help make things as simple as possible so you can get paid. If you’re looking for an easy way to navigate payments, here’s what we recommend. Head over to jane.app slash payments, book a one-on-one demo with a member of Jane’s support team. This can give you a better sense of how Jane Payments can integrate with your practice several other popular features that Jane Payments supports, like memberships with the option to automatically invoice and process your membership payments online. If you know you’re ready to get started, you can sign up for Jane and make sure when you do, you use the code ICEPT1MO as that gives you a one-month grace period while you settle in. Once you’re in your new Jane account, you can flip the switch for Jane Payments at any time. Let the Jane team know if you need a hand with anything. They offer unlimited support and are always happy to jump in. Thanks everybody. Enjoy today’s PT on ICE Daily Show. 01:29 APRIL DOMINICK Good morning PT on ICE Daily Show. Dr. April Dominick here. I am your host and I will be continuing our conversation on pain in the butt, this time with a spotlight on the obturator internus muscle. The obturator internus is a persnickety hip muscle that is housed inside the pelvis and it contributes to quite a few pelvic floor and hip conditions. So before we dive into that, I just want to give you all some updates from our ICE Pelvic Division. If you didn’t catch our big news from our newsletter that we sent out last week, we week online course that is going to cover advanced pelvic health concepts and it’s coming January 2024. So make sure you hop onto pdniice.com, check the resources page and get yourself signed up for our pelvic health newsletter for all things research oriented. And our next level one online cohort starts September 5th. So be sure and hop on to that course. And then you can catch us live for our two day course on the road next week and actually we will be here in Denver, Colorado. That’s July 29th and 30th with Dr. Alexis Morgan and myself. We’ll have a jam packed course for you. Our lecture will focus on all things pregnancy and postpartum. For the fitness athlete, labs will go over all internal external assessment of the pelvic floor with a option for video learning if that assessment does not sound like it is for you in terms of the internal piece. Other labs will cover management of C-section scar, diastasis recti, core work on and off functional barbell lifting, endurance including running, all sorts of fun fun stuff. So there are still a few seats available for that course if you want to come hang out with us and if you aren’t able to make it to the Denver course we’ll be in Sedona, Arizona and that’s going to be September 23rd and 24th with Christina Prevot and Dr. Rachel Moore. So if you missed it two weeks ago we chatted about another kind of pain in the butt, one that was focusing on a bony structure, the tailbone. It’s episode 1505 if you want to slide back and catch that. But today we’re going to focus on the soft tissue muscle or cause of the pain in the butt, specifically the obturator internus or I love abbreviations so I may call it the OI during today’s episode. So if you, the listener or if you have a client who has some sort of hip pain that seems difficult to pinpoint, they’re having trouble telling you where it’s at maybe because of where it’s at they may be kind of pointing in the nether regions or they might be headed up near the and you’re like, oh I don’t deal with that stuff or they may point just at the ischial tuberosa and you’re like, oh thank goodness, hamstring strains, I can deal with that for sure. But maybe you throw everything you have at it, your hip mobility exercises, your strengthening exercises and it’s just not getting any better. Well I encourage you to consider my friend the mysterious obturator internus muscle as that may be influencing some of that hip pain that you or the client has. So we’ll chat about the obturator internus’ unique anatomy, its functions, other competing soft tissue contributors as well as certain conditions or maybe client reports to be on the lookout for that may be influenced by this muscle. I love history so the word obturator actually originates from the Latin word obturo which means to stop or block up. This lines up given that the obturator muscle actually covers the opening of the obturator for Raymond. So this, the location of the obturator, it’s a big old hunk of hip muscle that lives on the front and side of the hip. So for those listening, I’m holding up my pelvic model, we’re looking at the pubic bone and going just lateral to it and there’s a, I like to think of it like they’re two skull eyeballs, but anyways, there’s a big old hunk of muscle that’s in red here and that is the belly of the obturator internus. And then it has this really cool tail that actually whips out and takes a 90 degree turn to then connect onto the top of the femur or the top of the leg. Due to this unique deep parking spot within the pelvis, it can affect both the function of the pelvis and, or pelvic floor and the hips. So in terms of function, we’ll go over three major functions of the obturator internus. Number one is it can externally rotate the hip when the hip is extended. So like when you’re standing, it can abduct the hip when the hip is flexed or when your leg is raised up like you’re marching. And then it also has a key role in stabilization of the femoral head or the leg into the acetabulum. So especially during weight bearing and propulsion. Based on a study in 2017 that looked at female cadavers, the, they, I love the phrase that they used in this article, they called it the architectural design of the obturator internus is affected by aging. In that, in their study, they found after the age of 60, both the force generation capacity and the fibrotic nature of the OI muscle is reduced. That’s so interesting. And what they suggested in that article was maybe we should be focusing a little bit more on functional upright movements that have the leg and weight bearing as that tends to be when the obturator internus is more in a shortened position. So maybe we can generate some greater functional capacity and strength in that position versus our typical non-weight bearing exercises like maybe a clam. In terms of impairments, the OI will often step up to the plate and compensate to stabilize the pelvis when other muscles like the glutes or abdominals are a little on the weak side. You can also develop just like any other muscle, any sort of muscle banding, knots, and it rare if it’s rarely lengthening or relaxing. And so all of that is definitely going to result also in some reduced range of motion and then reduce blood flow to this muscle, to this area and its surrounding nerves will definitely contribute to a cranky OI, which then may lead or lend towards hypersensitivity when that OI muscle is palpated. And we can palpate it externally near the ischial tuberosity as the obturator internus actually lies just on top of the ischial tuberosity, similarly to how the subscapularis lies on the underside of the scapula. So it has that similar kind of bony muscle contact. Or you can palpate this muscle intra-vaginally or interactively. And there are so many times during my sessions, if I’m doing a pelvic floor assessment and I roll over to the obturator internus that the shock and maybe relief of the person on the table is paramount. They’re like, oh my goodness, that’s the pain that I have during deep penetration. Or that actually just brought on some urgency for me, some urinary urgency. That’s the feeling that I get randomly. Or that’s the pain that I have when I’m sitting and it’s been hard for me to describe it to you. So it’s super powerful being able to palpate this muscle and just help bring some validation to your client who’s like, I just don’t know where this pain is coming from. And then due to its many functions and that unique anatomical location, the OI is capable of referring to lots of areas. So sometimes it’ll kind of act like a chameleon. One day, you know, it’s referring pain to the hip. Maybe one pain is referring pain if someone’s pregnant to the round ligaments. So other soft tissue areas that you should be screening if you’re looking at the obturator internus muscle would be the hamstrings like we talked about, the adductors, big, big relationship between obturator internus dysfunction and then the pelvic floor, specifically the levator anion muscle group, as well as the coccygeus. And then not to mention just muscle structures, but another nerve structure that would be super helpful to have on your hypothesis list that may be affected if the OI is cranky is one of its best mates, the pudendal nerve. So the pudendal nerves is going to support sensation in your urethral and anal sphincter function. So along its path, the pudendal nerve is actually surrounded by some obturator internus fascia. And that goes along alcox canal, which is on the border of the obturator internus. And it provides a really large opportunity for entrapment of that pudendal nerve, which then could lead to some possible pain and dysfunction. So the obturator internus, I like to think about it like a nosy aunt who has her nose in everybody’s business and the family, all the hot goss. So because of that, it is involved in so many different conditions. And these are a few things that you may hear from your clients in terms of aggravating factors. So they may talk about, hey, I just have this ton of discomfort when I sit for a long time. Or I just got my peloton and I actually have a lot more discomfort now because I’ve been cycling quite a bit. And we’re saying this, but maybe you will have already screened out the tailbone. deep penetration or sexual play like I chatted about. And painful or tight hips, urinary urgency, frequency leakage, SI joint tenderness, difficulty or difficulty with description or pinpointing some sort of pain or pressure that’s deep within the pelvis, deep within the vagina. Or sometimes people will often say, I have pain that is, it just feels like I have a golf ball in my rectum. So these are all things that I want you to keep in your mind when maybe thinking about could this be the obturator internus muscle. From a trauma standpoint, the OI can be injured in posterior hip dislocations, again, just because of where it’s at with from an anatomy standpoint. It can also be involved in acute or overuse strains from sports like kicking, tackling or falling. Falling, usually this is in young males. And then sometimes the obturator internus can be strained in conjunction with adductor longus strains. So in summary, if you have clients that are coming to you that are describing some pain up in that region where you may not be used to screening or palpating for in the nether regions and they point towards this yield tuberosity and you’re like, just stay there, don’t go higher. I want you to think about thinking outside of the hamstring adductor strain box and be sure to include the obturator internus in your hypothesis list. Due to its unique anatomy of living inside the pelvic bowl, but shooting a little leg out to the side or a little tail out to the side to attach to the femoral head, the obturator internus muscle is sneaky. It’s involved in so many different pelvic and pelvic floor and hip conditions. We talked about pain with intimacy, prolonged sitting, bladder urgency, frequency, just to name a few. And if this is describing your hip pain or if you’re dealing with a client who isn’t responding to traditional PT, consider reaching out to your local pelvic health PT to help screen for pelvic floor dysfunction. I actually have a really close relationship with a lot of the ortho-PTs in my area who don’t have an interest in treating the OI, but they’ve learned how to screen for it from me and they now refer out to me and nine times out of 10, they are spot on with calling that obturator internus as being a contributor to their client’s pain. And then better yet, for the PTs out there, come on out to our live course so that you can learn how to palpate and master and learn techniques for external and internal palpation and treatment of the muscle. So learning how to screen for this muscle will be such a game changer for successfully your clients with this hip and pelvic pain without you needing to refer out. Thank you all so much for being here. We appreciate you. Hopefully you don’t have any pain in the butts on the schedule, but if you do, at least you’re armed now with which other sneaky muscle that could be contributing. Happy Monday and I’ll see you next time.  17:02 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.

Alan Fredendall // #FitnessAthleteFriday // www.ptonice.com  https://pubmed.ncbi.nlm.nih.gov/34852731/ https://pubmed.ncbi.nlm.nih.gov/33630675/ https://pubmed.ncbi.nlm.nih.gov/32023545/ https://pubmed.ncbi.nlm.nih.gov/34770213/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493260/  https://pubmed.ncbi.nlm.nih.gov/31869820/  In today's episode of the PT on ICE Daily Show, Fitness Athlete division leader Alan Fredendall defines heat-based recovery including hot tubs, whirlpools, and saunas. Take a listen to learn how to discuss cold plunging with your patients or athletes. If you're looking to learn from our Clinical Management of the Fitness 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 00:00 INTRO What's up everybody? Before we get rolling, I'd love to share a bit about Jane, the practice management software that we love and use here at ICE who are also our show sponsor. Jane knows that collecting new patient info, their consent and signatures can be a time consuming process, but with their automated forms, it does not have to be. With Jane, you can assign intake forms to specific treatments or practitioners, and Jane takes care of sending the correct form out to your patients. Save even more time by requesting a credit card on file through your intake forms with the help of Jane Payments, their integrated PCI compliant payment solution. Conveniently, Jane will actually prompt your patients to fill out their intake form 24 hours before their appointment if they have not done so already. If you're looking to streamline your intake form collection, head over to jane.app slash physical therapy, book a one-on-one demo with a member of the Jane team. They'll be able to show you the features I just mentioned and answer any other questions you may have. Don't forget, if you do sign up, use the code ICEPT1MO for a one month grace period applied to your new account. Thanks everybody. Enjoy the show. 01:32 ALAN FREDENDALL All right. Good morning, team. Welcome to the PT on ICE Daily Show. Happy Friday morning. Hope your Friday's off to a great start live here on YouTube and Instagram, everywhere you get your podcasts. My name is Alan. I'm happy to be your host today. Currently have the pleasure of serving as the chief operating officer here at ICE and a lead faculty in our fitness athlete division here on Fitness Athlete Friday. We consider it the best start day of the week. We talk all things CrossFit, Power Lifting, Olympic Weightlifting, endurance athletes, running, swimming, cycling, all that sort of thing. So if you're interested in working with the recreationally active patient or client, Fridays are for you. We're going to talk all things heat based recovery today. We spent two weeks ago talking about cold based recovery. So it'll be a nice change of pace on the opposite side of the spectrum. Before we get started today, first of all, I want to say big thanks to our friends at FIRE, Foraging Youth Resilience for having Jeff, our CEO, and myself out this week to their annual camp outside of Boulder, Colorado. Huge fun getting to know a lot of the kids, the campers, as well as a great network of coaches, games athletes, all sorts of wonderful people from the CrossFit space coming together to help support FIRE. It was great to meet everybody out there. If you want to learn more about FIRE, you can read more on their website. We're big supporters of FIRE here at ICE. So you'll continue to see us have more opportunities to help get involved with FIRE and support FIRE as time goes on. Some courses coming your way from us in the fitness athlete division. If you're looking to catch us out on the road for clinical management in the fitness athlete live, that's our two day live seminar. Your next chance will be September 9th and 10th. That's going to be out in Bismarck, North Dakota with Mitch Babcock. And then you can catch the same month at the end of September, September 30th and October 1st out on the west coast. Zach Long, aka The Barbell Physio, will be out in Newark, California. That's in the Bay Area of California. And then online, our clinical management fitness athlete essential foundations, our eight week online entry level course into the clinical management fitness athlete curriculum. That will start September 11th. That's taught by myself, Mitch Babcock, Kelly Benfee and Guillermo Contreras. And then the next week after our level two online course, clinical management fitness athlete advanced concepts start September 17th. So you can learn all about that at ptenice.com. That's where everything lives that you want to know about ice. So today's topic, heat based recovery. We have talked about cold based recovery, specifically two weeks ago here on fitness athlete Friday. We talked everything regarding cold plunges and cold based recovery. We're going to go to the opposite side of the spectrum now and talk about heat based recovery. So the big summary from if you didn't catch us two weeks ago, the big summary from cold plunging is that we really want to avoid it after exercise. It seems to really have an effect on that post exercise inflammation effect that we want to build strength, build hypertrophy. It does have some benefits, but we mainly want to avoid it after exercise. You're going to see a recurring theme here with heat based recovery. But I do want to start by first of all, defining what is heat based recovery, talking about the differences between things like hot tub or whirlpool. Differences between you may have questions about infrared versus traditional sauna. And then I want to talk about some of the research supporting the use of heat based recovery, but also the application of it both in the clinic. And when you're discussing these topics in the clinic or the gym with your patients or athletes. So let's start first by defining it. What is heat based recovery? We have a couple different types. The first is what we'll call hot water immersion. This is basically the opposite of cold water immersion or cold plunging. This is where you get in a hot tub or a hot bath or a whirlpool machine, some sort of hot water immersion. Now defining temperatures here is really important. We did that two weeks ago with cold water immersion. Really important to note that at least from the research, we have specific temperature ranges that we're discussing with all of these modalities. And we're also assuming that you have your whole body immersed in something like a sauna. Or that if you're in hot water, for example, a hot tub or a hot bath, you're immersed at least up to the level of your neck. A lot of what we're going to talk about doesn't apply to you if you're somebody that just sticks your your foot in the hot tub. Or doesn't otherwise get fully immersed in whatever modality you're using. So two different types of hot water immersion, hot tub or hot bath. When we're at home and we run a bath, when we look at what is the temperature of what the average human being might consider quote-unquote hot. A hot bath is right around 100 degrees Fahrenheit. And that your average hot tub is not too different. A hot tub that you might get into is going to be somewhere between 100 to 110 degrees Fahrenheit. But now when we look at this from a research perspective, it's usually tightly controlled and it's usually tightly controlled a little bit hotter. So when they look at hot tub whirlpool type immersion in the research, they're looking specifically at a temperature range of about 110 to about 120 degrees Fahrenheit. So if you're somebody that really hates a hot bath, if you run a hot bath and you wait for it to cool down a lot, then just know this is going to be on the upper end of your temperature comfort. Why this matters is that when we add that that circulating bubble component to a whirlpool, to a hot tub, it seems with the water continuously moving that it makes that hot water immersion just a little bit more tolerable and therefore they bump the temperature up a little bit. Again, 110 to 120 degrees Fahrenheit. And again, immersion in a hot tub whirlpool up to the level of the neck. Now duration is really important. We talked about that with cold plunging. That if you're somebody that gets in for a minute, you probably don't have to worry about the positive or the negative effects because you're really not doing it. The same is true here. When we look at hot water immersion, when we talked two weeks ago, we talked about humans have a really great tolerance for heat at rest. We can sit outside 70, 80, 90, maybe even 100 degrees, especially if we're in some shade and we can be okay. We don't have a great tolerance for cold at rest. And we see this carry over into hot water immersion that because we're so much more tolerant to heat, we see duration for hot water immersion a lot higher. We often see duration 15 to 30 minutes in a whirlpool in a hot tub. Maybe you've been at a hotel or a resort or something. You've seen that sign. We've all seen that sign on the hot tub. You know, don't stay in here too long. Max time 20 minutes, 30 minutes. That tends to be our tolerance for hot water immersion. So somewhere between 15 to 30 minutes, but definitely longer than what we're used to seeing with cold water exposure where the general recommendation usually never exceeds 10 minutes. Now getting into sauna, temperatures are going to go up. We're no longer actually sitting in water. We're usually sitting in a room that is either steam heated or dry heated. Those also have different temperature parameters when we look specifically at how they're studied in the research. Traditional sauna, whether it's dry or a steam sauna, is a lot hotter. 150 to up to 220 degrees Fahrenheit. Infrared sauna is going to be lower, 120 to 140 degrees Fahrenheit. And again, the duration for sauna is going to be higher, a lot like hot water immersion. Somewhere between 30, maybe even to a 90 minute dose, and that's going to be mostly for infrared sauna. That would be really tough to do in a traditional sauna. So that's how we define hot water immersion and also what we would call just sauna, sauna protocol, traditional or infrared. Now the research. I want to share a couple of different papers with you as we get into talking about what does the research support? What does it not support? Talking back to hot water immersion. So again, our hot tub or our whirlpool protocols. A great paper from 2022, the Journal of Sports Science. More and more Gamino and colleagues, pardon me butchering that, looking at hot water immersion. They took folks and they had them sit in a whirlpool for 15 minutes at 110 degrees Fahrenheit. They also had another group sit in a cold plunge at 50 degrees Fahrenheit and they compared outcomes on the quadriceps muscle. They wanted to look at specifically the contractile properties of the muscle itself and found that the group sitting in the hot water after exercise had increased contract properties of the quadricep muscle compared to the folks who did cold water immersion and compared to the folks who did nothing, who sat at a room temperature room. So the the effects of hot water immersion appear to have a more beneficial effect on our muscle and we'll get more into that as we get more into the research. My next paper, really old. I love some of these old papers that just show how long we've been studying this stuff. Francisco and colleagues back from 1985, so before I was even alive, Journal of Applied Physiology. Looking at the use of hot water immersion and comparing it to basically an active recovery protocol. So two groups of subjects, one group exercising at 60% of their VO2 max. So essentially an active recovery spin on a cycle or a really really really low slow jog, something like that. To a group that did an hour in a whirlpool at 105 to 110 degrees Fahrenheit. And then they did a crossover here. So they took both groups and then flipped them a couple of days later and had them repeat the same thing. What they found in the group who sat in the hot tub for 60 minutes is they had an almost identical cardiovascular change. So they had an increase in their cardiovascular output and their mean arterial pressure, which just kind of tells us that there is a cardiovascular demand on the body when you are exposed to heat that mimics low-level active aerobic recovery type exercise. So what does that tell us? That tells us that first of all if we are looking for a recovery day that a longer hot water immersion or maybe a sauna can be a viable option in place of a recovery workout that we're going to get some increased cardiac output. Our heart rate is going to elevate. We know being exposed to heat we're definitely going to sweat. That's going to come on board no matter what. But we're going to see blood pressure changes as well. That tells us we're kind of getting a flushing pumping effect when we're exposed to heat specifically in this study hot water immersion compared to if we went to the gym and just spun on our bike or went for maybe a really long walk or a really slow jog or just some sort of active recovery exercise that they appear about equal. Which is great if that's what we want. If we're trying to limit cardiovascular load, if we're trying to limit volume on our body then we need to be mindful that a longer duration hot water experience can have that effect on us. So it appears to be about an equal effect, which is nice. The next study here, Borg and colleagues from 2020, the International Journal of Sports Physiology and Performance, looked at hot water immersion versus cold water immersion versus control. Specifically they had these folks do these modalities after cycling in what they called hot weather, 75 degrees Fahrenheit. So they went for a long bike ride in the heat and they came back. They threw one group in cold water immersion in the cold plunge. They threw one group in hot water immersion, a whirlpool, and one group just sat at room temperature. And they found that those exposed to the hot water immersion were more likely to report that the session they had just performed, the cycling session in the heat, was easier. And they also had a lower cardiovascular response to those who had a cold water immersion. So it seems like when we're cooling down we want to choose heat as it's easier on our body, easier on a cardiovascular system than finishing a hot workout in the heat. It sounds great. We've all had those workouts. I just had one two weeks ago where we literally want to stick our head in the sink, which is exactly what I just did, and just cool down our head. That seems like what we want to do, but we know that can have sort of a shocking effect on the body compared to if we ease ourselves out of the heat with maybe not exactly what we just did in the heat, but we choose something that's going to feel temperature neutral compared to what we just did, which was a really tough workout in the heat. Heat exposure after exercise, especially in the heat, seems to have a beneficial effect as we're trying to cool back down to baseline. Now switching gears and looking at the sauna research. So this is just as popular as everybody wants to know about cold plunges. Everybody wants to know about sauna protocols. If you listen to anything about Andrew Huberman, you have been blasted with more information than maybe you've ever wanted to know about the sauna. But I want to pick just a couple papers here looking at sauna exposure, specifically after exercise. So Bezoglav and colleagues 2021 International Journal of Environmental Research and Public Health. This is a great study. This doesn't actually research anything on sauna protocols itself. I love this study. This is basically a patient expectation, an athlete expectation of what athletes expect will help them recover and what they actually choose when they are performing their recovery. And it's just really important to know this paper in the back of your head. That 97% of athletes surveyed use sauna as their number one choice for recovery. So that's really important for us to know. We have to be able to speak intelligently about good, bad pros, cons about sauna with our athletes knowing that 97% of them are thinking I'm not feeling great. I'm feeling banged up. I am going to choose sauna as my number one recovery protocol. And we know this from physical therapy research. Massage is also popular. Not surprising. It's popular with athletes. 87% of athletes choose massage as their secondary recovery protocol. And then 80% choose taking a nap, third. So in that order, sauna, massage, and napping. So that's a really important paper to know. Miro and colleagues from 2015 in Springer Plus. This is an online open access journal. Looked at comparing folks doing infrared sauna, traditional sauna, after performing either hypertrophy focused resistance training for 60 minutes or endurance training. So they basically wanted to create a bunch of muscular damage and then have folks either get in an infrared sauna or traditional sauna. This study also had a crossover design. So the objective outcome here was a counter movement jump test and then also effects on the cardiovascular system. So that traditional sauna was performed at 122 degrees Fahrenheit for 30 minutes. The traditional sauna was performed at 70 degrees Fahrenheit for 30 minutes. And again, both groups exercise really hard for an hour. The traditional sauna group saw a reduction in performance on the counter movement jump after sauna protocol compared to the group using the infrared sauna. The traditional sauna group also had a significant spike in their heart rate. About 30 to 40 more beats per minute resting while sitting in the traditional sauna than the group sitting in the infrared sauna. So again, like we talked about a couple papers ago with environmental exposure, it seems like using sauna, specifically a really hot traditional sauna after exercise, seems to have a negative impact on our system. Of it's just too much heat load, it's too much cardiovascular load. It can lead to both negative performance outcomes, but also negative physiological outcomes. Supporting that, Skorsky and colleagues from 2019 International Journal of Sports Physiology and Performance. This group was looking specifically at performance. They had swimmers perform 4x50 meter sprints. I don't know anything about swimming. I assume that's a tough thing to do to do 4x50 sprints. Afterwards, the swimmers were either put in a group where they sat passively at room temperature. For 25 minutes or they did three eight minute rounds in the sauna, a traditional sauna at 185 degrees Fahrenheit. And then they had those athletes come in the next day and repeat the 4x50 swim performance. All of the subjects who used the traditional sauna after the sauna reported a stressful experience, both physically and mentally. And then the next day all of them had impaired performance when they went to repeat the 4x50 swims compared to the group that sat at control. They obviously did not report sitting at room temperature as a stressful experience. And they all performed better at the 4x50 than the sauna group. So it appears that longer duration, hotter traditional sauna seems to have a more negative impact on recovery. So what does this tell us? What does all this research tell us? How can we apply this with our patients, with our athletes, when they're asking questions about sauna? Maybe they're already using a sauna protocol. So as we talked about two weeks ago, cold water immersion, cold plunging appears to have a really negative impact on performance and recovery when used directly after exercise. Compared to hot water immersion, whirlpool, hot tub used after exercise. And it also really seems to affect our ability to adapt to the heat. So the takeaway here is that if we're just finishing exercise, maybe traditional sauna, especially for a longer duration, especially for a higher heat duration, is maybe not the modality of choice. Just like a cold plunge is maybe not the modality of choice. Which is not to say we can't use heat as recovery modality. But if we're thinking we just finished training, we should look towards that hot tub. We should look towards that whirlpool. We should maybe look towards that active recovery. And we should save a really long, hot traditional sauna or a cold plunge for maybe before training earlier in the day. Or what we don't have research on yet is what is that window? How much time difference between training and using a really hot sauna or using a cold plunge is still going to allow us to feel better recovery wise but not have those negative effects on performance. We don't know that yet. But for now what we can recommend is stay away from that cold plunge. Stay away from that really hot, long duration traditional sauna about right after training. Give yourself a gap. Again, we don't know how long. Or do it earlier in the day sometime before you actually start your exercise protocol. We do know that both hot water immersion and infrared sauna offer cardiovascular effects that are similar to active recovery. So if we really are not feeling like exercising today, if we're really feeling like we need a day off, we can still have some positive health benefits from going and getting in the sauna. Especially something like an infrared sauna or sitting in a hot tub for maybe 10 to 30 minutes. But we really need to consider avoiding that long duration traditional sauna. It appears to have a big effect on our cardiovascular system. It's adding a training load. It's adding a heat load to our body that's going to cause our body to need to adapt to that stress. So big term takeaways. There's no shortcut, right? What we're seeing in the research with both cold water immersion and hot water immersion, there's no shortcut here. We need to allow the body's natural inflammatory response to the exercise that we just did occur if we want to reap the benefits of that occurring. Yes, these things can help us feel less sore. Yes, they can help us feel less fatigued. But if we use them too much, they do seem to have a long-term detrimental effect on our performance. Which kind of defeats the purpose of going in and doing a hard workout, a long run, a long bike, a long CrossFit session, a long weightlifting session, whatever you're doing. If we chronically use these things, yes, we might feel better. But we need to be concerned that maybe we're leaving something on the table as far as strength, as far as hypertrophy when we use these kind of extreme temperature modalities, cold plunging, really really hot sauna. I could imagine that one study that showed a really detrimental effect was only 185 degrees. Some traditional sauna protocols in the 200s. I know Jeff Moore does the sauna at 205 degrees, I think for 15 minutes, which is even more of a heat load than 185 degrees. So just be aware of that and understand how to speak about these things with your patients and athletes because they're going to have questions about it. Remember that paper? 97% of people look to sauna is the first choice for a recovery modality and then massage and then taking a nap. So 97% of people could use probably more education on sauna because we know they're thinking about using it. So I hope this was helpful. We have an entire week in clinical management fitness athlete essential foundations dedicated to this now. We talk all things nutrition, sleep, we talk cold water immersion, hot water immersion. We also talk about compression therapy. So things like massage, massage guns, cupping, all that sort of thing. We discuss all of that research that your athletes, your patients want to know about when they come into the clinic and ask about recovering from exercise. So I hope you have a wonderful Friday. I hope you have a fantastic weekend. Thank you for joining us. Have a good day. Bye everybody. 22:33 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 CU's 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 Moore // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE CEO Jeff Moore discusses that the decision to innovate or imitate is a career-defining choice with long-term implications. The host emphasizes that while collaboration and sharing of ideas are common in any field, blatant imitation is detrimental to one's career. The host distinguishes between collaboration and imitation, stating that imitation involves repeatedly hijacking other people's logos, sayings, or content. The episode provides three reasons why being an imitator ensures a mediocre and short-lived career. Firstly, the process of creation, coming up with something new and contributing in a unique way, is described as the most invigorating aspect of any career. The host emphasizes the satisfaction and impact that comes from thinking differently and having others benefit from one's novel ideas or techniques. Secondly, the episode highlights the importance of authenticity in career success. The host suggests that imitators may experience imposter syndrome because their success levels do not match their actual contribution. They are described as grabbing ideas from others, recognizing what will resonate with their audience, and building their business without truly creating or going through the challenges that lead to breakthroughs. The more their success grows without a true contribution, the greater the asymmetry and imposter syndrome. Lastly, the episode emphasizes the value of continuous creation and innovation for a long-lived and energetic career. The host encourages listeners to keep creating and strive for novelty and harmony in their careers. It is emphasized that the decision to innovate or imitate is a defining one, and individuals should aim to put forth their authentic selves rather than copying someone else's. Overall, the episode argues that choosing to imitate instead of innovate can lead to a mediocre and short-lived career. On the other hand, embracing innovation and creating something new is described as invigorating, authentic, and essential for long-term success and fulfillment. Take a listen to today's episode. 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 00:00 JEFF MOORE Alright team, what's up? Happy Thursday, welcome to the PT on ICE Daily Show. I am Dr. Jeff Moore, thrilled to be your host, currently serving in the role of CEO here at ICE. It is Thursday, which means it's Leadership Thursday, but it also means it's Gut Check Thursday. Let's talk about the workout. This is going to be familiar to a bunch of you. So this is the workout from the CMFA Essential Foundations Course 21-15-9 Deadlifts Bar Facing Burpees. Quick, painful. Go get some of that. Post your time, post ICE Physio, hashtag ICE Train, hashtag Gut Check Thursday. It's a classic workout, we've done it a lot. It's a really nice benchmark one to challenge yourself in that kind of middle distance, high intensity space to keep coming back to every year and see how your fitness is evolving. So give that a shot. 21-15-9 Deadlifts and Bar Facing Burpees. Upcoming courses, I want to highlight Modern Management of the Older Adult Live because we've got a ton of options. So if you're trying to become the fitness for provider for your older adults in your community, you've got to hit the MMOA Live course. This weekend, they are in Watertown, Connecticut. Next weekend, July 29th, 30th, they are in both, Waukonson's, Georgia and Meridian, Idaho. That'll be the first, that's in Boise. That'll be the first course, I believe, at Onward Boise. So go get some of that. And then August 5th, 6th, they are at Onward Physio in Frederick, Maryland. Important to note, August 12th, 13th, they are in Lexington, Kentucky, and that is at Stronger Life, and that is the MMOA Summit. So if you want to meet all the MMOA faculty, they're going to be at that one course, August 12th, 13th, and that's at Stronger Life. So if you want to see the Stronger Life operation that Dustin and Jeff and the crew have been building out in Lexington, that is a really, really cool opportunity to kind of see behind the curtain and meet a ton of faculty. So go check out those courses. That's Older Adult Live on the road everywhere. So go get some of that action. Innovation or imitation, the career-defining decision. That's what I'm calling this episode. And I am not saying that lightly. I think if you really zoom out, and if we're talking leadership here on Thursday and thinking about looking long, long term at your career, if you decide to innovate or if you decide to imitate is probably the great decider. I mean, let me tell you the three biggest reasons why. But let me first note that we're not talking about sharing ideas, building off of each other, sharing techniques. There is a very reasonable amount of collaboration that is not copying an imitation. We're talking about blatant imitation, right? Where you know who you are, that you're hijacking other people's logos or sayings or content on the regular, right? Over and over again. I mean, if you scroll your feed, it's like you're obviously doing this. You've probably been reached out to. And then on the other hand, many of you probably have your own imitators, right? Where you look and you're like, gosh, that person's always taking my stuff and trying to put a very lame or benign twist on it. But it's pretty obvious what's going on. That's what we're talking about. Being that person, being in a position where you've got that person tailing you, we're going to unpack both sides of it. There's only one line on being imitated, many lines on being the imitator. So three reasons why being an imitator ensures a mediocre and short lived career. Number one, creation. Coming up with something new. Feeling like you really contributed because you saw something a different way or said something a different way and other people legitimately benefited that would not have if you didn't create that process is the single most invigorating thing in any career. That process of thinking differently, of contributing something novel, of having somebody come up to you and say, Hey, because you said it that way, things have really gotten better for me. I hadn't heard it like that. I hadn't thought about it like that. I have not used that technique. And now because you did that, things are better off in my sphere. That process of creation is the single most rejuvenating thing in any area of business. When you look at entrepreneurs, you look at people who are constantly high energy, are constantly seem to be thriving. It is largely because they're tapping into that creation energy on the regular and it gives back three times what you give it. That process of doing things novel and useful is what extends careers. It's what makes careers exciting. It would make it so it makes you get up in the morning and be absolutely beside yourself to dive into that next project. It's what builds anticipation for the next year of business. It is all of the things that constantly give you energy back that make burnout sound like a ridiculous idea because you couldn't imagine ever wanting to stop riding that train of creation. Creation is invigorating. And if you're copying, you're not creating. So you're never getting that energy back. And there is simply a timeline for how long you can go without it. Number two, this is the one that people don't see when they feel like taking other people's ideas is a viable way to continue their business. It's not. And this is why you can't build on a foundation you didn't pour. I'm not saying you can't go take the idea and put it on your platform and get a few likes. You can do that. You can get a short term bump in your business. There'll be plenty of people who didn't know you did it. Like you can do that, but you can't build on it. One breakthrough and by breakthrough, I mean the process of the breakthrough. When you were thinking about a certain idea and you realize in the moment, hold on, there's a better way to do this. There's a better way to say this. There's a better way to build this. That process, that breakthrough, having that moment changes you. Like it really changes you because not only will everybody that you told think a little bit differently or be able to use it novelty, but you changed because your mind saw a different pathway. That change is what's required to make you different, to see the next thing. When you're going through the hard work of trying to make something better and having that breakthrough, that process of when it happens is what allows you to see the next one because you're now different for having had that breakthrough. If you're just hijacking ideas all the time that sound good or look good or think might get you some business, you're not actually changing. You're not developing. You're not going through those breakthroughs. So you're not going to have the next one or the next one. So pretty soon your only option is imitation because you're not doing the work of creation. You can't build on a foundation you didn't pour. Other people's ideas being on your platform does not make them yours from the sense of you are not different for having come to them. So there is no way now that you're going to be able to go from there because you didn't even really get there. So think about how hijacking that process prevents your ability to look even further. The final one, and I don't speak all that much on this topic because it kind of annoys me, but it's important to acknowledge this is where imposter syndrome I think actually comes from. The worst cases of what you would call imposter syndrome, a complete lack of authenticity in an individual in a certain position that maybe didn't earn it, you can kind of feel that, that case of imposter syndrome, the worst cases are when somebody's, and I'm those listening on the podcast, when somebody's success levels don't match their actual contribution, and this is the case of the imitator, right? So somebody who's grabbing ideas from other people and they're catchy ideas, right? They're good at recognizing what's going to resonate with their audience, grabbing ideas from other people, putting them out on their platform, never really creating, never really never going through kind of the trough of challenge that leads up to a breakthrough, never experiencing that, just hijacking ideas and quote unquote building their business. The more their success grows in the absence of a true contribution, the greater that asymmetry, the greater the imposter syndrome. And the problem is the momentum only goes in one direction because like I said, once you start imitating, you're no longer changing, so you can't make the next step forward, so you're never going to. So all you're going to wind up doing is put yourself in a position where people think that you know a lot of stuff or have done a lot of the work when you know you haven't. And the more quote unquote successful you get, a lot of people knowing of your work and maybe even financially benefiting from it, but the more deep down you know you haven't really done any of it, the greater that asymmetry, the more fragile your steadiness in that space because of the absence of authenticity. You know deep down you haven't earned that success and the more that asymmetry grows, the more other people can feel it. The phonier it feels, the more it lacks authenticity. And team, as we talked about over and over again on Leadership Thursday, authenticity realness is at the end of the day, what people really resonate with long term. And you will have less and less and less of that every year, the asymmetry of what it looks like, you know, and what you've actually contributed grows. That is an exhausting place to be. Nobody likes that feeling of I'm going to be exposed. Nobody likes that feeling when it's getting worse and worse and worse and worse every year. It will eventually overwhelm that person. And that's what brings me to the last point of this podcast. For those of you out there who are doing the hard work of creation, who feel like you're often being imitated by that person in town, by that person online, whatever, right? You feel like gosh, I really thought that, you know, I put a lot of effort into that and it kind of got hijacked, right? And you're feeling that chronically. You're not. Because those individuals always succumb to the above. They can't have longevity because creation isn't filling their cup. They can't jump from a foundation they haven't built. And every time they do that to you, their imposter syndrome grows. They know it was your work. They know they didn't and couldn't have thought of it. But they also know other people think they did. And the more that asymmetry grows, it has a breaking point. They never have longevity in the space. So stay in your lane and drive fast. We know how frustrating it can be, right? We know how exhausting it can seem at times. But understand that because of the above, every single one of those people's careers will be short lived and fizzled because all of the above are fixed equations. There's no getting out of that stuff. It's the wellspring of what a long lived energetic career can be. In the absence of those things, it simply can't be. So for those of you who feel like your work is being ripped off, let that be kind of a statement of confidence that I promise you because of all of the statements above, that will be a temporary discomfort for you. Keep creating. Team, innovation or imitation, it is the career defining decision. Do the work to try to come up with novel things that excite you, that excite others, that bring harmony into your career because you're actually putting forth your authentic self, not somebody else's authentic self. Do it right. You only get one shot at it. Cheers, team. I hope that helps on Leadership Thursday. I will see you over here next week. PT on ICE.com. It's where all the goods live. Have an awesome Thursday. 13:18 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 PT on ICE.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 PT on ICE.com and scroll to the bottom of the page to sign up.