In this episode, The Word Magician and Bestselling Ghostwriter, Crystal Adair-Benning, talks about effective copywriting. Today, Crystal talks about ways to improve your copy, pleasure copy versus trigger copy, and when to hire a copywriter. What is copy? Hear about the eight levels of perspective and belief, using love letter language, and get Crystal’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways “The best copy meets our clients where they’re at, so we can take them where they need to go.” “The world is triggering enough. We don’t need to see it in our copy.” “Your clients will tell you exactly what to write.” “Follow your zone of genius.” More about Crystal Adair-Benning Crystal Adair-Benning is the Word Magician, Story Supercharger, Copywriter & Ghostwriter for rebels, misfits and world-changing humans. She is best known for being not known at all. A secret weapon amongst successful entrepreneurs who covet her Quantum Copy Method - combining the science of writing with the spirituality of creativity. A multiple NYTimes Bestselling ghostwriter and former highly sought-after luxury event planner, Crystal finds joy in being an Intuitive Creative, digital nomad - free to explore the globe with her husband, dog and laptop. If you really want to know Crystal, here are some fun facts: - She never leaves home without her passport. - She saves trees with tech (her Remarkable is everything)! - She was truly embarrassed to call herself an empath for years and hid her genius because of it. - She met and married her hubbend (husband/boyfriend) in a month... because she was a smitten kitten. - She believe in LOVE above all else and will happily destroy the bro-marketing patriarchy word by word. Suggested Keywords Healthy, Wealthy, Smart, Copywriting, Beliefs, Perspective, Communication, Conversion, Storytelling, Resources FREE Copy Workshop. To learn more, follow Crystal at: Website: wordmagiccopywriting.com Instagram: @wordmagiccopywriting Facebook: Word Magic Copywriting Twitter: @WordMagicCopy Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927 Read the Full Transcript Here: 00:05 Welcome to the healthy, wealthy and smart podcast where healthcare meets business with your host me, Dr. Karen Litzy. And just as a reminder, the information in this podcast is for entertainment purposes only, and is not to be used as personalized medical advice. Enjoy the show. 00:28 Hello, everyone, and welcome to the healthy, wealthy and smart Podcast. Today we've got a great podcast, which walks you through how to connect, convert and catalyze conversation through copy. And yes, this means how to get more conversions how to possibly make more money with your copy. So to bring us through today's episode, I'm really happy to have crystal Adair Bening, a word magician story supercharger, copywriter, ghostwriter for rebels, misfits and world changing humans. She is best known for being not known at all a secret weapon among successful entrepreneurs who covered her quantum copy method combining the science of writing with the spirituality of creativity, a multiple New York Times Best Selling ghost writer and formerly highly sought after luxury event planner, Crystal finds joy and being an intuitive creative digital nomad free to explore the globe with her husband, dog and laptop. So I met crystal a couple of months ago at Selena Sue's mastermind, and I am like in love with this woman, she is so good. She will walk you through what copy means how to make it your own and how to talk to your customers. Now, aside from all of this, wonderfulness, and you'll hear throughout the podcast on August, the last week of August, I think on the 31st She is having a free three hour master class word magician copywriting workshop. You guys, it's free. She's going to take you through everything. So you can head over to podcast dot healthy, wealthy smart.com. Go to the show notes for today's episode and click on for her free three hour workshop. You can also go to word magic copywriting.com. And you'll sign up it's like a waitlist, you'll sign up for the waitlist and you guys three free hours with a copywriting expert. I know I am no copywriting expert. So if you want to have better copy for your website, your sales page, your funnels, your social media, check out her free class, that is going to be the last week of August either the 30th or the 31st. Otherwise, enjoy today's episode. Hey, Crystal, welcome to the podcast. I'm excited to have you on today to talk all about copy. So thank you so much for coming on. My pleasure. Thank you for having me. Yeah, I'm excited. This is definitely an area where it is a weakness of mine. And dare I say weakness of a lot of people certainly in my profession of physical therapy, and I'm sure you hear that all the time. Not like that's anything new. But before we go on, I want you to define what copy is. 03:30 Oh, good question. So copy is literally the words that you use to market your business. So it can be your website, your emails, your social media, and ebook you use a book you write. It could be literally like an ad that you run on social media might be copy. So copy is all of those things. We think about the words that come out of our mouth when we're talking to our clients. But when we put it down on paper, it becomes coffee because it's something that somebody can refer to us. Perfect. And how important is that for business? Let's let's get into this. Essential, right. Super important, super important. And here's another question that might seem like a dumb question. But how can copy be used to make a connection with your audience maybe make that sale? What is the purpose? So when we write copy, the best copy that we write is naturally about us. It's for the humans that we're writing for. So I teach a lot of times about the idea of it being a love letter. So if you think about the average client that emails you and maybe they email you and say, Hey, I've got this problem and my back's sore and this and that and I need I'm struggling with this and how do I do it? You might immediately hit reply and you say yeah, but when appointment in my calendar, very good, right? Like that could be an option. What if we instead decided to treat it like coffee? 05:00 and use the love letter principle Love Letter language and say, Hey, I'm really sorry that your back hurts, that's awful. I know how challenging that can be. And we definitely want to take care of you, here's a link to my website, I would recommend we get you in within the next six to seven days, because that's probably when the pain is going to feel worse. And when we have the most opportunity to fix it. By simply adding words to the copy, you're still getting across the exact same message. But there's a level of I've got you that we feel in a love letter, if you think to honor the love letter you've ever received, what's the underlying tone, it's your magic, you're amazing, I love you, and I got you. And so if you can impart that into the language that you're reading, whether it's a website and email, your social media copy a book, your audience literally feels that vibration, and it starts to pull them in, because suddenly they not feel what they feel seen. They feel taken care of supported, they feel comfortable with you, they're willing to say, Hey, I may not know this human yet, but they're inviting me into their space, they're welcoming me. And that feels good. And so they will actually move toward you instead of against you. So that's one of the ways that I would highly recommend you use it. Yeah. And in the physical therapy, I'm a physical therapist. So in physical therapy, and in healthcare, I would say, a lot of people, when they're coming to see us, they're in a point where they're feeling vulnerable, where they may be in pain, they may not be at their best. And so I like how you describe it as a love letter, because we're trying to tell them like it's okay for you to be open with us. Do you have any other examples of how we might be able to convey that to someone who's feeling maybe at their worst? Yes, so absolutely. So what we need to do first and foremost, and this is where the psychology kind of takes over. So my work is a lot of science needs spiritual to kind of combine it all together and create what I call word magic. And this is the science piece of it. So each of your clients already comes in, they have a belief that they currently believe, right, they're living in a system, they have an understanding of the world around them, they have a perspective of their values of the beliefs that they believe in. So on a very basic level, because we've got a short window of time, I'm gonna give you the there's like eight levels. So I'm gonna give you the overview. So number one, we're basically survivors, these are babies. Oftentimes, if we're in a really traumatic situation, if you're a refugee, for example, if you're homeless, you might become this person, your whole goal is to get your basic needs met and actually survive, right? Your belief is just I need to survive period. In Level two, I call this cult cohesion, who ever desire to fit in, we're learning all about rules and how we fit into society, how we fit in with our families, how we fit in with our communities. These are the reasons we call it a cult cohesion is because often, if you've ever joined a call, not all of us have. But if you've been part of a cult, there's a very strong belief system around the rules of that cult and fitting into that cult people often don't leave because they're going to be excommunicated, right. And so that's kind of the second level, it's not real bonded Level. Level three, we go up and these are black sheets. Think teenagers, right? When we're teenagers think of that angst, right? But we're recognizing that we have special gifts, and we're different than those around us. For the black sheep of our family, you'll often hear that we're searching for our gifts and our talents and level three, so teenagers most often, but you'll also see it in a lot of musicians, artists, people that really don't fit the norm. Lady Gaga is a perfect example of a value level three or belief three, believe four, we move into family rules. So we return from I'm so special, I'm unique. I'm a I'm a black sheep and we move we come back to family. You'll often find mom's fit here really well. If you work with a lot of moms, you'll hear about family is the most important thing. And they're very selfless. They're very giving their marbles, right. They believe in process systems and steps if you're a strong family person, if you work in government, military, religion, schools, they all fit into this rule kind of category. Then we move into five, if you're an entrepreneur, like many of the PTS on here, maybe you are an achievement architect is what I call you. You're entrepreneurial, you're driven for money and achievement. You know, we associate words like hustle faster, stronger, easier, better. We're seeking a goal we're very goal oriented in this level. Grant Cardone, Gary Vee are examples that I can think of that are very achievement oriented. Then we go into level six, level six, we go from being very self motivated and as achievements to 10:00 Being very world motivated, we often have achieved a lot in our lives and fives were high achievers, who suddenly recognize that there has to be something else to this. We can't just achieve for the sake of achieving and doing it for ourselves, there has to be more to this. So we often come into spirit at this point. I kind of joke sometimes that this is often the people you'll find in Mexico doing Ayahuasca retreats, or going to Peru, and, you know, trying to find themselves trying to find God or their version of God. They often turn away from financial achievement at this point. So we achieved so much that we're like, I don't have to keep working for money anymore. And now we turn to like, what is spiritual like sound for us? John Lennon, Nelson Mandela are great examples of this. They're people who achieved a lot in their lives. And ultimately, we're like, it's not about the money. It's about how can I give back in my community? How can I impact then we go into sevens, sevens move again, from spiritual tools, it's about everybody. Sevens come back and go, well hold up. I haven't the money that I gave it away, and I found God. But now, why can't I find God and make money? 11:07 Why is that not a possibility. So they really want to make money, certainly with money, they really want to make money. And they want to have impact. They believe that they can do both. Tony Robbins, Oprah Russell Brand great examples of these humans. They're the ones that really have like, we have it all, and we're going to give it away in the celebration, it's affordable. So they're really trying to do better things with their money. And their opportunities and visions, number eights, these are harder to define. So the eights are the cosmic connections, these are Ascended Masters, these are the people that know and understand that we are living in quantum existence on multiple timelines, sometimes all at the same time, and that every single thing we do is affected by somebody else. So I'm in my hands. And this affects somebody else down the road, I write on an email, and like millions of people can be affected by the email I write. That's where the Cosmic Connection is. So what's important here, when we talk about making connection, and how does coffee really convert is, there's two things you need to understand what is the belief bubble that your client currently sits in? What is the belief bubble that you as the owner setting. And then just for bonuses, your business also sits in a belief bubble, your business has a belief system that it abides by, if you know those three things, you can write incredible copy, because we write to the client, and not to ourselves, which means that typically, so if I'm a five, if I'm a high powered entrepreneur, and I'm working predominantly with moms, and dads who are burnt out, they're family focused, but they are given at all for their kids, and there's nothing left for themselves. I need to write to them, I need to speak their language. I need to know how they speak about the problem, that they're experiencing, how they're experiencing it. And I need to reverberate those words back to them in the copy my language and their language may be different. We know this, right? A client may have a presenting problem they walk into your office with, and they use words like, you know, my back's sore, or my back's tender, or I can't lift my kids. And you might know that it's partially about those muscles in those numbers. But there might also be an emotional attachment that you have to deal with, there might be a traumatic injury that you have to deal with, or long term problem that you're trying to support, you know that the presenting problem is not the real problem. It's just what they're noticing. 13:47 We need to speak to the thing they're noticing, not to the thing they actually need help with what when we do that work is when they're actually our client, they trust us, they know that we understand them by speaking their language. And then the real work can be done. It's not lying to your client. It's called meeting them where they're at. So the best coffee meets our clients where they're at so we can take them where they need to go. Yeah, that was great. I took a lot of notes there. And so what I'm hearing the bottom line is know yourself, your business, your the values of your business, so that you're coming from a solid foundation, and then really understand your potential clients and really get deep into who they are, what they need. Maybe what they're fearful of what they like, dislike so that you can write to them from a solid from your own solid base. Exactly. You're using their language, your solid base is where they want to go. 14:53 We typically work with clients that are a belief below us or are just like during the same 15:00 We bubble but they're just, they're just underneath us in our beliefs, we have a belief and then we have a neurology. So what often happens is, for example, I tend to sit as I work with a lot of fives I work with a lot of entrepreneurs are really kind of trying to kill it in their business. But if I look at the five, their neurology is already in sixth, they're already starting to think more spiritual and about there has to be more to this, I'm thinking about impact. So they've got higher level neurology. But the problem is, their client is sitting in a poor potentially wanting to become a five, I have to meet them in the floor in the language where they first meet me. So the language where your client first meet to, in case you haven't figured it out yet, typically, it's your website and your social media, that's where your client first meets you. So it's super, super important that we speak their language, not necessarily our language, when we first meet them, once we get to know them, once they're involved in our processes a little bit more, once they've been part of things, I might offer a book that's more in my believable mind language for them. Because I know that they're going to work with me for a little bit, and we're going to get them there. But to start with, I have to meet them where they're at, they're not going to understand me, coaches are the worst for this, I'll use a great coaching example. Coaches will say things like I do quantum timeline therapy, or I'm somebody who does quantum releases or breakthroughs. Your client has no idea what that I was just gonna say. I don't know what that means at all. Exactly. And every coach who who does those things goes well die know what that means. But your client who has never worked as a coach has no clue what we're talking about. The same thing happens in PT, right? You have things that you know what this specific thing is, but if you said those words to client, a client, we go, excuse me, what? What is that? So we need to go okay, hold on to this, this complicated process that we do? How do we reframe it in a way that our clients can understand it? How, what is it in their life, and if it's as simple as a massage that releases your back pain, and allows you to functionally lift your children again, then that's the way you explain it, instead of a, you know, repetitive injury release tension system, whatever the whatever the phrase would be a BT, clearly, I'm not a PT, but you want to break it down to what are they saying? And how is this gonna relate to them. And the best tool you can do is if we go back to that love letter, languaging, rather than trigger them by being like, you're this problem. And this problem and this problem, if we then speak into the power of what they can create, by doing the work with us, that's better. So if I can say, I'm going to create the ability for you to keep up with your kids, lift them longer, have more energy and stamina to like, go three rounds in the bedroom at night, if you want. Whatever it is, if I use the language of what the outcome of working with you is, versus just the trigger of why they showed up in the first place, they're going to be much more likely to stay on board. The world is triggering enough. We don't need to see it in our coffee, we do need to show them that we understand them we feel their pain. But what we need to express more often than not, is what is the outcome of working with me, if you work with me, I will do X, you will feel x times better, you will have the ability to do X, Y and Zed that you couldn't do before. That is much more compelling than simply saying stop hoarding. 18:43 Right, right. 100%. Yeah, or just try and relax. 18:50 Right? That's another one that we hear a lot. It's like, never in the history of the world. Has someone relaxed by someone just saying we'll help you relax? Yeah, it's like, it's so like, What are you talking about? Is the ultimate oxymoron, right? Like, tell somebody the rocks and they're immediately gonna be like, 19:09 yeah, yeah. 19:13 I catch myself doing it too. Like, my like, word for kind of my mouth. And I'm like, Oh, that's not going to help the situation at all great. Just put in our coffee, we have a chance to be really clear and to really understand the belief system or climate, the understanding are going through. So if you're telling a busy mom to just relax, she's probably not going to be too receptive. However, if you tell her that she's going to be able to appreciate the moments with her family more by doing this work. That's a much more enticing and appealing approach to her. Yeah, no, that's a great example. Thank you for that. What advice do you have for folks who are trying to get there, whether it's their website 20:00 their social media or wherever copy may land. What advice do you have for them? If they're like, I just have no idea what to do here, like I? I am like, because, again, you'll hear again and again, I'm not a writer, I don't know what to say. So what advice do you have for people in that situation? 20:23 I mean, of course, the selfish thing to say here is, right, aside from hiring, right, right. Right from that, though, that the thing that I would say is this. Start with the understanding of the belief bubble that somebody's in, start by really listening to our clients, how do they talk about their presenting problem and mimic it back to them, the easiest thing you can do is your clients will tell you exactly what to write, because they're already telling you in clinical sessions with you, every single time, what is my problem? literally read it verbatim. And keep yourself a list. Oh, how many times did I hear mom say I can't look my kids. That's probably a problem that they're really interested in getting sorted out. How many times did I hear people say, I struggle to bend over and lift boxes? Okay, maybe I need to focus on the ability like functional movement and the ability to lift things. Functional Movement is jargon speak for us. But for client, the ability to lift boxes with ease? Are you kidding me, that's a great tool to start listening to your clients. If you want to write better. The second thing that you're going to do is honestly start following and paying attention to your numbers. How many of our emails get opened, how many things get clicks, how many people visit your website? How many people leave your website? How many people show up? Or how many people get your email and you get snarky responses back? Right? If you're finding yourself in a situation where a lot of your emails are short and snarky, you probably have a problem with writing love letters, you might want to check that out. But if we look at the numbers, the numbers don't lie. The numbers tell us important to the problem among our clients will literally tell us how to fix it. For me, there's two places I would always start, I would start updating your website, making your website in the belief bubble and language of your client. And I would have a look at your emails and see if there's a way that even with two or three sentences, you can make them more loving, kind and allow your client to be seen. And if you do those simple, two things are usually simple. But I obviously no, it's not recorded. But if you seriously take those things, and implement some minor changes to things, watch, your clients start to shift their ability to work with you their ability to show up to start being more vulnerable with you speaking more openly with you and really deeply connecting with you. And from there, they'll tell you exactly what to write. And if all else fails, then you come to somebody like me, and we start talking about the strategy behind it. But the simple solution to start emails and website, start there. I love it. And I love 23:19 that you said when you're listening to your clients, just jot stuff down, like make a list of things you're hearing over and over again, and then just put that on your website, or put that into an email. Yeah, I mean, it seems like a no brainer. But like, Why? Why did I not think of this? 23:41 And most of us don't, right? Like it goes in one way or the other. You might be doing an intake with a client and hearing them and they're talking about struggling to pick up their kids and you're busy reading, you know, they've got a lumbar problem or a back pain issue. You're putting it into your language, if you simply wrote down exactly what they said a few times over and you don't even have to do this for long like I'm talking like, take two or three days, like six or six or eight clients even and you'll start to hear repetitive patterns in your clients. You probably intuitively know then you've just turned them into PT speak. 24:18 So take them out of PT speak and put them back into client speak change site on your website. Make sure that your website itself is written like a love letter that it allows your client to feel seen and valued and heard. Give them the safe space it's not about you it's about them. So if your website has a lot of eyes in it, change it to WE ARE THEY ARE you it is not about you it is about them. So the number one tool after listening to your client is making a buy bomb. If your website currently is all about you and when you do, 24:50 flip the script, make it about them. 24:53 You are going to feel so much better when we work on your ability to 25:00 Let your kids know so much better than I help moms be able to lift their kids. Because that feels so impersonal. 25:09 Right? It was wanting to put that personality back into that love back into it. So if you do those couple of things, you're immediately going to start to see incremental conversion challenges where things are not challenging, but opportunities for you, where you're going to get more conversion. And then the next step is, of course, going in with a deeper strategy around how do we build all of your pieces together so that it's always about the client. It's always spoken from love. It's ethical, crappy, meaning that it's not triggering, it's really about pleasure for the person. So pleasure copy versus triggering copy is a great tool for people to be able to utilize. So pleasure copy is all about calling people in by giving them the real results and the inspiration that they're going to receive by doing the work with you. Because first and foremost, when we're purchasers, we want to know, what can you do for me? Not what's the like physical aspect, not the, like manipulation of my body, not the tools around mindset, we don't care about that stuff. It's not the how we're gonna get there. And so what am I gonna get? How am I going to do that? So that's what somebody actually wants. So I would say if you can go into pleasure, copy and writing pleasure, so don't trigger them, instead, inspire them, talk to them in Love Letter language, and speak in their belief system, not your own keys to converting and actually catalyzing conversation, which is truly the key to converting a man I mean, such great tips. I like I said before, I've been taking so many notes and thinking about Oh, does my website do this is it so now I'm gonna have to go do an an edit of my website. So thanks a lot for adding a little more work on to the plate. No, I'm just joking. It's good work. It's good work. It's good work. This was great. What? What would you like the audience to take away from this conversation concerning copy and how we can connect and how we can convert? And ultimately, because if we have a business, I mean, we do want to make money, right? We're not all in the world motivated, where, where we've made a whole bunch of money, and now we can give it away. But we do want to make money. And we do want to make an impact. So what what are the things that you want the audience to take away from? So I think the first thing is, know your beliefs. Know the beliefs of your client, know the beliefs of your business, right to your clients beliefs. First, knowing your beliefs is helpful, because it will, it will show you what the gap is between your beliefs and your clients beliefs. And that's important to understand because it's often about jargon or lingo, keep that out of your copy, speak to the pleasure, talk about the results you're going to create for their client and inspire them to live a life better than they currently have, by doing this work with you speak into that more than you speak into their pain, right? We're the life like literally triggering enough right now. Stop focusing on pain, instead, start focusing on the pleasure that they're gonna get working with you. And I finally move into love letter language. So love letter language is just taking a couple extra and this is rare for a copywriter to say, but add a couple sentences, show them that they're seen, show them that you hear them, allow them to be vulnerable with you by asking great questions that encourage that vulnerability from them. And you really utilize that and if all else fails after that, Kelly copywriter, that's what we're here for. But you can do this, it is completely possible to do your copy in a way that is fully aligned and a way that is loving to your client and immediately get to conversion. We only opt out by working with copywriters, but start doing it on your own. Everybody should do it on their own first and call us second. And speaking of hiring a copywriter where can people find you if they have questions or they want to hire you as their copywriter? Yes, sir. Absolutely. word magic. copywriting.com is my website. That's the best way to get a hold of me send me a smoke signal or a text message or whatever from Yeah, otherwise find me on Instagram at word magic, copywriting. Pretty simple. I'm always around. I've always got a free class coming up too. So there's usually a waitlist on my website to get into my next free class where I teach. And I talk about specifically how would you combine these things? And how do you how do you put it all together. So if you're interested in learning, you can always take one of my free classes. And then if you just want to hire me we can go that route as well. But I love it when people simply connect. And at the very least, I promise you if you sign up for my email newsletter, I send tips and tricks all the time. So if you 30:00 Want to do it on your own in small bits and pieces? That's a great way to perfect and we'll have links to everything crystal just said at podcast at healthy, wealthy smart.com under this episode, so one link, little quick click, and we'll take you to everything. So take her free class, follow her on Instagram and get the newsletter. Okay, Crystal last question. And so when I asked everyone, and that is knowing where you are now in your life and in your career, what advice would you give to your younger self? 30:37 Ooh, juicy questions, I would tell my younger self to follow your zone of genius first. And what I mean by that is I actually spent two decades as a live event professional. I was always a writer, I was a writer from the top, I could write, I won awards for it, I always wanted to write. And then I followed the money. And I wanted to advance and I kind of let my copywriting and my writing kind of slide a little bit. I mean, I was reading New York Times, bestsellers, and 16. Like it was brilliant. And I let it slide because the money was better in advance. And I slipped in and eventually became a zone of excellence. And I did it for two decades. But there was always a little piece of me that felt unfulfilled because I wasn't just a writer. And that's what I wanted. 31:29 And when I left the bounce, and just started writing, everything got easy. It was like I hit the easy button on my zone of genius and cerebral doing work, I was super passionate about stuff I loved. I got to you know, work in strategy and marketing, because copy is a lot about strategy and humans. So a lot of the work I did in advance actually magically comes into play and copy. But working in my zone of genius. I think from the get go, I would have changed everything for me, I would have felt so much more fulfilled, so much younger, and so much more let up by this work. 32:05 So yeah, I would have told my younger self to follow your love of writing. Follow your zone of genius first. What great advice crystal, thank you so much for coming on to the podcast and sharing all these tips and tricks to help us write better copy, whether that's on our website or our newsletters or our social media. So thank you so much. You're so welcome. Thank you and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart. 32:38 Thanks for listening. And don't forget to leave us your questions and comments at podcast dot healthy, wealthy smart.com

In this episode, Physical Therapist and Founder of Redefine Health Education, Dr. Katie O’Bright, talks about the role of the physical therapist in primary care. Today, Dr O’Bright talks about direct-access in outpatient clinics, patient satisfaction with teams-based approaches, and the sustainability of physical therapy as a profession. What is the primary care physical therapist? Hear about billing as a direct-pay PT, learning from ED PTs, and Redefine Health, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “The primary care team is a team.” “The more we can get integrated into teams, the better.” “I don’t think that our profession, the way that we’re doing things, is sustainable at all.” “Every health professional has a role in lifestyle intervention.” “Do we really know, for different pathologies, what views and types of modalities and studies are actually required in order to effectively rule out a condition?” “If we can do anything to make our population more healthy, and to make other healthcare professionals see our value, then do it.” “The more I learned about the things that I didn’t know, the better clinician and person I became.” “Always have listening ears.” “Never drink the Kool-Aid. It’s not a good idea.”   More about Dr. Katie O’Bright Dr. Katie O’Bright, PT, DPT, OCS is a residency-trained physical therapist and educator who has spent much of her career in multidisciplinary primary care settings. She started her career as an active duty Army PT where she worked in a team-based Soldier Centered Medical Home. Since then, she has worked in multidisciplinary care settings in academic health systems and private practices, including oncology care. She also serves as adjunct faculty in several DPT programs, teaching foundations in primary care, oncology, musculoskeletal and gross anatomy. In 2020, Dr. O’Bright founded Redefine Health Education, an education & consulting company with the mission of getting more physical therapists competent and prepared for work in first contact, team-based care settings, starting with primary care. She is the lead instructor in Foundations for the Primary Care PT and contributes to musculoskeletal imaging curriculum. She currently lives in the Chicago metro with her husband & 2 sons, enjoys being outdoors & Buffalo Bills football.   Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Education, Teams, Sustainability, Primary Care, Redefine Health, Lifestyle Medicine,   Resources Chicago PC Course (Aug 27-28). MSK Imaging Certification (Starts Sept. 7) - 2-hour modules, 1x/month for 9 months or online self-study. Use “HWSPodcast2022” for $50 Discount.   To learn more, follow Dr. O’Bright at: Email:              info@redefinehealthed.com Cell:                 312-772-2322 Website:          https://www.redefinehealthed.com Facebook:       Redefine Health Ed Instagram:       @redefinehealthed Twitter:            @RedefineConEd TikTok:            @redefinehealthed LinkedIn:         Redefine Health Education   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.   00:35 Hey everybody, welcome back to the podcast. I am your host, Karen Litzy. And in today's episode, we are going to be talking about the role of physical therapy as the primary care P T. So what does this mean? This means that if physical therapists being first point of contact for the patient into the medical system, and what do physical therapists need to know in order to be the primary care PT? So to talk us through this topic, I'm really happy to welcome Dr. Katie o bright. She is a residency trained physical therapist and educator who has spent much of her career multidisciplinary primary care settings. She started her career as an active duty Army PT, where she worked in a team based soldier centered medical home. Since then, she has worked in multidisciplinary care settings and academic health systems and private practices, including oncology care. She also serves as adjunct faculty and several DPT programs, teaching foundations in primary care, oncology, musculoskeletal and gross anatomy. In 2020, Dr. Albright founded redefine health education and education and consulting company with the mission of getting more physical therapists competent and prepared for work in the first contact team based care settings starting with primary care. She's the lead instructor and foundations for primary care PT and contributes to musculoskeletal imaging curriculum. She currently lives in the Chicago Metro with her husband and two sons and enjoys being outdoors. And as a Buffalo Bills fan. We'll let it slide because you know, I'm a Philadelphia Eagles fan. But I want to thank Katie for coming on. We've got a lot of resources on podcast at healthy, wealthy smart.com. And she's actually giving giving healthy, wealthy and smart listeners a $50 discount for courses at redefine health education. So you can use h w s podcast 2022 for the $50 discount. So big thanks for Katie for coming on talking about primary care, physical therapy. Hi, Katie. Welcome to the podcast. I'm happy to have you join us today. Thank you so much. It's really honestly a pleasure and a privilege to be on your show. I've been a longtime listener. So this has been awesome. Oh, that's so nice. Thank you for that. And today, we're going to talk about the role of the physical therapist in primary care, which for those of us like myself, who's been in the profession for quite quite many, many years, I feel like this concept of the primary care PT   03:15 is on the newer side, depending on maybe what part of the country or the world you're practicing in. So before we get into the meat of the interview, I would love for you to define what is the primary care physical therapist? Yeah, that's a really good question. And I think that you're going to get a different answer from, you know, you'll get 10 different answers from 10 different people that you ask, but the way that I really like to think about it, and even my definition has evolved a bit over time, but the way that I like to think about it is   03:50 a lot of people think that primary care PT just equals you know, direct access or first contact or seeing a patient without a referral. But as I've learned more about what it what it is to be a primary care provider, I think that it has a lot more to do with being a being able to comprehensively assess a patient across all different specialty areas. So it's not just you know, you are an advanced neuro musculoskeletal professional. It's you're able to assess and effectively manage the functional needs of a patient, whether they have primarily orthopedic complaints, or primarily, you know, maybe they're a pediatric patient, or they primarily her, you know, dealing with some other non communicable diseases like diabetes and hypertension. You as the primary care PT are able to understand what it all of those how all of those systems play into their functional needs. And you're able to provide guidance on the management in conjunction and in sync with other health care professions.   05:00 Smells like the primary care physician. But you're able to effectively manage a variety of different conditions, not necessarily just their orthopedic or just their neuro or just their pelvic floor.   05:12 So that's kind of what my definition of primary care PT has come to evolve into. And I feel like my colleagues at the primary care sing would probably agree with me. Yeah, that seems reasonable. Have you ever heard of people saying, Wait, primary care? pte. Isn't that overstepping our license? Or isn't that going beyond what we should be doing? How do you respond to that? Well, I respond to it this way.   05:41 I think that pride, the primary care team is a team. And you can have a primary care physician or PA nurse practitioner. And they're typically in most cases, and especially in the United States, you will have a primary care physician and they'll also have a team of, of nurses, maybe they'll have a clinical pharmacist. And oftentimes that doesn't include an in house co located or, you know, maybe not co located but down the hallway, PT. But I think a lot of health systems are starting to see the advantages of having a variety of healthcare professionals that can be first contact. So for example,   06:23 the there there's physicians that can build primary care codes like e&m Primary Care codes, nine, nine series codes, and then there's non physician professionals that can build those codes as well. And that's limit that's not not just limited to pas and nurse practitioners, it also is encompassing behavioral health professionals, midwives, clinical pharmacy to a certain extent, and I think you're gonna start to see more and more primary care teams functioning as a team, which also includes a physical therapist that can contribute to the, you know, the, like managing the patient's functional needs, and everybody contributes to what component they need to contribute to.   07:08 Yeah, and that's interesting, you bring up the code. So normally, the physical therapists are billing under the nine sevens, usually. So in this case, if you are working with someone within their insurance system, and you're not a direct pay physical therapist, how do you bill for the services? Or? Yeah,   07:33 great question. So I actually just connected with Rick, Glenda last week, and I want to talk to him a lot more about this. So I actually have some, some meetings arranged, or I'm reaching out to plan some meetings with him to consult on that specific topic, because the health systems that I have worked with, or that I've consulted with, they're all doing different things. Some of them are billing nine, seven series code codes within the primary care setting. But a lot of this over the past couple of years, since I've been really into this space, a lot of these clinics have not received the feedback from their billing and finance departments because of, you know, COVID, short, you know, short staffed because of COVID. And, you know, we were shifting our focus to this area, so we can't give you the finance data that you need in PT. So a lot of them don't have reasonable data. So I'll just tell you what I do know, some of them are billing nine, seven series codes, some of them are doing, they have a PT that is co located in primary care, they see a patient for a quick evaluation and may provide them with some treatments, if they do some treatments, the physician or other health care providers also seeing that patient in the same day. And they'll do a warm handoff to pt. So then they do incident to billing under the physician's care because they're so they're kind of like CO treating at the same time, even though the PT is collecting those RV use for that visit. So that's one way that they know it can get reimbursed. Some, some locations are not billing their services at all. They're sort of like eating the cost while they're in the primary care space, but they're seeing downstream, you know, boosts in their revenue because more of their patients that they have touchpoints with in primary care are actually then following up and actually seeing them in physical therapy.   09:29 And then they're also keynotes finding, like we were reducing imaging by being co located. So there's other you know, benefits.   09:38 Then, I mean, there's, I could go on and on, but there's tons of different ways that people are doing this. But we don't have the hard data or anything like in the research to show Yes, this is Effective here. It's going to be effective for every insurance and this and that. It's such a complicated problem.   09:58 So I'm just trying to figure out   10:00 But as much as I can about it so that when people approached me and asked me questions about how to bill for it, in a typical insurance type system,   10:10 I have a variety of options that they could start with. And then I, you know, I hope to eventually talk with some of my, some of my colleagues that are, you know, more more interested and nerdy about research that could actually help me set up a research trial and study the whole thing and report on it accurately. But right now, I'm just collecting data. Yeah, that makes sense. A lot of times as things that are a little bit newer, you kind of go through some growing pains until you can figure out, hey, where does this fit in. So let's say you're a physical therapist in an outpatient clinic, you're not co located with the doctor, and someone does come to you in that direct access. Way, which for those who don't know, it, direct accesses, that means you can see a physical therapist without a referral from a physician, which I think is getting more and more common across the country to a certain extent. So if, if you're   11:12 advertising, your marketing is including like, Hey, we're primary care, physical therapists, what does that look like in the clinic? Can you give some examples or an example? Yeah, I can. So one of the things that I teach in my course. So I, I'm the owner of redefine health education, and the two areas where we, where we teach, in particular, our foundations in primary care, PT, and musculoskeletal imaging, which really go hand in hand. And one of the main feet main things that I focus on in my primary care course is how to effectively perform a systems review in a way that is all encompassing, so that if a patient comes to you with a primary shoulder complaint, not only are you doing a systems review, to rule out red flags related to that shoulder complaint, but you're also identifying problem areas that can affect their health, in you know, in the near term, and in the long term, so that you can learn how to educate them appropriately. So let's say a patient comes in to you, you're not co located with another primary care team or anything like that. But if a patient comes to you with primary shoulder complaint, and you also find that they have have hypertension, and they're pre diabetic, and maybe they have an autoimmune disorder, and you know, oh, by the way, they had COVID really bad and they were hospitalized, and they're having some long COVID symptoms, how to ensure that you're including components in your plan of care that address all of that, whether it's just little bits of education here and there.   12:47 And also, you know, of course, you know, I want to the one of the other things I teach in my course, is not only just understanding all of that from an evaluation perspective, but then understanding how much the patient is willing to go down and actually allow you to intervene   13:04 in their lifestyle habits or, or other areas. So I think that   13:10 that process is something that PTS that are working in a typical outpatient orthopedic clinic, are not doing very well. Because usually, we are seeing patients exclusively for an isolated shoulder condition. And we're not really looking into what the rest of their medical history really spells out for us.   13:36 But what I teach is   13:38 basically intervening in lifestyle and ensuring that they're, you know, if they need medication management for an autoimmune disease, are they actually following it? How is that playing into are related to their shoulder pain? How is that affecting their nervous system? How is that affecting their cardiovascular system?   13:56 So yeah, I think that I think that you certainly could, you certainly could. And then another thing, I've had a, I had one outpatient clinic team, or they were kind of like a local regional chain. But they also had a kind of a, analogous to them was a local, regional primary care group, that they were interested in it both privately owned, really interested in collaborating together. So even though they weren't co located, one of the things they thought about doing and that they're in the process of building is they're actually going to have a PT hanging out in the primary care office, whether it's 1233 days a week, or a hat, you know, an afternoon here or there, just to be able to be there and to be able to address patient's functional needs on the spot if they need it. So there's there's all different ways that you can do it. Even if you're going to privately owned you know, private practice or you own your own cash based practice. I think that the more we can get integrated into teams, the better   14:58 and do you have any   15:00 Um, data that shows how perhaps a team based approach may may improve outcomes or patient satisfaction? I do. Yeah. So a couple of the a couple, there's there's a number of studies that have looked at this, but one of the one of the main ones that I was looking at recently was, I think it was a Dutch study, I'll have to look, I'll have to look at it. But I'm pretty sure this was conducted in the Netherlands. And it was looking at elderly adults, community dwelling, elderly adults, where they had a team based group. So they they looked at a comparator group work was really just a physician and nurses. And then they looked at basically the same, the same group that had a physician, nurses, social workers, I believe they had clinical pharmacy, they had a recreational therapist. So they had this team that would all work with the patients together. And one of the main things that they found was not only improved patient outcomes and patient satisfaction, but also provider satisfaction. And that's one thing that I have found. So that's just one study with one example. But there are a number of studies that show this and just from my own experience working in team based primary care,   16:16 I, if I would not have been in those settings, I do not think I would have as as good of an understanding of,   16:25 of the other body systems as I would have as I would otherwise. So I think that they, when you work together more frequently, whether you're co located or whether you're just on the phone, or being able to have like a texting relationship with other providers,   16:44 they're going to understand what you do a lot better. And, and then they'll learn and grow from that, and vice versa. So I think that not only is there benefit, not only do patients reap the benefits in their health outcomes, and in their satisfaction, but also providers are, they seem to be much happier and have a lower rate of burnout, when they do work in a team, as opposed to just kind of being around the same old, same old all the time, you know, if you just are surrounded by people that are so much that are like you and think like you and do like you and are trained like you all the time for your entire career.   17:26 You're not going to learn and grow as much as you would if you were around other people who don't, who weren't trained to like you, and who have a different perspective. And I think I'm able to treat my patients better because I for the most for most of my career have have not been around pts.   17:44 And how do you think this fits into the sustainability of physical therapy as a profession? Yeah, so that's, that's this is my favorite question. Um, I gave a presentation recently for the primary care sake, I think it was in May this year 2022. And one of the things I talked about was how I don't, I don't think that our profession, the way that we're doing things is sustainable at all. In fact, I think that   18:17 there are so few patients, you know, it's estimated that seven to 10% of all patients with functional complaints ever end up seeing a PT, which is not a good thing, that is not a good thing at all.   18:29 And the model that we're kind of trained under and the model that a lot of PT clinics tend to follow, especially if you're in the insurance market,   18:38 is they follow where they were, you're seeing a lot fewer, a significant fewer number of evaluations than you are seeing like treatment sessions per day.   18:50 But if if the World Health Organization is saying that, you know, 25% of all complaints 20 to 25% of all complaints give or take, you know, depending on your region, and the timeframe, and yada yada 20 to 25% of any any patient encounter in the primary care space or in the emergency department is going to be neuromusculoskeletal related.   19:11 And only 7% of those are ever ending up seeing us. Imagine what it would be like if we could be kind of that first person to consult with them. Just imagine that. And so you know, we might see a higher number of evaluations per day, but we can be there to intervene, where it's really the most important, where we can ensure that they're not receiving excessive amount of, you know, imaging or medications or unnecessary tests and studies. And we really are the professionals that should be determining and assisting in figuring that out. So I think that if we were able to intervene just in that one area, then we could save our healthcare system a whole lot of money, we could improve our population health tremendously and   20:00 Then we're also going to be leveraging our skills. Because I started my career in the army, I saw a lot of evaluations, like more evaluations than then treatments most of the time. And what I found was my differential diagnosis skills and my ability to screen got really, really, really good really, really, really fast. So the more evaluations and consults that we see, we've been, we're able to recognize more and more patterns, we're able to intervene quickly.   20:28 And other providers around us see our value more significantly. And then insurance companies on the other end CRC or value more significantly, if you if you flip the role, and we don't, let's say we don't do that we just continue down the road that we're currently on, where we have, you know, an evaluation or two a day and you know, all of these treatment sessions in order to keep the lights on, if you're still in an insurance based market, in order to keep the lights on for any private clinic owner, you have to you have to maximize the number of visits, that a patient is being seen. Whether that's necessary. Or if you're maybe just loosely saying that's necessary to make sure that you can keep the lights on   21:12 if reimbursement is only getting worse and worse and worse, because insurance companies are like, well, we don't really think that's necessary. And we're saying, oh, yeah, yeah, that's necessary. And maybe in some cases it is. But for the vast majority of musculoskeletal health, musculoskeletal problems, we know that if we intervene early, if we reassure if we educate, if we say stay active, and exercise, the the natural history is that they will probably improve and get better. So if we can intervene there,   21:42 then we probably will kind of see it shift where we'll do like more evaluations and consults and less treatments and therefore save the insurance company a whole lot of money, save the patient a whole lot of time and money. And then everybody's everybody's happy. So I think that if the roles flip a little bit, and we learn as as a profession, how to be how to serve in more of a consultant role for population health neuromusculoskeletal conditions, maybe, maybe just maybe, maybe I'm crazy, but maybe just maybe the tides will turn and we can be says more sustainable as a profession in the insurance market.   22:21 Does that's a long way of answering that question. No, that was a great answer. And you brought something up kind of   22:29 more and more people who are going to emergency rooms, a lot of times for musculoskeletal health, and we are starting to see PTs in the ER. And would you? I mean, that's obviously so certainly a primary care physician, right. So what do you think that your typical outpatient or inpatient   22:54 physical therapist can learn from those emergency room PTS, that we can kind of take into different settings? Does that make sense?   23:07 Sort of I'll start by addressing the the the IDI PTS, by the way, shout out to Rebecca Griffith who is you know, just launched her IDI DPT because this year and she's doing a great job with that but um so if you need specific questions about how to V any how to be a physical therapist in the IDI I personally don't have any experience in that space. But but she does so reach out to her   23:35 and maybe we can put her her name in the show notes   23:39 but there's a lot of overlap and I think you know we there since there are more there are more PTs in the IDI you'd be surprised actually I've been finding out more and more about PTs in primary care than I ever thought was actually there and probably maybe the the IDI has just been more there's been more exposure given to PTs in the IDI so, so to answer that question, what can   24:11 there's a little bit of a difference though. So PTs in the IDI typically don't see their patients back, you know, they might, they might see them one time and it's truly Well, unless, of course the EDC has a lot of repeat offenders but But if we're talking just like the average patient showing up at the IDI, they see their patient one time and it's truly there to to rule out red flags to ensure that they're receiving the most of if they need imaging, the most appropriate, most necessary type of imaging study and that they're getting the most adequate referrals and consults that they need.   24:50 Reducing opioid prescriptions and other types of unnecessary excuse me prescriptions and also giving them something to go home with   25:00 whereas if they if they just see, like an IDI physician or or another type of typical IDI care provider, they're not as, and I don't want to speak for them I am. So I'm such a huge proponent of working with physicians and nurse practitioners and PAs. But I know that from my experience, even they have told me that I have, I have the knack for just talking to those patients and being able to do that, do that little bit of motivational interviewing and figure out figuring out what's, what works for them, what's going to empower them what they need. And that little bit of education is is important. So but it typically in the day, they won't see their patients back, it's kind of like you're doing a quick evaluation, determining their needs, and then like discharge planning, or the patient is admitted or whatever, right? In primary care, my my whole theory, and really my vision for PTs in the primary care in primary care teams is that we would be co located and or just affiliated, maybe you're not in the same location, but you are affiliated somehow, or you have a close relationship with a primary care team, where you can have lots of good integrative care planning for the patient, and it becomes almost like a revolving door. So with your, with your patients that you see,   26:20 like I have my own primary care physician, I can go to my primary care physician whenever if I have a problem or for my annual visit or whatever.   26:27 Within my primary care team, I also have access to if I needed, I also have access to a behavioral health provider who is part of that behavior primary care team. And if at any point, I had, you know, a mental health crisis or something like that, I would go to this person because she's a part of my primary care team, and then they all work together and figure out what to do. And, you know, with with my, with my input, figuring out what is the best situation for me. So with PTS, being a part of those primary care teams, you you get access as a patient, you would get access to a PT on a revolving door basis. And then you have established, you have kind of, um, you know, if I, if I was, if I was   27:12 the, how do I jump jumbling up, because I get so excited talking about this. If I were a patient coming to see your primary care, PT, my very first visit would be a well visit. And then I would kind of like go through, maybe figure out identify some risk factors or maybe identify, you know, you're not necessarily having a problem. Now, here's what your body normally does and looks like. And this is what you do for physical activity. Let me give you some pointers, maybe, you know, maybe you want to increase your exercise, here's how to do it safely. And then if and when problems do develop down the road, we can address those and I know what your baseline is like. And it doesn't have to be this this finite linear relationship, where there's an evaluation, treat, treat, treat, treat heart discharge, for this one problem. You know what I mean? So I do like, yeah, so it becomes this, you have a team of care professionals that are on your side, and that know you and that know each other, and, you know, maybe they all they're all trained differently, and they all see things from a different perspective. But they all collaborate as a team to help you be able to help yourself the best. And I think that's that, that is my vision for what the future of pts and team based care looks like. And I am like just dying for it to happen, you know, I will make it happen thrive in this. I think that, you know, the rate of burnout in our profession is substantial. And it kills me like I some of my my students are coming out of school after their first couple of clinical clinical rotations. And they're like, this isn't what I signed up for, like, what are my other options? I don't want to be a PT. That's scary. And I think that PTS would   28:59 be able to at least at least delay the onset of burnout. If we were able to shift into these types of care models. It would be so refreshing. Yeah, I mean, it definitely sounds like that patient centered care that we talked about the bio psychosocial system of care model of care that I would say most health care professionals are moving towards hopefully.   29:28 But it does sound like it's a good environment for the patient a good environment for the clinician, and like you said, you have the opportunity to learn from different professions and from different folks who might not have the same skill sets as you and vice versa. And it also kind of started to bleed into a little bit of lifestyle medicine and things like that, which is something that we can all use. Absolutely. Yeah. I love it. I love all of it. Now   30:00 So you had said, you briefly   30:05 talked about redefine health. So do you want to go in and and tell the listeners a little bit more about that if they're interested in learning more on how they can brush up on their skills to be a better primary care? PT? Yeah, for sure. So,   30:22 um, I've always wanted to I had always wanted to get into the education space, but never in a million years did I think I would ever be starting my own education company. COVID did this to me. But you know what, thank you COVID For that, you know, if there's one,   30:39 there's like these unnecessary, I guess unprecedented things that came out of the pandemic. And for me, it was I lost my cash business after it just started.   30:52 And it there was a number of things going on with that. But I decided to just jump right into education. And it was a it was an evolving thing for me, I really didn't know exactly what what direction I wanted to take it at first. So it's taken, you know, almost two, it took almost two years to really find my to find my niche and really find my truth and what what I'm the most passionate about, and well, for me, it has always been primary care.   31:20 And it just took a while for me to like figure that out from a business perspective. So   31:24 So yeah, I teach foundations for the primary care pt. And my my partner, Dr. Lance Mabry teaches our musculoskeletal imaging certification. So I'll talk just briefly about both the foundations for primary care PT is an 18 hour CTE course, and it's really meant for the the physical therapist that wants to wants to like break free of this, this model where patient comes in for neck pain, and you're just really looking at their neck. And   31:56 lifestyle medicine, for me has been something that has been really actually life changing. For me personally, I after having kids had a lot of autoimmune problems that I had no idea what was going on. And I just was like kind of scattering going to different physicians here and there. And everyone was like, almost kind of like mandating all of my problems. And then I finally connected with a lifestyle. She's a board certified family medicine and lifestyle medicine physician. And, um, honestly, she helped me so much by just helping me intervene with my diet, and really looking deeply into you know, those six pillars of lifestyle medicine. So, after really kind of seeing what that did for me personally, and what I was able to do as a trickle effect with my patients, and then just diving into the research and seeing wow,   32:50 we really need to intervene in lifestyle, if we're going to affect population health. And everybody, every health professional has a role in lifestyle medicine, and lifestyle intervention. So in my primary care course, the whole first day is all about just taking your everybody learns a little bit of medical screening, or should learn pretty solid medical screening and their DBT education, taking what you learned and your DBT education to the next level, where you know, if somebody circles Yes, on a certain number of, you know, past medical history or symptom profile, if they certainly yes, on those things on their intake form, you know exactly what questions to rule up or rule down different conditions to bring you to your, you know, your final set, or your initial list of differential diagnoses. So that's kind of all day one. Day two is more,   33:44 kind of a deep dive into visceral pathophysiology. So, okay, we all learned about anatomy and physiology, the heart and the lungs and the GI system and all that stuff.   33:56 But when was the last time you really actually spent time with it. So day two is all review of visceral pathophysiology. And I focus a lot on the cardiovascular system, because let's be honest, everybody has Atheros everybody has some level of atherosclerosis. And for most people, it's just it's just your dislike a day or two away from becoming pre hypertensive. So I focus a lot on that and what PTS can do to intervene in patients in their, you know, in that sweet spot, you know, ages 25 to 45, where we can really have an effect on somebody developing or not developing those those chronic illnesses.   34:38 And then I also talk about, you know, you can maybe identify, excuse me, you can maybe identify that somebody has some lifestyle factors that need to be assessed, but how do you assess their readiness and their willingness to change? And how do you make sure that you're respectful of their wishes, maybe they don't want to go there. And maybe that's okay, so   35:00 I'm so that and then of course, interdisciplinary collaboration and communication as part of my core series I have, I've interviewed other physicians in different specialties of practice and kind of their thoughts on what what PTS are what PT should do. And I play these videos in my course. Because I think that overall,   35:20 I don't want to speak for my whole profession, but from my experience, there's more PTS than not that are afraid to pick up the phone and call a physician and tell them what they think and recommend what they want to or what they what they feel is appropriate and and say, Hey, I, you know, this patient seems like there, they've got a neurologic profile that kind of looks like Ms. And, you know, maybe you want to take a closer look at that. So, so what these other fishes physicians actually think and say about PT.   35:50 So that's kind of my primary care course, in a nutshell, and Lance's musculoskeletal imaging course. I mean, a lot of people think that imaging is just kind of like, something that's done, you know, if like, you have a if you suspect a fracture, you know, you got your auto ankle and, you know, you've got your, your,   36:12 your auto when he rolls and like all the you're Canadian CCI rules and all that. But do we really know for different pathologies? What views and what types of modalities and studies are actually required? In order to effectively rule out a condition? Do we recognize and understand that radiographs are inherently specific not inherently sensitive? So if you have a high level of a high index of suspicion for something, you need to continue the workup? And what do you continue the workup with? Is it MRI? Is it CT? Is it something totally different? Are you doing this to rule out something that's vascular or something that's soft tissue or something that's bony? And I think that, in general, probably not just PTS, but there's a whole lot of people that don't understand those things. And I think we're doing our patients a disservice by not fully understanding those. Because let them I mean, we have to face the fact that imaging is a part of the diagnostic process, whether we want to recognize it or not. So we have to whether you can place the order yourself or not. You need to understand how you need to understand how and why it's done for what purpose, and then how to clinically respond once a patient has had imaging, and who to communicate with and you know, when to pick up the phone and ask some questions to the radiologist. And so Lance does a tremendous job with a way better job than I would do with all of that. So. So yeah, that's kind of the the courses that we have to offer. And, really, I want to, I am not doing this to make money, trust me, like I would be   37:47 my husband just graduated with his MBA, like a little more than a year ago. And he's always like, go get your MBA, like you can use how much potential you can make so much money in this space. And I'm like, I don't know, I was put here to do a certain thing. And PT is the profession that I have just like it's, it's more of a vocation for me than anything else. And I just really feel like our profession needs some dire change, and needs people, certain people in it to make moves and make changes. And I understand that my, the visions that I have in my head right now for what our profession could be seem like pie in the sky, craziness, especially with the way that insurance is right now. But if this is the one area where I can have an impact, and start to make more PTS more confident and competent doing this, than Hey, I will, I will retire a happy woman, if that's the case.   38:47 Well, and I think that's a great way to start wrapping things up. And I was just going to ask you, like, hey, what do you want the listeners to take away from this discussion? I think you might have just said it, but is there anything else that you really want the listeners to take away?   39:04 I mean, basically just that, like, if you if you can, if you want our profession and see the value in what our profession has to offer, we have got to make moves. And and if we can do anything to make our population more healthy, and to make other healthcare professionals see our value, then do it. You know, don't don't like get stuck in your your ways of you know, one patient after the other and then you're home at the end of the day and you know, try to try to do those things to make a change for yourself and for your community.   39:42 Just by setting a positive example of what right looks like from a from an evaluative perspective, and from like a from a health care provider management perspective. And the one thing I will my one little parting, parting gift   40:00 for everybody, if they if you are interested in taking either one of our course tracks, I you can use the I have a discount code a $50 off discount code for, for either one of those courses for any of the listeners, if you just put HW s podcast 2022 And we'll just maybe put that in the show notes. That'll give you a $50 off discount and it's always Yeah, always happy to chat with anybody or,   40:30 you know, hear any inquiries, my email addresses info at redefine health ed.com You can call or text me any time and I'm so open to it at 312-772-2322 and I'm on social media and trying to trying to turn it into something so go and follow me at redefine health Edie on all the social medias except for Twitter because it was one character too long, which is so annoying at right so it's Twitter ad redefined Con Ed. Perfect. Well, thank you so much. I can't believe you gave out your phone number. That's insane.   41:06 Hopefully, business number.   41:10 Oh my god, I was like, I'm gonna have to edit that one out.   41:15 That's, that's, that's the big number. So all right, good, good. Good. Okay. Now, last question. It's when I asked everyone and that's knowing where you are now in your life and in your career? What advice would you give to yourself as your younger self maybe right out of PT school? Yeah, I think as a as a young PT, I really thought I knew a lot. And   41:36 I really thought I knew a lot I really thought PT could do everything. And   41:43 the more I learned about the things that I didn't know, I think the better clinician and person I became and I think that's just kind of the natural evolution and the natural evolution if you're really paying attention to who you are and what you do is you'll find out you just know less and less about you know, you know a little bit about less than less over time and   42:09 and yeah, so like always be open to learning other things in different ways from people that you didn't think were were were experts or   42:20 you know, just always have listening ears and never drink the Kool Aid. It's not a good idea. Kool Aid is not good for you anyway.   42:30 I love it. And you know, that's that is   42:34 definitely something that I've heard again and again, as the advice that people would give to their younger selves. So you are in very good company. So Katie, thank you so much for coming on and really, hopefully lighting a fire under some of the physical therapists who are hearing this to   42:54 be open to new ways and be open to the to primary care and lifestyle medicine and incorporating that into physical therapy so that we're more than like you said more than just treating the shoulder and the person goes away. So thanks so much for for all of this info was great. Yeah, absolutely. Thanks so much for having me. It's really a privilege. And everyone thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.   43:21 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media.  

In this episode, Physiotherapy Lecturer and Tendinopathy Researcher, Seth O’Neill, talks about tendinopathy. Today, Seth talks about his interest in tendinopathy, and his presentation at the Fourth World Congress of Sports Physical Therapy. What is the warmup response? Hear about Seth’s diagnosis framework, the appropriate use of imaging, rehabilitation, and get his advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways “You’re going to have some discomfort with these exercises and that’s okay.” “Get your diagnosis right in the first place.” “Say yes to things when you can. Push yourself and you’ll get there.” More about Seth O’Neill Seth is a Physiotherapy Lecturer at the University of Leicester whilst also maintaining clinical work. He has a PhD on tendinopathy, within this Seth has identified prevalence rates of tendinopathy in UK runners and developed a greater understanding of risk factors surrounding Achilles tendinopathy. His later work has completed a more in-depth analysis of how tendinopathy affects the Plantarflexors. This has focussed on how the strength and endurance is affected and which of the Plantarflexors is most involved. This work has highlighted the involvement of the Soleus muscle in human Achilles tendinopathy. This has led to the further work related to Calf injuries in sports. Whilst Seth’s focus is on the Lower limb he maintains a strong interest in all MSK conditions. Seth feels passionately about supporting Physiotherapists to undertake further research either as standalone projects or MRes’s or PhD’s. Seth is currently examining tendon structure and changes that occur during health and disease along with Biopsychosocial interventions for tendinopathy and LBP and developing an international database of calf injuries. Suggested Keywords Healthy, Wealthy, Smart, Tendinopathy, Physiotherapy, IFSPT, Injuries, Recovery, Rehabilitation, Diagnosis, Exercises, Resources IFSPT Fourth World Congress of Sports Physical Therapy To learn more, follow Seth at: ResearchGate: Seth O’Neill Twitter: @seth0neill Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927 Read the Full Transcript Here: 00:02 Hey, Seth, welcome to the podcast. I'm so happy to have you on. 00:06 Thanks very much for having me, Karen. It's great to be here. 00:08 Excellent. And today we're going to be talking about tendinopathy, maybe specifically Achilles tendinopathy. But before we get into that, I just want to let the listeners know that you're one of the amazing speakers at the fourth World Congress of sports, physical therapy taking place in Denmark at the end of this month, August 26, and 27th. And you will be talking about tendinopathy. So before we move on, I would love to know why. Why tendinopathy? How did that become sort of your specialty, your interest? 00:46 Yeah, tricky to sometimes answer these type of questions, really. But I've had tendon problems myself. So being active and sporty, I developed an Achilles problem, number of years back when I was a relatively junior physio, and we didn't really understand how we were trying to manage these things. And that took a long time to settle down. So that really sparked it off. And then not long after I developed poutine. And problem as well, my Achilles from wearing sorts of constricted footwear. So wearing wetsuits, boots, for a day, with doing wakeboarding and stuff. So developed the interest because I had the problem myself, which is probably the answer for most people, I think, with how we ended up specializing in one thing and went on to look at Achilles problems and differentiating these out as part of a master's dissertation project that did, and then still had some clinical questions I wanted to answer to help me understand how to manage people better. So I did my PhD in it as well. So yeah, it's one of those sort of sorry, stories of a while me. 01:50 And before this sort of deep dive into the literature, and a master's in a PhD, and maybe even during that journey, are there any cases that you worked on that you were like, Man, I would do it so differently now? Because I'm sure I mean, I know I have that every physio listening to this can probably relate to this. But where have you learned from your mistakes in relation? We'll say, we'll stick to Achilles tendinopathy. Right. So in relation to Achilles, tendinopathy, so that the listeners out there can be like, Oh, I think I just did that. And maybe I'm gonna change my mind. Yeah, 02:28 yeah, we're at a good number of these things, including not too distant past as well. I think like everyone, we're always learning. And we've all just got to admit to mistakes and where we can benefit and do better. So I think my early ones, particularly were around differential diagnosis, getting or missing things that were going on as well. So remember, one relatively young lad with an Achilles problem, sent him off doing Alfredsson Essentrics, this was probably 2001, something like that, came back loads loads worse and had this funny swelling around the back of his money, hola. And I was like, never seen this, this is rare, and didn't know what was going on at all. So sent them off for an MRI scan via our consultant at the time and came back with an accessory soleus, which is where part of the muscle is low lying and actually sort of fills where cake is fat pad is back in money can cause pain and be symptomatic. And the old school approach is to just go in and cut it out. So the surgeon is booked out and ordered and dusted. But I totally missed it. The first time I saw him, I don't know whether the swelling was there at that point, or whether I triggered him off or made him worse with the sort of rehab. So possibly, but also then I've had a couple of people during Alfredsson regimes that have actually ended up with ruptured or partial ruptures, partial tears, as a consequence, and then yeah, you end up sort of feeling terribly bad that what you were doing to try and help someone's actually caused a significant worsening of their function and symptoms, and they even had a patient with this happened last year, who will go and try and write up as a case study because it's really interesting management program afterwards with scans and stuff, but ultimately, they have big problems. 04:15 Yeah, it does. It happens to us all. And how do you from that? You can, you know, we can edit this out if you don't want to answer this. But how do you deal with that from sort of the mental standpoint of oh, shoot, like how do you mentally deal with that? Because I think that when that happens, it can you start to question why am I doing this? Am I the right person for this job? It can lead to burnout, that stress. So how do you manage that from a mental health standpoint, when things like this happen? 04:53 I think the thing is often as a junior therapist, you beat yourself up more because you sort of think I should have known I should sort of understand that, I think as you get more experienced than me, I'm 22 years 23 years qualified. Now you have lots of experiences like this and have to pick yourself up from them. And you just start to accept that that is like that's normal, whatever area of work you specialize in, or work in, whether it's physio, or even being an accountant or something, mishaps in things that you can learn from learning experiences happen all the time. And it's really just then taking what you can from it and developing and getting better. And when you have a bit of a boo boo happen like this, we tend to remember it and you never then miss it in the future. I mean, a couple of examples that I had in the past would be like federal stress fractures wasn't even on my diagnostic radar back when I was a junior therapist. You don't get taught at university and stuff, and then you sort of you miss one. And it's like, right, never missed one again. Now, it's always high up on your index of suspicion. So it's really just not trying to beat yourself up, realize it's a learning experience and identify what you can do. Going forward with it. Part of your CPD of your reflective practice that we're all encouraged to do and often do do but not formally. So yeah. 06:14 Yeah, great advice. Okay, now, let's get into the meat of the podcast here. So what we'll talk about is kind of you mentioned it differential diagnosis. So we'll talk a little bit about that, and then go into some possible treatments and, and outcomes and things like that. So let's say someone comes to you, with posterior ankle heel pain, they haven't been to their GP or to the orthopedic yet, because that happens a lot. Here in the US, I'm sure it happens a lot with you in the UK, as well. So I will hand the mic over to you. And you can maybe walk us through your differential diagnosis framework, what are you looking for when someone comes in with that? 07:03 So the first thing, I think is, as everyone already knows, is not to take whatever the previous diagnostic decision was, if they have seen someone as well, I make sure you do your own workup, because let's face it, we all make mistakes as well. So I'd always look at them with fresh eyes and not go with the the original diagnosis and make my own mind that the three big things that mimic Achilles tendinopathy really then are related to posterior ankle impingement. So in order to try going on, whether it's a bony impingement or not, and they're the ones actually see quite commonly that have been mismanaged that add a cricketer, recently, his professional cricketer, who had been sent from their medical team in one of the counties in the UK, or England, I should say, and unfortunately, that miss that he had a posterior impingement, not an Achilles problem and been trying to manage them and manage him using some invasive procedures, and actually scan and everything else when I scanned in, but absolutely pristine and fine. And that's the one thing I do come across time and time again, it's just people miss the impingement side of it, and normally, the x, so aggravating factors and easing factors that the patient will report to you if you listen carefully, and inquire, will be very, very different. It'll be a totally different set of positions, not about tendon load, it'll be their ankle position. And being in that plantar flexed position that's relatively simple and straightforward. But again, it just, it commonly crops up other common or relatively frequent presentations, then we'll be around several nerve. So one of the branches of your sciatic nerve runs on the lateral aspect of your Achilles, we just want to simply look at something like a straight leg raise with a neural bias for the inverter area. So you do inversion with dorsiflexion. And if movements like that provoked the pain, that's not normal for a tendon, it would normally only hurt when you put larger loads through it. And energy storage demands not simple structures, except in very highly irritable cases. But you can only determine that clinically. So they're the two big things that the third group then is other localized tendinopathies. So to be honest, posterior, or per Nei, which I think you guys call something different in the States. What are the perineal inverters of the foot? We always have problems when we teach anatomy with our students, if they use an American app, it gives it a different name. I forgot this. But anyway, so yeah, so just looking at the differential between those other tendons. So patients may refer and sort of suggest its posterior heel, but actually it's in front of the Achilles. So it's normally relatively localized pain and there's lots of debates on social media about what happens when you get diffuse pain in that area. diffuse pain is really quite rare in this area, and I do see a lot I still work clinically as well as work in that university from a research perspective and I do a lot of consultant work in sports. and wider as well. And we just don't see widespread pain in this region particularly. And the evidence really suggests that tendon off the Achilles particularly will be localized pain. It doesn't sort of spread out. But there will always be some exceptions, I'm sure. 10:15 And it sounds like from what you're saying one of the other really important things is that subjective interview. Yeah, right. So what questions are you honing in on? What are you What do you really want to know? 10:29 So I'm actually take a leaf out of Peter O'Sullivan's approach for back pain and look at the patient's story. How do they describe this originally starting? What's gone on with it from then? And what are their thought processes around that. So we really look at the whole patient, not just that the mechanical bio sorts of components here, but then our teas into the aggravating and easing factors. So where the pain is what makes it worse, what makes it better how long it takes to come on, often expecting a latent response. So the pain is not necessarily happening during this activity, it will be a latent flare up later. Although you'll sometimes get a warm up response during the activity as well. So we're looking for these hallmarks. And what we should pick up in the subjective is progressive tendons stress. So the example would be walking for the Achilles versus running versus hopping or jumping or London being progressive load, the higher you go up that ladder, the more it will flare them up or make them sore. And then what we're trying to do is look at the sin factor, then if you guys use that, as well, so severity, irritability, and the nature, but the irritability is key, the more irritable these are the lower level, we're going to start your rehab. And a lot of this subjective really helps guide our initial intervention program. But of course, on top of all this, we've got to consider the patient and the complexities that we get from our psychosocial component. And we've just had a sort of paper out with Neil Miller, and the group from Glasgow on biopsychosocial approach to tendinopathy. This the icon statement from the international group, that Karen Silverado that you mentioned earlier, and that's really looking at the psychological factors and social factors that are relevant for tendinopathy. Because like any musculoskeletal condition, the person's important, it's not just the the localized tissue that we sometimes can get overly focused on. 12:25 Absolutely, I'm preaching to the choir there. Now you had mentioned something in that, just now the warm up response. So can you explain what that is for the listeners in case they're not quite familiar with that? 12:38 Yeah. So this will be the person that will go for a walk or a run, or whatever their activity tennis, squash, whatever it happens to be, and they'll find it sore initially, and then it will get better, it feels better during the activity. And we tend to see this happens when they've sat for any length of time, if they're an inactive person, they'll get the same response then so the first five minutes of getting up having sat for an hour or two will feel sore, and then it gets better. And this is particularly common in the morning, where patients get up. And they say I was sore for 10 minutes until I've walked downstairs, made myself a coffee or had a shower. And then I feel better ready for the day. And that's typically what we see. So this sorts of pain that is focused around starting an activity when you've been inactive for a period. So that's 13:27 excellent. Thank you so much. So going back to our fictional patients here, they come in, they've got sort of posterior ankle pain, you've ruled out posterior ankle impingement, sural, nerve, local tendinopathies. And now you're really thinking well, given their subjective exam, given the little bit of objective exam that I've done, I think that we're dealing with an Achilles tendinopathy. Right, so you've kind of made that diagnosis. Now, what happens? 14:03 So once we've determined that we think it's an Achilles problem, we just want to make sure that's the case. And the best, most accurate, sensitive clinical test at this moment, whilst it gets a bad press is actually the site of pain. So asking the patient's point to it, or you look at then gripping it and looking at how Patri pain, they should put them to touch that tendon. If it doesn't, then we perhaps not dealing with an Achilles problems that would set up some alarm bells. The next thing then is to work out what sort of tendinopathy they have. And within that, what I mean is there's this sub entities, so there's different groups that will cause Achilles pain. So you could have a parent teen and disorder, like I mentioned, with myself earlier, which is essentially inflammation of the sheath around the tendon a bit like you get with the equivalence, Tina synovitis in the wrist or thumb is that same process, and that probably needs to be managed very differently because that's about friction of the sheath against the tendon. And so we've managed differently, we'd also then consider insertional, tendinopathy versus midportion, the risk factors, and some of the subtle management may differ. And as part of that, often we'll talk about trying to reduce compression of the tendon, which is what happens when you're in a dorsiflex position where the tendon will swash against the superior aspects of the calcaneus. That is had probably inappropriate interpretation from lots of clinicians, where they've heard about it and then say, we should avoid dorsiflexion. And patients then get told to avoid it. But that is forever. And of course, dorsiflexion is normal. So we've got to make sure we have encourages it. But in a highly irritable case behind center factor, we'd avoid that in the initial phases, or reduce it. So might use a heel wedge, so midportion and insertion burn, then with the mid portion, we're trying to look at whether it's really related to the Para tienen there's a potential of a partial tear. Or you can get these other disorders, which we have academic disagreements about, called splits, where actually, if the fibers run sort of longitudinally, you can get a pull in a part of the fibers. And they're called longitudinal splits, or occasionally get a flat tear where the back of the tendon or deep section and tendon pulls off. 16:18 Clinically, for me, they are much harder to manage. And they're the ones that I have, certainly in the last 510 years, made much worse, both symptomatically, functionally and also structurally. And they're the ones I think we need to be cautious about how we look at differentiating those out clinically is on subjective, again of how did it start? Was this a onset that you develop during a sporting activity or a activity a functional activity, like crossing the road and stepping up a curb? Or going down stairs or making a bed or something? Or did it involve whatever else or did it just come on gradually, you were sore the next day, after you did a long walk or a long run, that's more akin to normal typical tendinopathy being a generalized process of degeneration with some inflammatory elements that we sort of know and love as tendinopathy. But these sub entities seem to be very different, I think for management, the problem with all the research, nobody splits them out. So all the research doesn't differentiate out these sub entities, they stick them all together. And part of this is why I think a lot of regimes have washed out, they they look like people get a generally good response, some get worse, some don't respond. But generally about 70% of people get better. I personally think if we can look at these different entities, we will probably improve our rehabilitation. And Karen silver novels work I've forgotten now is going to go ahead and first author a bit. So I apologize. Currently the senior author, they've looked at actually identifying clinical groups, so psychological. So the profile group, a structural group, and more of a biomechanical sort of weakness group. And that's, I think, got some legs to go forward with how we might look at our patients in the clinic. And remember, if there's one more group, there is one more sort of sub entity which is plant Taris, induced tendinopathy. So typical presentation will be middle section pain, a little bit higher than typical midportion. And they may find that actually been in plantar flexed or dorsiflex positions when contracting the muscle, and therefore loading the tendon actually hurts. And that's because the RENNtech muskies work that he's done has shown that you get some compression of the plantaris tendon against the Achilles tendon, it seems to then set up a tendinopathy based on compression. So we can identify that clinically with palpating, the medial side. But ultimately imaging is probably then the better way to identify it. But it doesn't mean they need surgery, either. That's the other important message for you to take away from it, they've always had that plantaris. It's always been there for that person's life, they've developed the symptoms for whatever the reason, and they will probably respond to normal management, but maybe with some modification to load in in dorsi, flex or plantar flex positions. So we work in the middle a bit more initially until we're starting to settle and improve. Certainly in my clinical work, they will settle just as well as any other area does. But of course, with a lot of the research people are seeing tertiary sort of work failed, we have failed rehab with multiple people. And then of course, they're more likely to go on to surgery. So we've always got to interpret the literature a little bit with caution based on the populations that the research groups or whoever is writing the paper actually see and deal with clinically. 19:45 Yeah, that was a great overview. Thank you so much. Now that you mentioned imaging, so can you explain how you explain to the patient Do you need imaging? Do you not need imaging? When it comes back? Let's say an MRI comes back. And they're all out of sorts, because Oh, the doctor said, I have damage to my tendon, how am I going to fix this? Right? So how do you deal with that? Because if that is what happens, and then people say, well, when we're done, should I get another MRI? So that I can see the tendons back to normal? So how do you respond to that? 20:29 So that last one I'll deal with first, that is that actually, you're probably going to see some residual changes in the tendon that will take a long time to settle down. And this may be akin to scarring. So when you put your hand you end up with the scar afterwards. And that actually, what we're seeing on the imagery at a later date may be similar to that scoring process. And also reminding them that attendance is very slow to remodel and recover. So really, we're talking about imaging a year plus, if we want to look at it. And it doesn't matter what the tendon looks like, it matters, whether their symptoms and their function and good early on, I would have a different conversation in an elite sporting population, though, where actually, we know that attending that has structural changes is seven times more likely to develop symptoms the next season. And actually, I would probably then want to be changing the tendons structure. But again, that will be a discussion I have with the medical team, perhaps not the athletes so much, because we don't want to, we have to be very careful about the psychological impact of our words with our patients. And this is why imaging has had bad press over a number of years. Because it's often given to patients and they get told, Well, you've got tendinopathy, you've got big tearing there, there's loads of fluid and inflammation and the patient's like, well, I need to then rest until it settles, I need to sort of get this better, and how the hell is it loading exercise is going to help me get better when that's actually what's triggered it. So they're the clinical challenges that we have to explain in terms of the first phase, when we do the imaging, I simply try and D threaten them with it. So say, Look, this is typical of what we'd observe for somebody with tendinopathy. So that is tendon pain that you've presented with. This is not out of the ordinary, this isn't something that's particularly severe, assuming that that's the case based on the imaging. And I've also with MRI identify that it's actually a poor technique to look at collagen. So all we're going to see is high signal, really, it's very, very hard, you need to be have an excellent scan and an excellent radiology radiologist to really examine collagen fibers with it. So it will tell us how big the tendon is. And it will tell us how much fluid there is in there. But we know that that doesn't have a strong relationship with pain. And this is again, part of the reason why we wouldn't want to do it down the line say much. Having said that, again, Karen southern handles group, it's got some lovely papers that have come out that showing structural change does occur with functional resolution and improvement in symptoms. So we've got 42 different research groups in the world at the minute the Australians have often said we shouldn't be looking at imaging, whereas actually Karen's group and I think where we're taking it in the UK is that we should it has a use. But we've got to be very careful with that interpretation. And we certainly see changes in tendon structure as we have patients, we don't need to see it in order to get resolution. But that's because structure doesn't correspond to what's likely to be the key chemical factors in the tendon that are actually what's triggering pain. And we know there's lots of different chemicals involved in tendinopathy. So it's sort of trying to tie it all together. My reason for imaging, I use imaging in practice most of the time is to help we lay patients fears because often they're concerned about the risk of rupture. And this has come out in Shama core lifts qualitative work on Achilles patients. So by imaging, I can actually say, Look, your tendon has plenty of healthy tissue here. This, as best we can say, at this moment in time, is a very low risk for rupture is no higher than a normal person, because there's the same amount of tissue as a normal person would have. 24:06 Where we then have to be careful is where we find that's not the case. And we've just been doing a big longitudinal study in premiership rugby in the UK. Looking at this to see about how that changes. And Matt, who's doing a PhD with me, is going to be analyzing and looking at that data. So Matt Lee is head of medicine at Northampton saints. So Matt's got a big bit of work to determine whether really it ties in and whether we can predict who gets more symptoms, how that ties and, and they don't leave those, but we need to test that and so we're going into it to see probably, but yeah, good use, I think for imaging but not longitudinally imaging for most of your patient group. And it's not necessary and most of you patients you've got coming through your front door for a normal practice. But where there was a sudden onset of pain during activity, and they don't respond Do a six week sort of period of intervention or 12 week period, that's when I would want to image to see what I'm dealing with. Or where there's overt metabolic changes in the person. So adiposity, so high lipid levels, high adipose levels, so the waist circumference, and diabetes, then we want to just make sure they've not got some underlying problems, like, sort of gout that's going on or pseudo arthritic complaints. So yeah, that's where we're going, we might just step up a little bit and maybe consider blood tests as well. 25:33 Great, thank you. Now, let's move on to some treatment options. Right? So we've we've done the differential diagnosis, maybe we got imaging, maybe we didn't, we've, we've ruled everything out, we're pretty confident we've got an Achilles tendinopathy, I will leave it up to you, if you want to say well split it from like, you know, lower to sort of an upper you can, I'll let, I'll leave that in your hands, and how the rehab may be different. 26:05 There's no magic. So that's the first thing. There's no exercise, it's better than the other. It's about understanding the basic principles of rehabilitation here. And this is really what we do, I think, for all of our patients we ever see during a normal clinical role is going well, what do they want to do? Where are they now? How do we bridge that gap? And that's essentially what you're trying to do with your patient is, what's their functional ability at this moment in time? What do they want to do going forwards and coming up with a strategy to try and progress through that? Making sure that that allows for appropriate timescales. So tissue recovery, after exercise, if we're trying to adapt muscles, and muscle strength, which is often one of our big aims, we need to allow appropriate timescales. So 12 weeks plus, rather than expecting rapid changes quickly. So what that looks like in practice is going well, initially, we're going to start off with some form of loading for the Achilles tendon. Now, I would use a very, very isolated exercise, because you can compensate by offloading us in other muscles if we do more complex tests often. So an isolated simple exercise will be a heel race, you can't cheat, you can't use your quads and glutes to compensate, you have to use your calf and it puts stress through your tendon. And there's a nice work with Steph Leser, there's just to out on a systematic review, we're just sort of tweeting about earlier today on tendon material properties and how loading modifies the tendon, and part of what we want to do is improve the stiffness of the tendon, because with the Achilles tendinopathy, it will be less stiff. And that's generally pretty accepted. So we want to make it stiffer. And loading does that the loading needs to be progressive in nature. So we use the symptoms to determine that current simple novel, initially pioneered the pain monitoring model. So looking at how sources during the activity and afterwards, getting an appropriate level of discomfort that the patient can tolerate, doesn't impact their function and making it harder. So something like bilateral heel raises if somebody's really Niggli and saw progressed to a unilateral heel raise, that's about four times body weight through the Achilles tendon. For a bilateral erase, again, depending on the modeling method that's used Josh Baxter in the state system, some nice work on this in his lab, and he's got a lovely paper with Karen as well showing exercises that increase tendons stress. And that's a really good paper for your listeners to have a little read off to look at how to progress or to give ideas of exercises and how they would progress through that. Running, for example, be about five to six times body weight for the Achilles per step. So what we're trying to do is go well walk ins for running six, how do we cross that boundary and use other exercises, or just add external load on to heel race, which is probably easiest way. And that then allows very isolated, monitored exercises. At the same time, I would always use walking or running the same period of time, we wouldn't withdraw them unless we're very, very slow and very struggling. So we'd always use that. And in most patients, if we're not talking athletic, we don't need to use plyometric training jumping up in and stuff we can use walking and running, if necessary to do that. But the more elite athletes, I would always be looking at plyometrics. So hopping jump in London, whatever it happens to be accelerations decelerations off tangent runs, they all increase the stress through different fascicles of the tendon. And that's I guess one of the aspects we can consider that's not been researched yet, and it's where we're going with our work is how we might bend the knee or straighten the knee or rotate the foot to isolate the stress through different sections of the Achilles that correspond to where on imaging we see the degradation. So if we ever want to remodel the tendon, we also need to Reese stress To the tendon at an appropriate threshold, that needs to be 85 to 90 or more percent of your maximum voluntary contraction. And let's face it, we have never done that because most rehab doesn't quantify strength. So I'd always measure spend 30 on a lot of you guys, I think in the states have access to isokinetic devices within your clinics or in local clinics, or other force measurement devices. And I, Scott Morrison's, got quite a lot of sort of workout suggesting how you might be able to do this with a handheld dynamometer, then there's methods we can do with that, or even a set of bathroom scales, to actually utilize a measure strength to give a patient a marker. So our normal data in rugby and football on large cohorts is twice body weight is normal. And we've got similar in endurance runners, our patients are typically one and a half times the weight. But that means doing a heel raise with just their bodyweight will not strengthen them significantly. And that's where we lack we have been our rehab has to be a lot heavier than we've often done in the past. So yeah, so in a nutshell, bilateral raises unilateral progressing through I don't use isometrics early as a method for pain relief, because the evidence substantiates it's not actually that good for pain relief, unless patients find it when the fork which case use it, the heel raises. good warm up response anyway. 31:24 Perfect. Yeah. And in the states do a lot of places have isokinetic testing? I don't know. Sorry. I don't I don't know about that. Even here in New York, I don't think you know, outside of like the larger systems. I don't know that a lot of individual physical therapy offices have that i i do have a handheld dynamometer. And I'm lucky enough to be friends with Scott Morrison. So he was able to kind of take me through and and how to use it. And but it's sometimes this setups can be a little complicated, especially if you don't have an office, if you go to people's homes, how do you stabilize one end and use the other end, and I've come up with some interesting options? Yeah, it's work. I use a seatbelts, I have chains, I have like this, the green, you know, the green stretch strap. Yeah, that with all that I started using that, because it doesn't give, you know, it's pretty, it's pretty good. So kind of it kind of along the line of a seatbelt, you know. So I started using that instead of using even some chain link, I found it to be a little bit easier, a little more gentle for people on their phones, 32:49 strap ratchet strap that you might use on a roof bar. So roof rack, you might actually use that strap and those type of straps can be very good, especially if the wider if the narrower than it hurts the person's knee when you strap it on top. But ultimately, I like it because we can showcase that they need to do strength work because they are weak, more data to give them when you haven't got that opportunity, it's really just sort of giving them this sort of step sort of wise approach to go while you're here need to be there, we need to progress through this and you then just target an exercise that is tolerable, but is sort of getting a little bit of reaction afterwards for a short period. So I've said bilaterally raises unilateral, unilateral with weight, or progressive forwards. And if you're a physio or PT that likes lots of different exercises, give them a dozen, that's fine. But if you're like me, I'm very simple, I just give them one or two things to do really well to do very regularly. And what we avoid in that way is they don't do the things that feel comfortable and easy, because that's what patients generally do. And they're avoid the ones that hurt them because they think it's making them worse. But if we educate them that this is critical, we've got to poke it a little bit to stimulate the cells and improve muscle strength to help the muscle shock absorber for the tendon, which is our current understanding of what we're trying to do with rehab. Then we've got to actually sort of work very well in a bit of discomfort. 34:21 And you beat me to the punch that was going to be my next question is how do you talk to the patient about like, this is not going to be pain free, necessarily, you know, you're gonna have some discomfort. So you kind of beat me to the punch on that. But I think it's important that patients know that you're gonna have some discomfort with these exercises and that's okay. Because a lot of people have been told, I certainly I see it, I'm sure you see it their whole life if it hurts, don't do it. 34:47 Yeah. says and what you've got to explain to them and I often use examples of relatives that you might have had that have had a hip or knee replacement done in the hospital and how afterwards they have to bend it have to walk And actually, yes, it hurts when he gets better or if you've broken your arm and you're in a plaster how gently stretching out when you come out of plaster help to get better. And that's then normally enough to help people go. Yeah, I understand that I can see how that would help and I also then often just explain that as you do this and you get the symptoms afterwards that's the cells in the tendon excreting some chemicals that whilst it makes it a bit sore, they also actually be modelled the tissue. And what we're trying to do is wait the cells up to repair the tissue, wait, repair the tendon, but also improve your muscle as well at the same time. And we've got to stimulate it. It's no different from delayed onset muscle soreness if you go to the gym so that's the other one that are commonly used as the example then we'll turn them penis Dom's is this chap called William Gibson in Australia has done a whole PhD on delayed onset soreness, because it's tendons that you've looked at and connective tissue, not muscle fibers sarcomere itself. And his work I think is really pivotable pivotal with our understanding of it. So yeah, flip it around as Dom's most patients have had Dom's at some point in their life. Yeah. 36:11 Oh, that's great. Yeah, I love that. Well, I have to say, I'm gonna have to re listen to this a couple of times, even though I'm here, I feel like I'm missing things. Like you're speaking I'm like, wait, what? Wait, did I miss this? And we have to listen to this over and over again, because everything is so good. And I think thank you for making it so applicable to the practicing therapist. Because I think that there are nothing against researchers. But there are a lot of practicing therapists out there probably more so than researchers who depend on you guys to be able to to some disseminate this information in a way that is practical and makes sense. So thank you for that. Now, as we start to wrap things up, what do you want the audience to take away from our conversation today? What are some key points, 36:56 I guess the most important parts of monitoring and treating people with tendinopathy is just get your diagnosis right in the first place. Differential diagnosis gets a lot of bad press at the moment, I think on social media, and it's been wanting to sort of dumb down and go with just we've got posterior heel pain, but how I treat an impingement versus tendinopathy will be very, very different, you need to differentiate. And then you need to look at isolated tendon and muscle exercises that is progressive in nature. And I think the key message to physical therapists and physios is that we need to load a lot heavier than often we've done in the past. And by getting normative values for certain sports like we're doing at the moment will help guide what we should be targeting. And they have performance relevance as well when you're dealing with athletes. But for a normal patient, this is a difference between crossing the road quickly in front of the car that's coming in, versus actually ended up with the car getting a bit too close to you. 37:55 Got it? Yeah. And and I love that load heavier and looking at the normative values, because like you said, if running is five to six times body weight, and you're working with someone doing a single leg heel raise, just with their own body weight, that's just not going to be enough. Yeah, right, we've got to we've got to push them a little bit more to load a little heavier. So thank you for that. Now, Seth, where can people find you if they have questions they want to ask you or they, you know, they want to find your research, where can they contact you. 38:27 I'm not a huge one for pushing the sort of research out other than via Twitter. So I have a Twitter handle that we sort of use regularly. And we'll put papers on there and things. But I don't have technically got a website that's on my Twitter profile, but I don't update it. So I'm terribly slack and too busy to bother updating it and need to sort it out. But hopefully this next year, I have a bit more time. So Twitter's The best one is just Sefo Neil, but yo is zero, because there's already another stuff anyone in the world someone and then my other handle is Achilles tendons on there. And just so you all know, it wasn't ego thing. We set it as Achilles tendons, because we went on Twitter originally to recruit patients for our research because some cancer specialist at the University had suggested it was a really good way is terrible, because you need loads of followers to be able to recruit patients and actually get your message out there. It was great for networking. And that's I think the big thing with it. So I network predominantly and occasionally advertise research projects that we're doing now. I've got enough followers to actually get some patients through the door that way. But yeah, not ego because it just so we're clear, 39:33 of course, and we'll have links to those Twitter accounts in the show notes at podcast at healthy, wealthy smart.com. And like I said at the top of the our conversation, you are speaking a few times at the fourth World Congress is Sports Physical Therapy in Denmark at the end of this month, August 26 to 27th. So do you want to give a little sneak peek about what you're going to be talking about? At And what are you excited about for the conference? 40:03 So, myself and Karen Silva novel are going to be running a joint session for the British Journal Sports Med breakout on treating people with tendinopathy. So we're gonna do two sort of sessions of that. So replicate it. So hopefully, if you're interested in coming in, you can come in and send that and hopefully, it'll be nice and interactive, and flesh out some of the aspects we've discussed now, Karen, and then I'm chairing the session, which will be the session that I'm most looking forward to with Karen's there, who else have we got, I gotta get it right now. Michael Caja, and also Ben, Steph, Dakin, as well. So really looking forward to that. We're really nice to hear these guys talk because they are literally at the top of that sort of pinnacle of researchers and clinicians really worldwide. And then Denmark's nice. I mean, every conference, all I've ever managed to see is a little bit of Copenhagen. Because it's been sports Congress. And I normally dash in and bash out at conferences. So it's a little bit the same this time around. But I'm actually looking forward to seeing a bit of seen a bit of Nyborg. And also put two hours in the middle of the day for activity. And they've suggested paddleboarding. And whilst I dislocated my shoulder a week ago, or two weeks ago, it's my second time and I'm actually I was paddleboarding at the end of the week. So I'm hoping that there'll be a bit better by then and actually get out and have a decent paddle board and some exercise rather than just sat at the conference. So that's one of the things I'm looking forward to, and of course, enjoying a small beer with yourself. 41:40 That's yeah, it's a small beer. I look forward to it. And I'm looking forward to going in the summer, because I've only been to Copenhagen in February, and it is cold, and snowy and rainy, and all that stuff. So I'm looking forward to going in the summer. And just looking forward to seeing a lot of people that I haven't seen in a while. So that'll be really fun. And now last question, it's a one I asked everyone knowing where you are now in your life and in your career, what advice would you give to your younger self? 42:13 Oh, gosh. Yeah, it's a really hard question. For me. I always fancied doing research, but I was always put off because there was no ability to do it when I first qualified to do a PhD in the UK was rare in physio, and you might have been able to get a stipend which is 15,000, a year, UK, which actually quite peaker often they further physios as well. Whereas now I'd actually say if that opportunity comes up, even if it's a bit of paper, I take it if you can, because it does open a lot of doors as you progress forwards. And I would unlike other people, sometimes I'd actually say yes to everything. Generally speaking, when it comes to work, not anything else in life, to look at options that we can just opens doors, you get so many things that you don't realize where it will lead and you agree to do something and actually, certainly in these uncertain other things that are fantastic and change your career. So say yes to things when you can push yourself. And yeah, you'll get that. So read the next Roscoe put that. 43:21 Perfect. Thank you so much. This was a great interview you gave us so much to think about as myself as a practicing clinician. So this was great. Thank you so much. 43:31 Pleasure, absolute pleasure. And thank you very much for having me, Karen. Yeah. And 43:35 everyone. Thanks so much for tuning in. Have a great, great couple of days, stay healthy, wealthy and smart. And also if you hope to see you in Denmark, so there's still time we've still got a couple of weeks before the end of August. So if you haven't already, sign up because it's going to be great. So thanks, Seth, and thanks everyone for listening and stay healthy, wealthy and smart.

In this episode, Founder of the Elevate to Thrive Academy, Relinde Moors, talks about self-limiting beliefs and entrepreneurship. Today, Relinde talks about how our inner work can determine our business success, and how to identify limiting beliefs before they take hold. What are 5 limiting beliefs that keep us stuck? Hear about ways to change limiting beliefs, how our thoughts impact our beliefs, and get Relinde’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “You can shift a belief in a moment what has taken a lifetime to build.” “If you are feeling a desire to change that story in some way, you actually can.” “The thought creates a feeling or emotion, and that emotion creates an action.” “The thoughts, in the end, creates the result, not the circumstance.” “If you have the vision or the idea or the feeling or the impulse, that is the thing to follow.”   More about Relinde Moors Relinde Moors is the founder of the Elevate to Thrive Academy. Elevate to Thrive helps vision-driven coaches and experts make more impact and money, by elevating their energy, story, and sales. Her clients have turned their freelance work into a multiple 6-figure thriving business, changed to 3-day workweeks while doubling their revenue, and moved to their dream country with their now 100% location independent online empire. Her signature approach comes down to creating a clear and simplified business strategy and elevating your subconscious beliefs to support you goals. Relinde lived and worked worldwide and recently found her way back home to a beautiful little ‘castle’ in a Dutch forest.   Suggested Keywords Healthy, Wealthy, Smart, Entrepreneurship, Limiting Beliefs, Vision, Strategy, Myths,   Resources 5 Myths About Limiting Beliefs that Keep Entrepreneurs Stuck. How to Assemble a Mental Superhero Team to Realize Your Dreams.   Get Your FREE Gift!   To learn more, follow Relinde at: Website:          https://relindemoors.com Facebook:       Relinde Moors LinkedIn:         Relinde Moors Instagram:       @relindemoors   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hi, are you there? Got it. Okay, great. Yeah, yeah. Hi, Melinda. Welcome to the podcast. I am so happy to have you on as a guest. We've been trying to do this for a while. So I'm really excited. Thanks for coming on.   00:19 Yes, thank you for having me. I'm really happy to be here. Finally.   00:22 Yes. And our connection is we did Selena Sue's impact accelerator in 2020. I believe it was, because it was right during the beginning of the pandemic. And so we spent nine months together, I think, right? Was it nine months, six months, nine months was a long time. So it was really a wonderful group of women led by Selena and her team. And Linda was one of those wonderful women. And I'm really excited to have you here now. And we are going to talk about some limiting beliefs that we may have as entrepreneurs that keep us stuck that don't allow us to move forward. But before we get to those nuggets, let's talk about how you came to realize that business success was highly dependent on the inner work we're willing to do. So I'll kick it over to you.   01:23 Yeah, great. Okay, so a little bit of my background, I studied dance and theater. So I actually worked as a choreographer as a dancer for like, 17 years, and I have my own dance company. And, and I thought that that was going to be what I would be doing my whole life, until things just changed. And I ended up going for a holiday to Bali. And in that holiday, a lot changed. And a lot happened. Long story short, I decided to quit my dance company. And I decided that I wanted to start more of a business of my own and an online business. And I ended up staying in Bali. So I got a little job there in a local yoga school teaching yoga and teaching contemporary dance, making very little money, because that was in rupee, us. And you need a lot of rupees to go around. So I could just maintain my living there, I was living on my savings, and I was making there. And in the meantime, I was learning more about business. Because even though when I look back, I wasn't an entrepreneur before that. I really didn't know that in a way that was just artistic. That was my focus. So it was learning about entrepreneurship, about online business, I found out how to do things I learned all the techniques started to create online courses, that all the things but it didn't really take off. And in that time on Bali, I took a course on limiting beliefs, it was specifically on that topic. And in that course, I at one point said to the teacher, listen, I need to really take a break because I'm working with a business coach, and I need to write my about page and I need to write all these things. And I have been working on it for days and days and days. And I don't seem to get it and I need to spend time and she said, that's okay, you can take the afternoon off. But why don't we look at the beliefs that are in the way of you just writing them. And she tested beliefs. And I remember there were beliefs like, I am a leader, I'm an expert. I I know who I am, I know what I want to do things like that. And some of those beliefs and I say tested actually have to explain that. We tested that with muscle testing with a Kinesiology technique. And she did that. And they were like testing as a no. So we worked on the beliefs and right after I said, Okay, I'm gonna sit down and write is about page and I just wrote it. I got it out. And that felt really good showed it to my business coach. And about like, two weeks later, I started to make so much more money. I literally made $15,000 In two weeks, which was totally surreal for me. And from then on, just something clicked in my head, I was okay, I needed to shift certain beliefs to have a breakthrough in a way to put myself out there and actually run a business and make money in a healthy and empowering way.   04:33 And what were the beliefs that were holding you back? What did you have to step over?   04:39 Yeah. I mean, fairly, honestly, a big belief that I found that I didn't know wasn't in because these beliefs live in your subconscious. So they often feel very big and dramatic, I would say. But there was a belief that I found that was I'm a failure, which was also related to me as because in the Netherlands, I was having a good career as a choreographer, my dance company against all odds was touring in the Netherlands and, and even abroad. And I was quitting that, but I felt I'm a failure, I'm like a failure, if I do that, because I didn't become this artist, or I'm gonna always feel at this business thing, I can never make so much money. So that were the kind of beliefs that I was mainly battling. And, and that and that felt deep, that felt really painful. It was very confronting to look at that. And to, to see that and so we did all the work around it. We'll get to that a little bit. Maybe later on, but there's just events in life that create those beliefs. So all of that came up. And I had to work through pretty emotional things to really let them go and have the change happen, because those beliefs changed.   05:59 Yeah. And now let's talk about those limiting beliefs. So there are a lot of myths kind of swirling around about some limiting beliefs that might keep us stuck. So why don't we dive in? I think there's five I'm sure there's 50. If there's five, right. But we'll take maybe some common ones. So let's, let's talk about number one.   06:26 So one is that a belief is just a thought that you keep thinking? And I don't I don't agree with that it does. It's not for that song on repeat. Because very often, we don't even know what are those beliefs, we think now I think I'm good enough, I think I'm good enough the way I am, right? And then when you look at the subconscious mind, it might not actually deep down believe that. Or I've worked with people, even really successful business people that make millions, and, and they have built so much success in their life. And I've worked through that. And they have, you know, the cars and the house, and they have the success. And we worked and we found beliefs around confidence. Like again, like the kind of I'm not good enough beliefs, or I'm not confidence, I actually don't know. This only can cut. And, and what so what seemed is that you can have this external reality of really success and being confident and being all the things. But then the belief doesn't have to support that. And then it even seems that this belief of I'm not successful, or I'm not confident, so I'm not good enough, actually became a motivator. A drive to always work harder to always do better. So it becomes it's another reason for the for the subconscious mind to not let go of that belief is like, hey, we get a lot out of that. Mm   08:01 hmm. Yeah. Especially if it becomes a driving force, you think, well, this is a good thing that I think or believe this, because it's driving me to where I am now. And then so then the question is, Is it harmful to get rid of that belief? Or what would happen if if that belief were to change if that's your motivating factor?   08:22 Yeah, when I work with my people, like in the method that I use, really, literally tell the brain? I mean, we will look for like, what are those benefit benefiting factors that came from that limiting belief? What are the good things and often Yes, motivation, or I'm connected, you know, other people like me, if I don't have I'm not so successful, I play a little small, and really liked and loved. And, and those are good things. And it's good to be connected to other people and to be humble even if you want that. But you don't need the limiting belief for that. And we will literally tell the brain, you can be successful and still be liked and loved and still be a really good person. And you know, you can have all those good things. I'm thinking of a woman I worked with, and it's a really clear example. She had this limit of she had her own business, and she was making about $5,000 a month. And she really felt like a limit there. Like, really like every time I go above that I get really uncomfortable. I do something to have a be relaxed the next month, she would even sometimes get physically sick. And I said, Okay, let's look at the belief. And what turned out is that in her life, in many different ways, she had learned that it's really, that you become a bad person if you make a lot of money. And she had worked before that for oil and gas companies and had stopped that because she felt my values just don't align with that. But it was over Ever in her life, it was reinforced that you can only make if you make a lot of money, you're a bad person. And when we could switch that I remember so well that she switched it. And she said, Oh, I want what I really want to believe is that money can be a force for good. And that if I make lots of money, I can make a beautiful positive impact in the world. And she literally, we did that session. And literally the next month, she started making three times more or four times more, just because she could not do that in a way that will stand in line with with her values. Really?   10:43 Yeah. And that's a deep, that's a deep one. To get over. I was   10:48 really deep. And then you also see it already, the parents have, you know, always taught her things like that. And then you just see how to hold family. And of course, the whole society would would teach things around them. Yeah, yeah. Oh, wow.   11:02 Okay, so that's a big, that's a big myth. What's Myth number two.   11:08 So Myth number two is that you can just replace the belief with a simple thought. So you just decide, I don't feel good enough or rich people are evil, like rich can be literally you believe or if I'm rich, I'm, I'm, I'm bad, or anything like that. And then you see it, and you just change it. Sometimes that might be the way and that is great. But it really isn't always. And that is because there's different reasons, as we just talked about this idea of like, hey, it's actually served me that the subconscious holds on to it. I speak about four reasons which one reason is the gifts as we just said, like the good things that came out of the limiting beliefs is the fear of the positive belief, I have so much money, that no, I will lose all my friends, because we will get to bigger difference, for example. And then there is people in places, which is people that told you that. So for example, my father told me that and I'm part of the family, as we just said, because he believes that so I want to believe the same. And then as emotions, which has to do with forgiveness, letting go of anger and letting go of resentments or regret.   12:22 Right, so you just can't say a positive thing every day. And poof, the belief is expunged?   12:30 No, yeah, as I said, it's really great. Because sometimes, yes, sometimes that works. But if something is a bit deeper, it's really good to do some deeper work around it. And that is, yeah, what I hate if people feel bad because of that, they're like, Oh, I just did all my affirmations. And I noticed and still I don't do this, and they almost get angry with themselves. And I'm like, let's get really kind with ourselves, because it's nothing but your subconscious mind actually wanting to protect you and thinking, hey, this believe we've had this for a long time. We want to keep it Yeah, right.   13:07 Right. Okay, that makes a lot of sense. Okay, what's Myth number three.   13:12 Myth number three, that would be another side of the coin is that you can't change them. So some people think this is just the way you are, people don't change in the core as they are, this is how it is or, and that is not true. either. You can definitely change them, you can change them on a deep, subconscious level. And then it will be you will almost forget it. Like I get clients and I have forgotten that I felt that behavior. Normally I would get really nervous if I would get on stage and speak in front of people. And this time, I just didn't even feel anything because we shifted to believe that was causing that nervousness, for example.   13:54 Yeah, and I'm sure a lot of people even as they get older, so you know, I've, I've been around for 50 years, you're not going to change my beliefs. That's part of who I am. Right. So that must be challenging to work with someone like that. So how do you approach a person that may come to you and say, Well, this is me. Can't change it? Yeah,   14:15 absolutely. I mean, first of all, I would talk about the fact that a lot of the beliefs that we have appear to be the truth, and that this might be one of them. So I would challenge that and I would see if I could get an opening in and what if we could we could change in right now. And and and then it might take time to really embody it and to really integrate it in your life. But what if that wouldn't be possible?   14:50 Yeah. And then it gets people thinking, Well, I mean, well, what if it did happen, then what would the outcome of that be what would my life look like? If I was able to, to change some of these beliefs that I think are impossible to change.   15:06 Yeah, exactly. I would also explain that. And this makes it quite concrete, I think that we have, you know, you have all the outer circumstances in life, the things that we experience. And then sometimes we feel powerless over those circumstances. Yet, the moment that you become empowered is when you think, Okay, this is the circumstance, I don't know, what would be a good example something that we're not happy with.   15:36 Let's say your what's your it'd be a good example. You. I mean, we can you can't find people to join your or to to be a part of your online course you you're launching an online course you've launched it, it's been a couple of months, and it's crickets no one's coming. So must mean oh, well, I just as I thought it's not good enough. No one's coming.   16:10 Exactly. Okay. Great example. So we have that circumstance, not selling anything, you did a whole launch did all the work, and it didn't work. So now, if your foot is exactly that must mean, it's not good enough, this is not gonna work, then you can ask yourself, Okay, I have that thought about the circumstance. I have that thought, what kind of what emotion does that create? So if I think you see is not good enough, I'm gonna feel a little sad and tired, I think and not so motivated to start over again. Then if I have that emotion, what kind of actions do I take? Maybe I quit it once. I, you know, I won't do it again. It's just like, I tried that this didn't work. And then I will have that results, it will never come. So this is how we and that is also how it works is like all the time does belief gets confirmed in life. That's how it works. So now when you change the thoughts, and you think, Hmm, interesting with curiosity, it didn't work this time. I am totally convinced that it can work. What can I change? Now you will have a different emotionally motivated, you're curious, maybe you'll ask a mentor or your hire a coach, I don't know what you'll do to figure that out. You take different actions, you launch it again, this time it sells out, yay. And then you have a different result. And then the belief will really be shifted. So this makes it I think, pretty concrete, and how those beliefs shape our reality, and how we actually have so much more power over our circumstances, no matter what happens, because we have power over what we think about him.   18:00 Yeah, I love that. And it, it's like, instead of looking at it as a complete failure, perhaps it's an opportunity to go a little deeper to do a little investigating. And to put it out again. Yes,   18:20 exactly. Yeah. And you know, if we go even a little deeper into that, for example, when I had my belief, I'm a failure, and some fat and I had actually a course that I sold it only to one person, and this person had in two weeks time asked for refunds. So imagine having that belief was horrible. It was so shit ashamed. You see, I'm a failure. So triggering that but having the understanding and then shifting, that belief was so powerful, not only for the business side, but in so many other areas of my life. So I now always say, Never waste a good trigger. If something like that happens. Yeah, that's amazing. We can find a belief we can shift it and that actually good news.   19:02 Wow, thanks for sharing that. What about myth number four?   19:08 Myth number four. Is that if you have that, yeah, we talked a little bit about that, but that it takes a lifetime to change them that if you've I've heard this often well, if you had something for 30 years, you will take 30 years to get rid of it. If you do and I really believe in going into that deep subconscious work. Because the conscious mind of course, it does a lot that the subconscious drives a lot of the behavior and results in the end, then you can actually change it in in a single session or in a in a moment. And then of course, as I said, it takes time to integrate it but they are Yeah, you can shift to believe in in a moment What has taken a lifetime to build? Yeah,   20:02 right. And I think that's important because a lot of people may think, Well, I don't have time to do this kind of work, because it's going to take months and months and months, years and years or a lifetime. I don't have the time.   20:15 Yeah, that that would be. It depends on how. So as I'll think about it right now is that it really saves me a lot of time, because instead of trying to change the outer reality, I'm going to get to the core shift the belief, and then the other reality on so many areas will change. So I think that that would be also my answer to that. And yes, indeed, it doesn't have to take you don't have to be in talk about it in therapy for a long, long time, you can actually find it another modality that works with this is EMDR. It has a similar approach. And yeah, I think it's very, very effective in a short amount of time.   21:05 Yeah. Because, you know, people these days, I mean, we can't even sit through, you know, an entire movie, sometimes going onto your phone or being distracted by a million things. And now you want to just short, tic TOCs, or short reels are all like, it seems our brain is primed to, to have the attention span for Do you know what I mean? So it's like, if it's gonna take a week, a month, years, whatever, people will throw up their hands and say, Oh, forget it. Yeah,   21:39 yes. And in a way, I think in a way, that is a way for the brain to avoid the possible, confronting things that this might bring up. So there is this feeling of I know, this might bring up things from my childhood or things that I find really painful. And I believe that that thought of like, I don't have time for that is actually a resistance to that might not because part of the work is in the moment maybe uncomfortable. Yeah,   22:17 yeah. So it's your brain saving you that discomfort and and protecting you essentially, that's what the I mean, our brains protect us, right? And so if, if the brain feels like, Oh, this is going to, no, I don't want to do this, it's going to be too uncomfortable. I'm going to protect you, we're not going to do it at all. If we compare it to like, the physical body. Like if, if you you were on a ledge, and it was a 10 foot drop, your brain would be like, Nope, because you're gonna probably hurt yourself, if you go down and jump off this 10 foot drop instead, why don't we take the long way around and use the stairs? To save to save ourselves? Right? So it's kind of the same thing. It's like the brain is just protecting you from what could be something that's uncomfortable that is going to make you do something you don't want to do.   23:08 Yeah, yeah, absolutely. Yeah, absolutely. Yeah,   23:11 that makes a lot of sense. Okay, what is myth? Number five? I feel like this is a big one.   23:17 Myth number five, is that the ones from your family that you can't change it? So this is a big one. And there are studies on that believes genetically or trauma genetically gets passed on, right? So there is and the experience is I just I've grown, this is who I am, we, my, my whole family lives this way. It's important for me to protect that. And I understand. And really, you know, sometimes when you change a certain belief or attitudes towards something, it might be that people are confused for a moment, or that it changes your dynamics with your parents or with your family or with your loved ones. And that fear, again, is underneath that as well. It is the most beautiful and empowering thing, I think to to realize that you can write your own story. That's how I think about it, that the family line comes with a certain story. But if you are feeling a desire to change that sort of story in some way that you actually can, and very often it actually changes the dynamic also for the better, very often it releases or unleashes things in the family that are actually really healing not only for you, but also for the people around you. Yeah,   24:50 yeah. So again, things can change. beliefs can change. So I'm going to recap myths one through five you'll let me know if I Don't get them. Right. So myth one is their thoughts just stuck on repeat. Myth number two, you just replace them with more positive thoughts. Myth number three can't change them hardwired? Sorry, I'm too old to change can't What is it? You can't teach an old dog new tricks, right? Exactly that myth number four, they take a lifetime to change. And myth number five, the ones from your family can't change. So all those are myths. So I think we've busted all of them. Now, a lot of people may think, oh, boy, subconscious mind, the brain. This all sounds a little too out there for me. So what would you say to folks who are resistant to go there? Because they think it's a little too out there?   25:47 Yeah. I would actually ask, like, imagine that you would see that as a belief, first of all, so that you would say, okay, I can, for a moment just play an experiment and the things that I see as true to my life. Let me see you this. Okay. That's the that's really the rooted belief that I have right now. And then play around with what if you would say, Yes, I'm going to completely subscribe to that idea. I'm going to think that limiting beliefs can be changed in a subconscious in one session, just like Melinda just said, like, what could possibly be bad about that? How could that be a bad thing? And that would actually be fierce around that whole idea. Now, maybe when you've determined that, why not give it a try? Like why you don't have to completely believe that it works that way. But why not give yourself the benefits of you know, give this whole idea to benefit of the doubt and just say like, you know what, I can experiment with it, I can just give it a go. And when a belief comes up, or when something comes up in your life that doesn't go the way that you wanted, or you have something that really triggers you in some way. Why not write down what you think the thoughts and the beliefs are that underneath that, remember that idea of we have the circumstance, the outer reality, and then we have the thoughts that creates a feeling the feeling creates an action and the action creates a result? So what if you would slightly change your foot around it? And just give yourself that that play of okay, well, good, what would that actually do to me?   27:32 Yeah, well, I love that. Can you say that again? So you start with the external, and then it goes to your thoughts. Go ahead. You complete it, because I thought that was really great.   27:42 Yeah, yeah. So yeah, so the external is a circumstance, the reality is the bank account that doesn't have enough money, the arm that hurts the I don't know. I don't know, boyfriend who is not calling like, I don't care, like whatever that is the business, as we said, the course that isn't failing. And then the thinking, okay, that's the circumstance. Now, what is my thought about him. And this is such a great first thing to do to become aware of the thought about it, you know, that these thoughts goes so fast, because you've practiced that a lot. So these wires in that house that is wired in a brain that is just happening so fast, that you might perceive them as the truth, but slow down, and just write down this is the thought, the foot creates a feeling or an emotion. And that emotion creates an action. So as we just said, If I feel a little disappointed and powerless, I might not take action, or I'll stop my business at all my online course thing at all. And that action creates results. So here's where you can see that the belief the forts, in the hands created the river, so not the circumstance.   29:00 I love it. I think that's great. And what a fantastic takeaway I was going to ask, okay, what do you really want the listeners to take away and I have to tell you, I think you beat me to the punch, because that's great. And it also shows, like we say, in the physical therapy world, I work with a lot of people with chronic pain, that the brain has plasticity, the brain can change. Yes. And it's not just in the physical. So what you're saying is you have these circumstances, here's your initial thought about it, if we can change that thought, perhaps the emotion connected to that which we sort of comes out of that amygdala area of the brain, that can be changed, that can be altered because the brain is plastic, and it can change. And I think that's such a great way to button up this conversation. I love it. I'm gonna think about that. Now. Every time something happens in and I have a thought and be like, Okay, wait a second. So Slow it down. What if I thought about it differently, I may have a different feeling. But then most importantly, your action will be different. So instead of saying my corset and tell I'm going to curl up in a ball on my bed and never leave, instead, it's my Corsten cell. Okay? Let me that could be an opportunity for me to go in and look at it, maybe jigger things up and see if I can, I can change things to make it a little bit more appealing. So then your action would be way different. So instead of curling up in a ball, it's let's edit this course, which are two very different things.   30:37 Exactly, exactly. Yeah, that's it. I love that.   30:40 Yeah, I love it. I think that's awesome. Now, where can people find you if they want to learn more about you, they want to work with you. Go ahead.   30:51 Great. Okay, so you can find me on all the socials, you can find my website, which is where Linda morris.com If you're listening, maybe not so easy. to spell that one, I do have a little mini course on how to shift any limiting belief. And I made a tiny URL, it's just to make things easy. And that would be tinyurl.com/shift. Any limiting belief altogether. So little sentence, that one, I think is a great one to have. It has a couple of videos and some PDFs, where all of the things that we just talked about gets explained a little bit more in depth and just give you a simple process to do it or try it out for yourself.   31:41 Awesome. And we'll have all the links at podcast at healthy, wealthy smart.com. So that you can go on and click and take a take this limiting shift any limiting belief course. So we will have all of the and links to all of your social media and everything else as well. Now, before we go the last question, which is when I asked everyone, and that's knowing where you are now in your life, and in your career, what advice would you give to your younger self?   32:13 Yes. So I would really tell my long younger self to be more trusting of the things that I felt that I want to I've been always doing things I would say kind of against the status quo. I've even had a teacher one who said you always have to make the impossible possible. And now it would be like okay, trust yourself, and then it's gonna turn out okay. And even if somebody else doesn't believe it, or doesn't see it, if you have the vision or the idea or the feeling or the impulse, that is the thing to follow. So that is what I would say. I think   32:55 that is wonderful advice for your younger self and for all of our listeners listening today. So Linda, thank you so much for coming on sharing all this info. And again, everyone will have all of her Linda's information at podcast at healthy wealthy smart.com. So Linda, thank you so much for coming on the podcast.   33:14 Thank you, Karen. Really lovely to be here.   33:17 And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.  

In this episode, Co-Founders of Trailhead Learning Collective, Jenn Bell, PT, ScD, COMT, and Audrey Elias, PT, PhD, OCS, talk about their work doing Continuing Education different. Today, they talk about the current state of Continuing Education, integration of information, and addressing Continuing Education courses. How is Trailhead Learning Collective different? Hear about active learning techniques, some upcoming retreats, and get Audrey and Jenn’s advice to their younger selves, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Our patients are human, but we, as clinicians, are human, and it’s important to respect that.” “There is a time and place for everything.” “There is an alternative way to get your continuing education done that also takes care of yourself.” “Remain flexible and keep watching for those opportunities.” “All of it is worth it. All those experiences are things that you can draw on.” “It’s alright to go do different things that aren’t exactly on your path.”   More about Audrey Elias and Jenn Bell Jenn Bell, PT, ScD, COMT, and Audrey Elias, PT, PhD, OCS, are co-founders of Trailhead Learning Collective. Audrey is clinical faculty in the University of Montana School of Physical Therapy and Rehabilitation Sciences. She completed her DPT in 2009, did her residency with Therapeutic Associates in Washington state, and then completed her PhD in clinical  biomechanics at the University of Montana in 2015. She then did a post-doc at the University of Guelph before returning to UMPT as clinical faculty, training entry-level students and residents in the DPT program and in the UMPT clinic. Her primary area of research involves how psychological factors play into movement, particularly following knee injury. Most importantly, she loves being outside, whether skiing, running, hiking, paddle-boarding, or lounging around a campfire with her son and husband. Jenn is the Program Director and Director of Clinical Education at UMPT. She completed PT school in 2006, then completed her COMT in 2012 and her ScD from Texas Tech in 2013, all while treating patients in a variety of settings in rural Alaska. She has treated patients and taught in PT programs in virtually every setting all over  the world, including Kenya, Ethiopia, and Malawi, and is an internationally-recognized expert in inter-professional education and global health. She is also the co-Primary Investigator and Team Advisor for Montana Inter-Professional Student Hotspotting, improving outcomes in underserved populations in rural Montana. Above all, she is always, always, having a good time outside with family, friends, food, and an adventure, setting an example for her two young daughters. Together, and through the values of adventure, growth, authenticity, collaboration, and respect, Jenn and Audrey are working to build a collective of compassionate, confident, critical thinkers who utilize best-practices in their field.   Suggested Keywords Healthy, Wealthy, Smart, ConEd, Education, Learning, Research, Networking, Integration, Innovation, Collaboration,   Resources Prevention & Wellness for the Running Athlete. https://www.trailheadlearn.com/healthywealthysmart   Get 10% off your first retreat: Mention Healthy, Wealthy, & Smart at Registration.   To learn more, follow Audrey and Jenn at: Website:          https://www.trailheadlearn.com Facebook:       Trailhead Learning Collective Instagram:       @audreyroseelias                         @jennbell427                         @trailheadlearning   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.   00:35 Hey everybody, welcome back to the podcast. I am your host, Karen Litzy. I want to thank you all for joining us today. And again, if you haven't then definitely subscribe to the podcast on any platform in which podcasts are streamed. So today's episode, we are talking about doing continuing education different and my guest today are Dr. Jenn Bell and Dr. Art Audrey Elias. They are cofounders of Trailhead learning collective. Audrey is a clinical faculty in the University of Montana School of Physical Therapy and rehabilitative sciences. She completed her DPT in 2009 Did her residency with therapeutic associates in Washington state and then completed her PhD in Clinical biomechanics at the University of Montana in 2015. She then did a postdoc at the University of Guelph before returning to you and PT as clinical faculty training entry level students and residents in the DPT program and in the UN PT clinic. Her primary area of research involves how psychological factors play into movement, particularly following knee injury. Most importantly, she loves being outside weather, skiing, running, hiking, paddleboarding, or lounging around a campfire with her son and her husband. Jen is the program director and clinical and Director of Clinical Education at UMP T. She completed PT school in 2006 then completed her Colm T in 2012, and her side Dee from Texas Tech in 2013, all while treating patients in a variety of settings in rural Alaska. She has treated patients and taught and PT programs in virtually every setting all over the world including Kenya, Ethiopia and Malawi, and is an internationally recognized expert in interprofessional education and Global Health. She is also the CO primary investigator and team advisor for Montana interprofessional student hotspotting improving outcomes in underserved populations in rural Montana. Above all, she is always having a good time outside with family friends food and an adventurer setting example for her two young daughters together and through the values of adventure growth and authenticity, collaboration and respect. Jen and Audrey are working to build a collective of compassionate, confident critical thinkers who utilize best practices in their field. Now, like I said, they are the founders of Trailhead learning collective. And Jen and Audrey have a special offer for healthy, wealthy and smart listeners. If you go to their website, which is on the podcast dot healthy, wealthy dot smart page, and you want to check out their next learning opportunity. Then you get 10% off because you're listening to this podcast. So if you go to Trailhead learned.com Or go to the podcast website, and when you apply to be part of their next learning opportunity, and mentioned this podcast will get 10% off. So a big thank you to Jen and Audrey for that. And in the meantime, everyone enjoyed today's episode. Hello, Jen and Audrey. Thank you so much for coming on to the podcast today to talk about the innovative way you guys are doing continuing education courses. So doing Con Ed differently, and I love it. But before we get into that, Jen, why don't we start with you say a little bit about yourself. So the viewers know or the viewers, the listeners know who's who.   04:12 Yeah, it sounds great. So I'm Tim Doyle and I'm the Program Director and the Director of Clinical Education at the University of Montana's physical therapy program. I've been at UN for nine years. I'm just going in to start my 10th year there, which is wild to think I've been doing this for almost a decade. And prior to moving to Montana, I was in Rural Clinical Practice in Alaska. And so I lived in a town of 2500 people at the end of the road for bed hospital. So got to kind of treat whatever walked in the door. It was a really great opportunity. And during that time, I was working on my doctorate of science who Texas Tech University Health Sciences Center. So yeah, it's all about   04:53 Excellent, Audrey. Go ahead a little bit more about yourself.   04:59 Thanks, Karen. And I'm Audrey Elias. I am also at the University of Montana and clinical faculty there. I treat patients in the clinic, but most of my time is actually treating patients with students. So I'm a preceptor in our integrated clinical education program. And then I also teach in the DPT program, as well. I did my PhD at the University of Montana, I did my DPT at the University of Montana. So I pretty much have been in Montana for a very long time. But I also practiced in Washington, in the far west, on the Olympic Peninsula, in rural areas where we saw lots of different folk. Yeah, and then Jen and I are also cofounders of Trailhead learning collective. So we're heavy, heavy University of Montana. But we're also doing this other thing.   06:02 And we are going to talk about that today. But before we get into that, let's talk about the why behind it. So what has your clinical education or continuing clinical education been like in the past where you thought you know, this, I'm not connecting with this and I need to do something different. So talk a little bit about your journeys.   06:26 And you go ahead   06:29 yeah, um, so you know, carrying that's a great question kind of what informed us to get to this place or we decided to found Trailhead learning collective. You know, I've done I've been in clinical practice and a PT for 15 years, and I've done everything from going to CSM was 17,000 of my closest friends to Education Leadership Conference with the APTA Academy of Education, to, you know, the weekend course that someone brings into their clinic. And what I find oftentimes is that I'm in these courses. And, you know, I'm, I'm finding myself kind of not super engaged with the learning, there's a lot of lecture. And, you know, sitting around going from being in a really active profession where I'm doing everything from crawling around on the ground with my patients to helping them stand up and walk to sitting oftentimes at a plant in a clinic all weekend long, being lectured to. And so I was really looking for something different from that. Actually, what's your experience been? Well,   07:39 I did my orthopedic residency right out of school, and in private practice with therapeutic associates in Port Angeles, Washington, and I averaged one three day weekend of Con Ed a month for almost a year and a half. And I hosted those courses, I got the bagels, I got the coffee, I made sure the bathrooms were clean, I did all of that. So I've done a lot of that. And I've been I did my PhD and went to CSM was 17,000 of my closest friends over and over and over again. I've done like every kind of Con, as you can imagine, I've done you know, 45 minute online things through Harkness school for dance injury. I've done level one pelvic floor. And, you know, they got real intimate with 15 brand new people. And to be so to be my authentic self here, I will fall asleep if I am sitting down for more than 20 minutes. And I will not remember a single thing. Anyone tells me if I'm being lectured at, if I'm not actively engaged in I fell asleep in my first class in undergrad. I it's just how I work. So I have to have really engaging Con Ed, you know, if I'm going to learn anything, otherwise, I do it all on my own afterward, right? So I'll go to 18 hours on a weekend where I don't get to go on my run. I don't get to spend time with my family. I have a 10 year old now I don't get to do these other things that I wanted to do. And then I would have to go home and I'd have to review it all on the treadmill. Because now I'm moving I'm doing stuff and then I can actually learn or I'd have to like go for a run with Jen and tell her all about what we just did in order for me to actually process and I just thought to myself You know, I want something different. I want, I want to use this, I want to use this information immediately. And I also think, doing my PhD, we did, I did a randomized clinical trial, post ACL reconstruction stuff, and just trying to get help people understand how to use that. I can't just tell them, it does not work. It doesn't work. We have to do it, we have to not just show we have to do and work together on it. So yeah, I think it's just a long time of realizing that there's a place and a time for everything. And but there's but there needs to be this thing as well, that can serve people like me.   10:57 And, you know, you kind of described what a lot of continuing education courses are in the PT world where you go, you sit at a plan, you're taking notes, maybe you get a stretch break, you have like some sort of pastry, and coffee. And the question I always had with those in particular is, what if it's not your learning style? What if you need a little something different, like something that involves more demonstration, more movement, more, getting up more? Just a different style of learning. So what have Have you seen the current state of continuing education? And do you feel like we're really maximizing professional development? Go ahead, Jen.   11:44 Oh, Audrey, go ahead. Oh, well, I feel like what's really interesting is that in a physical therapists are super committed to learning. Just in general, I was actually so we're both huge nerds. So he's doing quite a lot of literature search on this. And if I was trying to write an abstract for CSM, I wouldn't be able to, because you have to have at least five papers within the last five or seven years or something. And there just aren't any, there's no literature on what's going on. With Con Ed, currently, there's a paper just this year about so in the PT and PT J, with continuing education courses for orthopedic and sports PTs in the US often lack supporting evidence. And so they went through and review available intervention courses. So great paper. But there was one by Adrian Lowe this year, looking at the impact of a three hour PMP course, on low back pain, and how people did. It was pretty good. It was really interesting. But otherwise, well, next paper is 15 years ago, that I combined. So we don't really know what's going on in the form of knowing that I'm familiar with, we don't really know, in terms of my anecdotal experience, go, the learning environments that I have experienced are not really set up to maximize learning based on pedagogical evidence. So we know that active learning is important. And it just, it makes it like it's really, really hard. We just don't see a ton of that. And I think what happens is that, then we get where content becomes like a chore, right? It's a box, you have to tick, I gotta get Montana, I have to have 20 hours every two years. So I think 3030 Whatever it is, I have to have it and I have to go and check in order to check them tick that box. And I think it ends up becoming problematic on a lot of different levels. Yeah. I don't know if I answered that question completely.   14:15 I think so. Jen, do you need to fill in any blanks there? Yeah, well,   14:20 you know, I think what Audrey was hitting on thinking about in our continuing education courses, we can bring in the pedagogical research, just like we bring in to physical therapy research. And until you know, we do this a lot in our entry level program, we're thinking about what are the best ways that adults learned? How can we convey this information in a way that's effective that's going to address our learning outcomes, not just our patient outcomes. And so that's really one of the things that Audrey and I are looking to bring to our Trailhead learning collective courses and retreats is bringing in the research on active and learning mean, and teaching adult learners. And so bringing that in, you know, really minimizing the amount of lecture that we do engaging in active learning techniques, whether it's going through cases together, having discussions, you know, putting up big whiteboards and doing some, you know, throwing out ideas and looking at other people's ideas, you know, that way really kind of shifting the paradigm from being teacher centered to being learner centered. So you know, when you're in that lecture based course, it's about this expert that's standing in front of you talking and conveying to you what you should be doing in clinical practice. We're really trying to flip that and bring all of these learners together, oftentimes have, you know, decades of clinical practice, have all of these pearls all of this knowledge, and asking them to share it with one another. And we'll bring in the evidence on, you know, the the content that we're teaching on. But really, not bringing a group of people together that have years of clinical practice, and have learned a lot and asking them to not talk to one another and just listen to what an expert says. So really trying to kind of flip that model and really focusing in on the learner experience, and learner engagement.   16:16 Right. And that kind of leads me to the next question, what a perfect transition is, you know, going from a traditional model, which can be effective in getting information from me, the teacher to you, the student? But is it effective when it comes to information processing integration into clinical life? So can you kind of talk about the those concepts as perhaps not being equal and not being the same? And how can we get better integration of information?   16:58 Yeah, can you make a great point, you know, lecture is a really effective way to just transfer knowledge. But that piece of integrating it and making changes is where we see that active learning tends to be more effective. Like Audrey said, there's really not great evidence about, you know, do continuing education courses, impact and change how people engage in clinical practice, we hope and we believe that, you know, if we can effectively teach you something, then you'll use that information. So that's like, that's a gap in the research. But we do know that active learning techniques, improve retention, and kind of consolidation of information, and kind of thinking that information deeper into our longer term memory. And so that's why we use active learning techniques. There's also some really cool, early research coming out on looking at the impact of exercise of aerobic exercise, on learning. And so boom strand and inco, Hall and 2020 published a study and they looked at a single bout of aerobic exercise. And what they found is that it improves attention, concentration, and learning and memory functions and young adults. And so there's some studies like that coming out showing that if we can incorporate this component of physical activity, with our learning, either right before, during or after there's some different sides looking at the different benefits of those, then we can improve learning and retention as well.   18:33 And can you give some examples of active learning techniques? Because we've said that a couple of times, and I can just picture people being like, Okay, that's cool.   18:42 But what does that mean? It was so fun. Because I mean, we've both been teaching. For so long, both I will say we've taught both in the entry level DPT program. And then we've also we teach continuing ed courses before this as well. And mostly in that lecture based thing, we're like, oh, I don't like to teach that either. And I think we both were like, Okay, we need to change this up. So we've gone to a week long training on for the National Institute of scientific teaching, and just teaching how to teach in this way. In the sciences. It's very, it's pretty easy to do in the humanities. But in the sciences, it can be very, like, Oh, I just need to get this information across. Right. So in STEM fields, it's like, well, I just need to know how to pipette or whatever in chemistry. So there are lots of different ways so we can do like gallery walks, put up things with small groups. They process the information put up different ways and how they would do it around the room the rest of the day, and then their entire group walks around the process, we can do two to one, activities, give a prompt, everyone has a minute, maybe, to think on their own individually, maybe write something down there is that reflective cognitive process that comes from actively hand writing something down, that there are mental changes who have to write it down, turn to their neighbor, talk about the individual thing, and then come back in a larger group and, and everybody has to go around and say what their partner did, and pros and cons thereof. So lots of discussion. Obviously, when Jen, you had a really good one that you are doing,   20:50 what are the ones that I do with some of my classes is that I, when I start to teach about a new topic, the first thing I do is kind of the same scenario that Audrey just talked about candidate seat by myself, think with a partner and think with a group. But I prompt the group and the learner is to think about what it is you need to know about this topic. So based off your experiences you've had so far, kind of brainstorm, what are the things that you need to know? So we're really priming them to, you know, what is it that I do know? What is it that I don't know? What are things that are what are those, maybe when we share out to group, then people are going to identify those unknown unknowns that they didn't know, they needed to know. And so we can kind of start off by kind of forming a list of everything we're gonna need to go through and talk about, it's great for me, because then I can be like, oh, I need to make sure that we you know, dig into this some more and, and then at the end, we can go back through that list and be like, did we do we know everything we needed to know going into this? And so oftentimes, you know, instead of just starting off with me, like, hi, welcome. And then I start lecturing, why don't we start with you kind of digging into what it is that you want to learn about a topic, and going from there?   22:07 Yeah, I love that that's very similar to a course that I took last year through Goldman Sachs called the Goldman Sachs 10 KSB program, which is 10,000 small business program. And it is exactly what you just described, we would get the information, we would they would give us prompts to do ourselves, we have a paired partner, where we would talk about them, then we go into the larger group and talk about what our partners did. And the partners would talk about what we did. And it was really, really helpful. And that's the first time I've experienced that I've never experienced that at a continuing education course. So in it, it it really, like when you're done, you're like, Oh, I yeah, I know this, I understand it, I get the concepts, it's like rooted in there, because you had so many conversations about it with one on one with your instructor and with the group.   23:00 I think physical therapy can be so at work, we are so busy, right? Seeing 12 to 20 people a day, sometimes you have to be going, I know, and getting your documentation done all this stuff. It's rote, you're just going, boom, boom, boom, boom, boom. And so going into a Con Ed course and learning a clinical Pearl for five minutes. And maybe you even talk briefly with your buddy about how you might use that. The sad fact is that on Monday, when you go in your brain, you are going to drop down into habitual levels that just are, especially if you've been in practice for more than six months. And it takes a lot of energy to, to, in the moment, reflect back on what you did and saw and actually incorporate it deeply into your body. But with these techniques, we can get at least a tiny little tendril, of a root. And hopefully that can grow and root a little deeper, so that we see more change in how we're actually working. And we're actually treating patients   24:17 and does it sounds like we're becoming a little too robotic. A little too robotic, maybe in work a little too robotic in continuing ed. You know, like, you're okay, I have to go. I'm going to sit, I'm going to listen to these lectures. I'm going to get through it. I'm going to get my CPUs and then I'm going to do this on Monday and then it just doesn't happen. So then what what happens to that continuing education? Does it just fall out of your head like what happens?   24:47 Well, how many times have you take learned anatomy of the hip? Every single continuing education course you teach anatomy of the hip? I have taught I learned it. I've taught it many, many times. Each and every single time, I forget it. And I need that review because those things do drop out of our heads so quickly. And it's not bad. It's not saying that we're wrong or awful, that is normal. That is being a human, we can't get away from it.   25:18 One of the things that we try to do with these opportunities to really engage with the different people that are there in this in this group with you learning together, is giving you the opportunity to take that that new knowledge, or maybe that review of knowledge you've learned before, and take it and look at it a different way. And think about how you know, the person you're working with is going to use that in their practice, and then really work as a team to think about how can I take this knowledge in on Monday, in my setting, I mean, you know, here in Montana, I have clinicians that are going back to, to dot Montana, and are practicing in the next PT is 100 miles away. So how can they incorporate that into their clinical practice, versus the clinician, you know, that's in a sports specialized clinic in Bozeman, Montana. And so we really want to empower clinicians not just to suck in all the information that we're giving to them, but actually really dig into the material and think about how they can use it. And so one of the things we're trying to do with our courses is challenge the assumption that in these 15, CEUs, that you're going to earn, that we have to pack in as much material as possible. That's really not an assumption that we're working off of. So we're we're going to kind of switch that paradigm and say, instead of having this massive breadth of information, we're gonna give you a smaller amount of information, but we're gonna go a lot deeper. And we're really going to dig into how you can use this in clinical practice. And so it's just a kind of a shift in that assumption.   27:01 Yeah. And that leads me into the next question, again, a great lead in how is Trailhead learning collective different? How were you set up differently,   27:10 one of the things that we talked about a lot. And going back to when you said, it sounds like we're getting a little robotic. I think one of our kind of prime values, our main values is authenticity and respect. And that's respecting everything from the land that we're on to the humans that we're working with. We are working with humans, our patients are humans, but are we as clinicians are human. And I think it's important to respect that, like taking that much time away is hard. And burnout is very, very real and extremely prevalent. So one of the things that we are really wanting to do is make a trailhead learning retreat, actually, that like it's a retreat, it is the time to rediscover joy. In physical therapy, it's a time to go to a cool place, have someone take care of you. So all inclusive, your housings included, it's delightful, you're on a mountain or on a beach or wherever we happen to be in the desert. In house chef cooking your meals that are delicious, and primed for you. And having active learning where you're an active participant and feeling engaged, and validated and real, and also get to go out and adventure like experience the place. Yeah, I've been to so many cool places for continuing education, and ended up sitting in a plant in a clinic or in a conference room for the entire day. And then, in order to get any exercise at all, I just went for a run on the treadmill in the hotel. And I didn't get to experience anything about that place. So I think one of the thing that is making Trailhead different is we're really trying to treat the learner as a whole human being and make this time worth it both personally and professionally. In kind of all of those different aspects when you go for a cool trail run, we can make that happen. And you can get 15 hours you can tick that box for sure. And we'll make it worth your time. And you get to be taken care of for a little while.   29:44 Yeah, kind of reminds me of when you see on social media people saying How come I didn't take Monday off of work after having this continuing ed course it was too much and now I'm like totally burned out. So it sounds like maybe this would quell that a little bit. it. And the other part I wanted to talk about is something that we spoke about before we went on. And that's making a connection with the people in the course with you. Because so often we go to these courses, maybe there's 20 people, maybe there's 100, and you end up knowing no one, when you leave. Right. So how, how are you addressing that?   30:21 Yeah, Karen, that's a great point, I went to a continuing education course, a few years ago in San Francisco, and coming from, you know, at the time I was practicing in rural Alaska. And so I really would have loved to get to know more about, like, what is clinical practice, like, in San Francisco compared to, you know, what I am navigating and I left not knowing a single person, you know, part of that is on me, I didn't, you know, I did the thing that a lot of us do it kind of courses, I sat at my phone in the plant, I said, some, you know, small talk at the coffee. And so we're making a really deliberate effort, we're all in the same housing, we're sharing all of our meals together, and engaging in physical activity together, in addition to the time that we're doing the act of learning and getting those continuing ed credits done. And so really creating a space for folks to show up authentically. So I don't expect anyone to show up to her courses, having had 100% success with every single patient they've ever treated, but we want folks to show up and, you know, talk openly and honestly about the places that they struggle in their clinical practice, and, you know, had those conversations and to have this network develop, as we're in this space together. The the course that we're teaching in October is, of course, provincial wellness for the running athlete. And, you know, Audrey is gonna start us off with some really great conversation about bias and how our beliefs about ourselves as runners impacts how we believe and talk to our running athlete, patients. And so you know, being able to kind of explore those parts of ourselves and how they inform our clinical practice, or maybe, at times, potentially cloud our judgment, we can start to have those more intimate conversations as clinicians and people and start to build that network so that when you leave, you have this collective of physical therapists that you know, that you've created some bonds with.   32:25 Yeah, so kind of being a little more social. And, you know, off it sounds to me, like business retreats that I've gone on, you know, even if it's a one day mastermind, you leave with these people who, even after one day, kind of stay with you, because you've purposefully made those bonds.   32:46 Yeah, exactly. And I think that's one of the things that, that the business role does really well is that if we're gonna bring all these people together, we're going to, you know, put them in spaces and create opportunities for them to network on that deeper level. And in physical therapy, we are so focused on getting our patients better at all are we're so focused on the patient, that oftentimes the time when we gather for continued education, we're not speaking about each other as clinicians. And, and like Audra said those hope people that show up. And so that's one of the ways that we are approaching this differently.   33:24 Yeah, it sounds it sounds delightful. And now as we start to wrap things up, what do you want the listeners to take away? What are your big talking points? Or maybe there's only one? I don't know. But what do you want people to take away from? How and why you're doing things differently?   33:47 I think one of the one of the things that I want people to understand for themselves is that there is a time and place for everything. And sometimes you need that quick online 30 minutes learning about FAI, or stroke or whatever, because you have a patient who's really like, right, then you need a little bit and you should get some credit for the work that you do in that moment. I think that's excellent. I really like the you know, read for credit that JLS PT does, I had a paper that was a read for credit paper and I was like, This is great. Somebody's gonna like get value, monetary value from reading my paper. That is excellent. traditional lecture has its place but then I think it's fine. I think it's important for people to say you know what, this is what I need. I I need this time and I'm okay with going and getting it I deserve that. I am a value as well. And this is important. So I think you know valuing Oh, that kind of experience a little more. want somebody to take that away? Well, you know, I think that   35:09 I have two small daughters. And oftentimes the parenting people say, you know, it's really important to take care of yourself so that you can better take care of your kids. And I think that we have to remember that as clinicians, and so finding ways to really take care of ourselves as, as people and humans, as we're doing this continuing education, certainly there's those times where like Audrey said, you need that quick Con Ed. But there, there is an alternative way to get your continuing education done. That also takes care of yourself.   35:43 Yeah, I love it. I love the concept around it. And I, I think you guys are going to be successful in this because it sounds like it's plugging a hole in the continuing education world that people really want. And I also think it's outstanding that you are both been educators for close to a decade. And you can bring all of that to, to continuing education courses. Because I think that's really important. Now, let's talk about when the course is where people can find it social media, where can they find you give us all the details.   36:28 Yeah, so our upcoming courses October 7, eighth, and ninth in Whitefish, Montana. So as I said earlier, so of course on prevention and wellness for the running athlete that is paired with guided trail running with our friends and partners with Alpine reading diets. So you can find information about our course and upcoming courses, we're about to announce a winter course that snowshoeing skiing, and biking, fat biking. That's all on our website, Trailhead. learned.com,   37:01 I wanted to say that we're gonna do 10% off the first retreat for healthy, wealthy and smart listeners, just we so the way we do it is we get your information, and then call you this is a very intimate environment. So we want to start off that way. So you would send us your information that you're interested in the course we call you, we get everything. And at that point, just say that you heard about it from healthy, wealthy and smart.   37:29 The last question is what I asked everyone, and knowing where you are now in your life, and in your career, what advice would you give to your younger self and your younger self, let's say maybe right out of PT, school,   37:43 you know, the advice that I would give to my younger self, is actually advice that I continue to get to my, I'm not gonna say older self, but current self. And we'll get to my future self. You know, I read this great book, by Adam Grant called Think again. And in the book, he talks about, you know, really staying flexible in your thinking. And I think there's been a lot of times in my life that I've had a five year plan, and I'm going to fix my five year plan. And I think I would encourage my younger self to have maybe a very loose plan, but to not get too stuck on what the five year plan is, there are certainly times in life where that five year plan helps you stick it out, like when you're doing your doctorate or science. But there's been so many opportunities that if I was, you know, had pigeon holed myself into that five year plan, I would have missed them. And so to remain flexible, and keep watching for those various opportunities.   38:42 Yeah, I love it. Audrey, how about you?   38:47 I think they would give the same advice to myself now that I did, that I would give to my younger self as well. And it's advice that I give to my students. And that would be that it's all worth it. Like all of those experiences are things that you can draw on for your as you're talking to patients. And as you're thinking critically, I teach clinical reasoning, and all of those experiences give you some flexibility of thought. And I think that's really important. So like going and just experimenting and being okay, like it's alright to go do different things that aren't exactly on   39:30 your path. Excellent advice from both of you. And I do want to thank you so much for coming on the podcast and talking about doing continuing education different with Trailhead learning collective. I think it's it sounds like a great opportunity, and I encourage all the listeners to check it out. We'll have links at the podcast, follow them on social media. So thank you so much for coming on and sharing all of your fun stuff. Coming up. Thanks so much.   40:03 Thanks for having us. Ontarian it's been great to chat with you. Yes. Awesome.   40:06 Thanks so much,   40:07 and everyone thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.   40:13 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. 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In this episode, Founder of Enhanced Recovery After Delivery™, Dr. Rebeca Segraves, Co-Founder of Entropy Physiotherapy, Dr. Sarah Haag, Owner and Founder of Reform Physical Therapy, Dr. Abby Bales, and Co-Owner of Entropy Physiotherapy, Dr. Sandy Hilton, talk about the consequences of overturning Roe v. Wade. Today, they talk about the importance of taking proactive measure in communities, and the legal and ethical obligations of healthcare practitioners. How do physical therapists get the trust of communities who already don’t trust healthcare? Hear about red-flagged multipurpose drugs, advocating for young people’s education, providing physical therapy care during and after delivery, and get everyone’s words of encouragement for healthcare providers and patients, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Our insurance-based system is not ready to handle the far-reaching consequences of forced birth at a young age and botched abortions.” “We do need to know abortive procedures so that we can recognize when someone has been through an unsafe situation.” “We really need to take into consideration the ramifications of what this will do.” “This is not good healthcare and we need to do more.” “We’re going to have to know our rules, our laws, and what we’re willing to do and go through so that we can provide the care that we know our patients deserve.” “We’re looking at the criminalization of healthcare. That is not healthcare.” “We know who this criminalization of healthcare is going to affect the most. It’s going to affect poor, marginalized people of color.” “We can no longer choose to stay in our lane.” “We need to have a public health physio on the labour and delivery, and on maternity floors.” “We don’t get to have an opinion on the right or wrongness of this. We have a problem ahead of us that is happening already as we speak.” “We need to create more innovators in our field, and education is the way to do that.” “This is frustrating and new, and we’re not going to abandon you. We’re going to figure it out and be there to help.” “Our clinics are still safe. We are still treating you based on what you are dealing with, and we will not be dictated by anybody else.” “If you need help, there is help.” “If we believe in the autonomy of an individual to know all of the information before making a decision, then we still believe in the autonomy of an individual to know all of the information that is best for their body.” “This affects everyone. We’re dedicated to advocating for you.”   More about Dr. Rebeca Segraves Rebeca Segraves, PT, DPT, WCS  is a physical therapist and Board-Certified Women’s Health Clinical Specialist who has served individuals and families within the hospital and home during pregnancy and immediately postpartum. She has extensive experience with optimizing function during long-term hospitalizations for high-risk pregnancy and following perinatal loss and pregnancy termination. In the hospital and home health settings, she has worked with maternal care teams to maximize early recovery after delivery, including Caesarean section, birth-related injuries, and following obstetric critical care interventions. She is the founder of Enhanced Recovery After Delivery™, an obstetrics clinical pathway that maximizes mental and physical function during pregnancy and immediately postpartum with hospital and in-home occupational and physical therapy before and after birth. Her vision is that every person will have access to an obstetric rehab therapist during pregnancy and within the first 6 weeks after birth, perinatal loss, and pregnancy termination regardless of their location or ability to pay.   More About Dr. Sarah Haag Dr. Sarah Haag, PT, DPT, MS graduated from Marquette University in 2002 with a Master of Physical Therapy. She went on to complete Doctor of Physical Therapy and Master of Science in Women’s Health from Rosalind Franklin University in 2008. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health, becoming a Board-Certified Women’s Health Clinical Specialist in 2009 and Certification in Mechanical Diagnosis Therapy from the McKenzie Institute in 2010. Sarah joined the faculty of Rosalind Franklin in 2019. In her roles at Rosalind Franklin, she is the physical therapy faculty liaison for the Interprofessional Community Clinic and teaching in the College of Health Professions. Sarah cofounded Entropy Physiotherapy and Wellness with Dr. Sandy Hilton, in Chicago, Illinois in 2013. Entropy was designed to be a clinic where people would come for help, but not feel like ‘patients’ when addressing persistent health issues.   More About Dr. Abby Bales Dr. Abby Bales, PT, DPT, CSCS is the owner and founder of Reform Physical Therapy in New York City, a practice specializing in women’s health and orthopedic physical therapy. Dr. Bales received her doctorate in physical therapy from New York University and has advanced training through the renowned Herman and Wallace Pelvic Rehabilitation Institute, Grey Institute, Barral Institute, and Postural Restoration Institute, among others. She also holds her Certified Strength and Conditioning Specialist certification from the NSCA and guest lectures in the physical therapy departments at both NYU and Columbia University, as well as at conferences around the country. Dr. Bales has a special interest in and works with adult and adolescent athletes with a history of RED-S (formerly known as the Female Athlete Triad) and hypothalamic amenorrhea. A lifelong athlete, marathon runner, and fitness professional, Dr. Bales is passionate about educating athletes, coaches, and physical therapists about the lifespan of the female athlete. Her extensive knowledge of and collaboration with endocrinologists, sports medicine specialists, pediatricians, and Ob/gyns has brought professional athletes, dancers, and weekend warriors alike to seek out her expertise. With an undergraduate degree in both pre-med and musical theatre, a background in sports and dance, 20 years of Pilates experience and training, Dr. Bales has lent her extensive knowledge as a consultant to the top fitness studios in New York City and is a founding advisor and consultant for The Mirror and the Olympya app. She built Reform Physical Therapy to support female athletes of all ages and stages in their lives. Dr. Bales is a mom of two and lives with her husband and family in New York.   More About Dr. Sandy Hilton Sandra (Sandy) Hilton graduated with a Master of Science in Physical Therapy from Pacific University in 1988. She received her Doctor of Physical Therapy degree from Des Moines University in 2013. Sandy has contributed to multiple book chapters, papers, and co-authored “Why Pelvic Pain Hurts”. She is an international instructor and speaker on treating pelvic pain for professionals and for public education. Sandy is a regular contributor on health-related podcasts and is co-host of the Pain Science and Sensibility Podcast with Cory Blickenstaff. Sandy was the Director of Programming for the Section on Women’s Health of the American Physical Therapy Association from 2012 - 2017. She is now on the board of the Abdominal and Pelvic Pain special interest group, a part of the International Association for the Study of Pain.   Suggested Keywords Healthy, Wealthy, Smart, Roe v Wade, Abortion, Trauma, Sexual Trauma, Pregnancy, Advocacy, Pelvic Health, Healthcare, Education, Treatment, Empowerment,   To learn more, follow our guests at: Website:          https://enhancedrecoverywellness.com                         https://enhancedrecoveryafterdelivery.com                         https://www.entropy.physio                         https://reformptnyc.com Instagram:       @sandyhiltonpt                         @reformptnyc                         @enhancedrecoveryandwellness Twitter:            @RebecaSegraves                         @SandyHiltonPT                         @Abby_NYC                         @SarahHaagPT LinkedIn:         Sandy Hilton                         Sarah Haag                         Abby Bales                         Rebeca Segraves   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy. Hey everybody,   00:36 welcome back to the podcast. I am your host, Karen Litzy. And on today's episode, I am very fortunate to have for pretty remarkable physical therapists who also happen to be pelvic health specialists. On to discuss the recent Supreme Court ruling in the dobs case that overturned the landmark ruling of Roe vs. Wade. How will this reversal of Roe v Wade affect the patients that we may see on a regular basis in all facets, facets of the physical therapy world. So to help have this discussion, I am very excited to welcome onto the podcast, Dr. Rebecca Seagraves and Dr. Abby bales and to welcome back to the podcast Dr. Sandy Hilton, and Dr. Sarah Hague. So regardless of where you fall on this decision, it is important that the physical therapy world be prepared to care for these patients. So I want to thank all four of these remarkable physical therapists for coming on to the podcast. Once the podcast starts, they will talk a little bit more about themselves, and then we will get right into our discussion. So thank you everyone for tuning in. And thanks to Abby, Rebecca, Sandy, and Sarah.   02:03 I, my name is Rebecca Seagraves, I'm a private practice pelvic health therapist who provides hospital based and home based pelvic health services and I teach occupational and physical therapists to provide their services earlier in the hospital so that women don't have to suffer.   02:20 Perfect Sarah, go ahead.   02:22 I am Sarah Haig. And I'm a physical therapist at entropy physiotherapy in Chicago, and I'm also assistant professor and at a university where I do get to teach a variety of health care providers.   02:35 Perfect, Abby, go ahead. My name is Abby bales. I'm a physical therapist, I specialize in pelvic health for the pregnant and postpartum athlete. I have my practice in New York City called perform physical therapy, and I do in home visits and I have a small clinic location.   02:54 Perfect and Sandy. Go ahead.   02:56 Sandy Hilton. I'm a pelvic health physical therapist. I'm currently in Chicago with Sara entropy. And I'm in Chicago and online. Because we can see people for consultations wherever they are, and we may be needing to do more of that.   03:13 So the first question I have for all of you lovely ladies, is how will the recent Supreme Court ruling in the dobs case, which was overturning Roe v. Wade? How is that going to affect people who give birth that we see in our clinics in the hospital setting in an outpatient setting in a home setting? So let's start with Sara, go ahead. I'll start with you. And then we'll just kind of go around. And and and also feel free to chime in and you know, the conversation as you see fit? Got?   03:58 That's such a big question. And I get to go first. So the question was how, how is this decision going to affect people who give birth? And I would say it just it affects everyone in in kind of different ways. Because I would say what this will undoubtedly do is result in us seeing people who didn't want to give birth. And and I think, you know, the effects of that are going to be far reaching and that we I think maybe we in this little group can have an idea of, of the vastness of this decision, but I think that even we will be surprised at what happens. I think that how it will affect people who give birth. Gosh, I'm kind of speechless because there's so many different ways. But when we're looking at that person in front of us with whatever they need to do For whatever they need assistance with after giving birth, we're going to have to just amplify exponentially our consideration for where they are and how they felt going into the birth, how they got pregnant in the first place. And, and kind of how they see themselves going forward. We talk about treating women in the fourth trimester. And it's, I mean, I'm in that fourth trimester, myself, and I can tell you that it would be harder to ask for help. And I'm really fortunate that I, that I have that I do have support, and that I do have the ability to seek help. I have a million great friends that I can reach out to for help, but I'm just how the how it's gonna affect the women, I'll say, I'm scared, but it's not about me. I'm very concerned for other women who won't be able to access the care that they that they need.   06:05 Yeah, Sandy, go ahead. What do you think? How do you feel this decision will affect people who can give birth, especially as they come to see physical therapist, whether that be during pregnancy? As Sarah just said, the fourth trimester, or perhaps after a procedure, or abortion that maybe didn't go? Well? Because it wasn't safe?   06:30 Yeah, so I work a lot with pain. One of my concerns is, but what is the future gonna hold for some people who did not want to be pregnant not added some sort of convenience or concern for finances, both of which, you know, your spot in life determines whether or not you have the the ability to raise another person at that moment. So there are individual decisions that people should make, in my opinion, but also, there's the if something happens to you, that you did not give permission to happen. And then you are dealing with the consequences. In this instance, pregnancy, and you happen to have back pain or have hip pain, or have a chronic condition, or a pelvic pain history, where you didn't not want to be pregnant. How's that going to affect the pain and the dysfunction that you're, you are already happening? And will it sensitize people to worse outcomes and recovery afterwards, because this is a, you know, there's a perceived injustice scale, I want to pull that back out. I hadn't been using it very often in the clinic just didn't seem to change the course of care. But I think that when I'm working with the people pre post, during pregnancy, I think I'm going to pull my perceived injustice scale back out and see if that might be a nice way to find out. If I need to hook someone up to a counselor, a financial counselor, psychologist, sexual therapist, anyone who might be able to support this person, we already don't have good support systems for pregnancy. I just am astounded at how much what a bad choice it is to add more need to a system that isn't currently handling the demand. I know we're gonna need to get creative because these people will need help. But I am a little awestruck at the possible quantum s we're gonna walk into   08:51 an abbey you had mentioned before we started recording about you know, some of the folks that you see that may have a history of different kinds of trauma, and how that may affect their abilities are to kind of wrap their head around being pregnant and then being forced to give birth because now they don't have any alternative. So how do you feel like that's going to play out in the physical therapy world, if they even get to physical therapy if they even get to a pelvic health therapist?   09:34 Yeah, that's, that's one of the things that I was I was thinking about as everyone was chiming in was, we really are just at the precipice in our niche of our profession, where people who give birth are seeking or even hearing about pelvic health and postpartum care, pregnancy care there. Just barely hearing about it. And my I have, you know, a concern, a very deep concern that these people will go into hiding if they have had an abortion in the past, because are we obligated to report that, and what is the statute of limitations on that, and the shame that they might feel for having had an abortion, or having had give birth and didn't want to, and the trauma that my patients who have, for the most part, not everyone who have wanted pregnancies that either the birth is traumatic, the pregnancy is traumatic, they get to a successful delivery, or they have a loss during the pregnancy, the trauma that they are experiencing, and for the most part, I'm seeing adults, and I cannot comprehend children, because it's this gonna be a lot of children who are forced to give birth, or who are having unsafe abortions, and the trauma that they're going to experience, and how, how much it takes for a person who has sexual trauma or birth trauma to get to my clinic, how these young people how these people who feel that shame, I don't know how they're going to get to me, or any of us, except for a real team based approach with pediatricians, with hospitals, with OB GYN, with your gynecologist with people who might see them first before us. I just don't know how they get to us to be able to treat and help treat that trauma. And like Sandy said, that pelvic pain that might be a result of the trauma if if it's unwanted sexual intercourse, I just don't know how we get to them. And that is something that we struggle with now, with, for the most part, wanted pregnancies. And I don't know how we get there. And I don't think we're prepared as a profession. for that. I think the advocacy for getting ourselves into pediatricians offices into into family medicine offices, is going to be so crucial in getting to these patients. But there aren't enough of us. We are not prepared. And our insurance based system is not ready to handle the far reaching consequences of forced birth at a young age and botched abortions. It is not ready to handle that.   12:52 Rebecca, go ahead. I'm curious to hear your thoughts around this because of your work in acute care systems.   13:00 Absolutely. I believe that I'm beyond the argument of whether this is right, or whether this is wrong. I think that as a profession, we're going to have to quickly change to a mindset of can we be prepared enough to handle what Abby was saying the amount of trauma, the amount of mental health I think, comes to mind when when someone's autonomy is taken away from them in any regard. I was very vocal as to how dangerous it was to force, you know, mandates on people even last year. And now here we are, we're at a point in our profession where we have to now separate our own personal beliefs and be committed to the oath of doing no further harm because this will result in harm, having treated individuals after an unplanned cesarean section or a cesarean hysterectomy, because of severe blood loss. They had no choice in those procedures. And they had no choice in the kind of recovery or rehabilitation they would get. I had to fight an advocate for our services, physical and occupational therapy services to be offered to individuals. So when you're looking someone in the eye who has lost autonomy over their body as last choice has gone through trauma that changes you it changes me really as a profession, even on this a professional or even on this issue. I'm now pivoting as quickly as I can't decide, do I have the skills that's going to be needed to address maybe hemorrhage events from an unsafe abortion that's performed? Maybe the mental health of having to try All across state lines so that you can find a provider that will treat you maybe the, you know, the shame around, you know, even finding Well, you know, is there a safe space for me to be treated for my pelvic health trauma from you know, maybe needing to carry this pregnancy longer than then I would have wanted to, there's, there's so much around this that we really have to start looking at with a clinical eye with a very empathetic or sympathetic eye as pelvic health therapists because of the fact that there's so few of us. And because now we're in a scenario where there will be more people who will be needing services but not knowing who to turn to. So my my biggest hope from this conversation, and many more that we'll have is that there's some how going to be a way to designate ourselves as a safe space for anyone, no matter what choice they've made for their body, period, I'm really done with being on one end of the spectrum with this, I'm a professional that doesn't have that opportunity to just, you know, be extreme on this, I advocate for the person and for their choice over their body period.   16:17 I think we need to, and it's just beautifully, beautifully said, the the getting getting some small systemic procedures in place in the communities we live in, is most likely the first step is reach out to the pediatricians and the chiropractors and the massage therapists and the trainers and the school athletic trainers and whoever you find that can have a connection with people and let them know on an individual basis. So like how do you tell people hey, I'm a trustworthy clinic to come to is not usually by writing it on your website. But if you can make connections in your community and be a trusted provider, that's going to go further, I suspect. I'm assuming there's going to be a fair bit of mistrust. And we have to earn it once it's lost. We've got to earn it back. So yeah, I like the proactiveness of that.   17:22 I, I totally agree on something you said Sandy sparked something that I would love for a health care lawyer to start weighing in on is we want, I am a safe space. I think every patient I have ever met who sees me cries. And I hold I hold that part of what I do. Very close to me, it's it's an honor to be someone that my patients open up to. And I know all of you on this call feel the same way because we we are that place that they they I love hearing birth stories. I love it. Even it just gives me an insight into that person into that experience. I feel like I'm there with them. And I understand better what they have gone through. But what happens when the legal system is going to come for us? Or them through us? What happens to that? How do we continue to be a safe space where they can share their sexual trauma, their birth trauma, their birth history, their pregnancy history, their menstruation, history, their sexual history? All of those really, really intimate things? How do we continue to be that for our patients?   18:56 I think we've had to do this I've had to do this previously, for in some very, in situations of incest in for the most part, we need a trigger warning on this. But, you know, there you have an individual that is a minor, or, or for some reason not independent that is being abused in what is supposed to be their safe space. And then that person, the abuser can be like, Oh, look, I'm helping you get better. And they're actually not safe. So there's some things and if the person you're treating is a minor, that adult has access to their records. And so I've worked in places not I don't know how to do with an EMR but I've worked in places where we have our chart that we write down the official record and sticky notes, which are the things that will not get put in the official record. But we need to have written down so people know it. And we've had to do that in situations where the patient wasn't safe. We all knew the patient wasn't safe. was being worked on to get them safe, but they were not yet safe. And you had to make sure there was nothing in their records that was going to make them more unsafe. I don't know how to do it as an EMR, if someone has a clever way to do that, that'd be great. Or we go back to EMR plus paper charts.   20:18 Even to to add to your point, Abby, if we're looking now at possible, you know, jurisdiction, you know, lead legal their jurisdiction or subpoena of documentation, you know, after having intervened for someone who may have had to make a choice that their state did not condone? Yeah, no, I, I'm completely, you know, on guard against that now, and that those are things that I'm thinking about now and thinking about, well, what would my profession do? Would we back, you know, you know, efforts on Capitol Hill to advocate for, you know, someone who, who has lost their, their autonomy, or lost their ability to, to at least have a safer procedure, and we've had to intervene in that way. You know, I think about that now, and I, that makes me fearful that this is such a hot topic issue that, you know, we might not as an organization want to choose size, but we as professionals on the ground as pelvic health therapists, I don't think that we have that luxury and turning someone away. And so So yeah, I think more conversations like this need to be had so that we can form a unified front of at least, you know, pelvic health specialists that can really help with the the after effects of this.   21:38 And I think a big barrier to that legal aspect of it is, you know, what is our legal responsibility. And what happens, if we don't do XYZ is because a lot of the laws and a lot of these states, some of these trigger laws and other laws being that are being passed, the rules seem to be a bit murky. They're not clear. And so I agree, I think the APTA or the section on pelvic health needs to come out with clear guidelines as to what we as healthcare professionals, can and should do. But here's the other thing that I don't understand and maybe someone else can. What about HIPAA? Isn't that a thing? Where did the HIPAA laws come in to protect the privacy between the provider and the patient? And I don't know the answer that I'm not a lawyer, but we have protection through hip isn't that the point of a HIPAA HIPAA laws? I don't know what   22:44 you would think so. But unfortunately, one of the justices who shall not be named has decided that abortion does not fall under HIPAA, because it involves the life of another being in so I can only state what has been stated or restate. But yes, the those are the very things that I'm afraid we're up against as professionals.   23:12 Yeah, I think they're going to try to make us mandatory reporters. for it. I think they're gonna try to make all healthcare we are mandatory. For some things, the thing that's good for some things. Yeah, the   23:24 thing that bothers me about that is the where I'm in Illinois right now, Illinois is a designated, look, we're not, we're not going to infringe on people's right to health care. Just great. But some of the laws and I've lost track, I was trying to keep track of how many have are voting on or have already voted on laws that would have civil penalties, penalties of providers from other states, regardless of the Practice Act of that provider, to be able to have a civil lawsuit against that provider. So that's fun. And then we go back to what ABBY You had mentioned before we started recording about medicine, that that is considered an abort efficient, I have a really hard time with that word. But that is also used for other conditions that we see in our clinics for pain for function and things like that. And then where's our role?   24:33 Right, so does someone want to talk about these more specific on what those medications are and what they're for? So that people listening are like, Okay, well, what medications, you know, so do you want to kind of go into maybe what those medications are, what they're for and how they tie back into our profession. Because, you know, a lot of people will say, well, this isn't our lane. So we're trying to do these podcasts. so people understand it's very much within our lane.   25:03 Well, I yeah, it's just from a pharmacology standpoint, the one of the probably most popular well known drugs that's used for abortion is under the generic name of Cytotec misoprostol, and that's a drug that's not only only used for abortion, but if individual suffers a miscarriage is used to help with retained placenta and making sure that the uterus clears. What other people don't know is is also used for induction. So the same drug is used for three or four different purposes. It's also used for postpartum hemorrhage. So measle Postel, or Cytotec is a drug as pelvic health therapists we should be very familiar with. And we should be familiar with it. Not only you know, for, you know, this this topic, but it's also been a drug that's been linked with the uterus going into hyperstimulation. So actually putting someone at risk for bleeding too heavily. And all of this has a lot of implications on someone's mental health, who's suffered a miscarriage who's gone through an abortion that maybe was not safely performed, which I have had very close experience with someone who's been given misoprostol Cytotec, it didn't take well, she continued bleeding through the weekend, because she lived in a state where emergency physicians could opt out of knowing a board of medications. So as professionals, we do need to know, a board of procedures so that we can recognize when someone has been through an unsafe situation it is, it is our oath as metal as medical professionals to know those things, not to necessarily have a stance on those things that will prevent us from providing high quality and safe care.   26:52 Another one of the medications is methotrexate, and it's used to treat inflammatory bowel disease. And as public health specialists, we'd see people who have IBD, Crohn's and Colitis, who have had surgery who are in flareups who are being treated like that treated with that medication. And it is again used in in abortions. And when you're on that medication, you have to take pregnancy tests in order to still be able to get your prescription for that medication. And as a person who I myself have inflammatory bowel disease and have been on that medication before, I can tell you that you don't go on those medications lightly. It is you are counseled when you are of an age where you could possibly get pregnant, and taking those medications. And it's very serious to take them. And you also have to get to a certain stage of very serious disease in order to take that it's not the first line of defense. So if we start removing medications, or they start to be red flagged on EMRs, or org charts, and we become mandatory reporters for seeing that medication, God forbid, on someone's you know, they're when they're telling us what type of medications they're taking, that there would be an inquiry into that for for any reason is just it's it's horrifying. I mean, it's, we treat these patients and they trust us, and we want them to trust us. But as we get farther and farther down this rabbit hole of, of going after providers, pharmacists, people who help give them information to go to a different state, I just it is. Like I said before, the breadth and the depth of this decision, reverberates everywhere. And if if PTS think that they are in orthopedic clinics, that they are somehow immune from it, you're absolutely not. And for those clinics who have taken on or encourage one of their one of their therapists to take on women's health because it's now a buzz issue. It's really cool. You are now going to see that in your clinic. And you know, like Rebecca was saying before, you know any number of us who have really strong and long term relationships with patients who are pregnant who are in postpartum I have intervened and sent patients to the hospital on the phone with them because they have remnants of conception and they have a fever and someone's blowing them off and not letting them into the IDI and sending them home. And we we are seeing those patients, they have an ectopic they're, they're bleeding, is it normal, they're calling me they're not calling their OB they can't get their OB on the phone. They're texting me and saying what should I do? And they have that trust with me and what happens when they don't? And they're bleeding and they're not asking someone that question and they don't know where to go for help. And so I know I took this in a different direction and we talked about pharmacology, but I just thing that I have those patients whose lives I have saved by sending them to the emergency department, because they are sick, they have an infection, they are bleeding, they have an ectopic, it is not normal. And I don't know what happens when they no longer have that trust with us not not because we're not trustworthy, but because they're scared.   30:26 The heavy silence of all of us going   30:31 you know, it's, it's not wrong. And I think the like, it just keeps going through my head. It's just like, so what do we do? I mean, Karen, you mentioned like, it'd be great if somebody came out with a list of, of guidance for us. And I just, that just won't happen. Because there's different laws in different states, different practice acts in different states. And no one, you know, like you even if you talk to a lawyer, they're going to say, this would be the interpretation. But also, as of yet, there's no like case law, to give us any sort of any sort of guidance. So that was a lot of words to say, it's really hard. I can tell you in Illinois, like two or three weeks ago, I'd be like, like, I'm happy, I feel like Illinois is a pretty safe space. We have, we have elections for our governor this year. And I have never been so worried, so motivated to vote. And so motivated to to really make sure to talk to people about it's not just like this, this category or this category, it's like we really need to take into consideration the ramifications of what this will do, I think there was a lot of this probably won't affect me a whole lot. But I think I'm guessing I think a lot of us on this call maybe I think all of us on all of us on this call, have lived our lives with Roe v. Wade. And, as all of this is coming up, and just thinking about how it impacts so many people, and how our healthcare system is already doing not a good job of taking care of so many people, the fact that we would do this with no, no scientific, back ground, no support scientifically. Like I pulled up the ACOG statement, and, and they condemn this devastating decision. And I really, I was like, it gave me gave me goosebumps. And this was referred to in our art Association's statement. And it makes me sad that we didn't condemn it. Hope that's not too political. But I'm really sad that we didn't take a stronger stance to say, this is not good health care. And we need to do more. Again, and that's like, again, so many words, to say we're gonna have to make up our own minds, we're gonna have to know, our rules, our laws and what we're willing to do, and go through, so that we can provide the care that we know our patients deserve. And that's going to be really hard. Because, you know, if I talk to someone, and if I call Rebecca in Washington State, she's going to have something different than if I talk to Abby in New York. And you know, that so it'll be, it'll be really hard even to find that support. That support there's going to be so much support, I think, from this community, but that knowledge and that, that confidence, we have to pull together so we have to pull together with all the other providers, but also we're gonna have to sit down and figure this out to   33:59 the clarity. So it's, I think a practical step forward would be each state to get get, like, every state, come up with a thing. So pelvic health therapists in that state come up with what seems to work for them get a lovely healthcare lawyer to to work with them with it. And then we could have a clearinghouse of sorts of all of the state statements. I don't know that that needs to go through a particular organization. I I know that they're in the field of physical therapy, two thirds of PTS aren't members. And we need this information to be out there for every single person so that they know   34:44 that we'll have to be grassroots there's I don't think that there's going to be widespread Association support from anywhere. But that being said, I think it's a great idea.   34:58 What are we going to do about it? Hang on issues that are too divisive, you're absolutely right, individual entities are going to have to take this on and just put those resources out to therapists who need them need the legal support, need the need to know how and how to circumvent issues in their states. And, you know, like I said before, even how to just provide that emotional support, there's going to be needed for their, their, their patients, so, and that's okay, if the organizations that were part of are not willing to take a heavy stance, you know, even like last year, if you're not willing to take a heavy stance, on an issue where someone feels their autonomy, and their choice is being threatened, then it's okay, well, we'll take it from here. But, you know, that's, that's really where these grassroots efforts come from and abound, because there are a group of individuals who are willing to say, No, this is wrong. And I'm going to do something about this so that our future generations don't have to suffer.   36:02 Yeah, and I think, you know, we're really looking at the criminalization of health care.   36:09 That is not healthcare.   36:12 And we also know who this criminalization of healthcare is going to affect the most. And it's going to affect poor, marginalized people of color, it is not going to affect the wealthy white folks in any state, they'll be fine. So how do we, as physical therapist, deal with that? How do we, how do we get the trust of those communities who already don't trust health care, so now they're going to stay away even more, we already have the highest mortality, maternal mortality rates in the developed world, I can only imagine that will get worse because people, as we've all heard today are going to be afraid to seek health care. So where do we go from here as health care providers? I,   37:10 Karen, you're speaking something that's very near and dear to my heart, I act as if you had to take this on, I am very adamant that we can no longer choose to stay in our lane, we do not have that luxury. And I as a black female, you know, physical therapist, I don't have the luxury to ignore that because of the color of my skin, and not my doctor's degree, not my board certification and women's health, you know, not my faculty position, I when I walk into a hospital, and I either choose to give birth or have a procedure, I will be judged by none other than the color of my skin. That is what the data is telling me is that I am three times likely to have a very severe outcome. If I were to have a pregnancy that did not go as planned or or don't choose a procedure, you know, that affects the rest of my function in my health. And so given the data on this, you're absolutely right there, there is going to be very specific populations that are going to receive the most blowback from this. And as a pelvic health therapist, I had to go into the hospital to find them, because I knew that people of color and of marginalized backgrounds, were not going to find me in my clinic. And we're not going to pay necessarily private pay services to receive that care. But I needed to go where they were most likely to be and that was the hospital setting or in their home. And so, again, as a field of a very dispersed and you know, not very many of us at all, we're going to have to pivot into these areas that we were not necessarily comfortable in being if we're going to address the populations that are going to be most affected by the decisions our lawmakers are making for our bodies.   39:11 You know, there's something that I think about, often when I hear this type of conversation come up in, in sexual health and in in whenever I am speaking with one of my patients and talking about their menstruation history, and, and them not knowing how their body works from such a young age is I just wonder if we should be offering programs for young people like very young pre ministration you know, people with uteruses and their parents, and grandparents and online, online like little anonymous. Yep. nonnamous   39:51 for it's just   39:52 Yes. Yes, it's it's just, you know, Andrew Huberman talks a lot about having data Back to free content that scientific, that's factual. And I think about that a lot. And I think, to my mind, where I go with this, because I do think about the lifespan of a person, is that creating something that someone can access anonymously at any age, and then maybe creating something where it's offered at a school? You know, it's it's ministration health. And it doesn't have to be under the guise of, you know, this happened with Roe v. Wade, but this it could be menstruation, health, what is a person who menstruating what can you expect? What you know, and going through the lifespan with them, but offering them? You know, I think I think about this with my own children, as our pediatrician always asks the question of the visit, who is allowed to see under your clothes who is allowed to touch you? And it's like, you and my, I have a five year old. So it's Mom, when when when I go number two, a mom or dad when I go number two? And that's it. And you know, I think about that, and I think about how we can educate young people on a variety of things within this topic, and kind of include other stuff, too, that's normal, not normal, depending on their age. Absolutely, there   41:22 was what I was excited about in pelvic health. Before this was people like Frank to physician and his PhD students and postdocs are working on a series of research about how if we identify young girls that are starting their period, and having painful periods, treat them and educate them, then that they will not go on to have as much pelvic pain conditions and issues in the future. So we look at the early childhood events kind of thing, but also period pain. And How exciting would it be if we could get education to young girls about just how their bodies work. And to know that just because you all your aunties have horrible periods doesn't mean that you're stuck with this, just like maybe they just didn't know, let's help you out and constipation information and those basic health self care for preventative problems. So I was super excited about all that. And now it's like, oh, now we have to do it. Because in that we can do little pieces of information. So people have knowledge about their body, that's going to be a little bit of armor for them, that they're going to need and free and available in short, and you know, slide it past all the YouTube sensors. This is this is doable, but it's gonna take time money doing, but we can do it. Well, it sounds like, ladies,   42:52 we've got a lot of work to do. One other thing I wanted to touch upon. And we've said this a couple of times, but I think it's worth repeating again and again and again. And that's that expanding out to other providers. So it's expanding out, as Rebecca said, expanding out to our colleagues in acute care, meaning you can see someone right after a procedure right after birth right after a C section. And, and sadly, as we were saying, I think we they may start seeing more women, I'm not even set children under the age of 18. In these positions of force birth on a skeletally immature body. So the only place to reach these children would be maybe in that acute care setting. How what does the profession need to do in order to make that happen? And not not shy away from it, but give them the information that they need. Moving forward?   44:07 I was just gonna say that I've given birth in the hospital twice. Not at any time was I offered a physical therapist, or did a physical therapist come by and I am in New York City. I gave birth in New York City, planned Solarians because of my illnesses. And nobody came by I did get lactation nurses, any manner of people who were seeing me I was on their service. But that has been something that we needed anyway. We mean to have a pelvic health physio on the labor and delivery and on the maternity floors, who is coming by educating as to what they can start with what they can expect. When can they have an exam if they want to have one? Who is a trusted provider for them to have one. And we need to get the hospitals to expand acute care, physical therapy to labor and delivery and, and the maternity floors. As a routine, it's not something you should have to call for, it should be routine clearance for discharge the same way you have to watch the shaking baby video to get discharged.   45:27 I'm happy older than all of you. I don't have it either. But taking baby video is not something that even existed back in the day. But that makes sense. I mean, I once upon a time was a burn therapist, and I was on call at a regional Trauma Center. And you know, it's like you're needed your, your pager goes off, because that's how long ago it was. And you just came in, did your thing, went back home went back to bed. There is no reason other than lack of will, that PTS couldn't be doing that right now.   46:03 I'm now of the opinion where it's unethical to not offer physical or occupational therapy within 24 to 48 hours of someone who had no idea who did not have a planned delivery the way they expected it who has now and a massively long road to recovery. After a major abdominal surgery, I'm now of the opinion that is unethical for our medical systems to not offer that those rehabilitative services. And I've treated individuals who had a cesarean section but suffered a stillbirth. So the very thought of not providing services to someone who has any kind of procedure that's affecting, you know, their their their not only their pelvic health, but their mental function. That to me is now given the you know, these these, this recent decision on overturning Roe v Wade, is now now we're never, you know, either we're going to now pivot again as pelvic health therapists and start training our acute care colleagues, as we did with our orthopedic colleagues, as we've done with, you know, our neurology colleagues, whatever we've had to do as pelvic health therapists to bring attention to half of the population, you know, who are undergoing procedures, and they're not being informed on how to recover, we will have to start educating and kind of really grow beyond just the clinics and beyond what we can do in our community or community. But we are going to have to start educating our other colleagues in these other settings, we don't have a choice, we know too much, but we can't be everywhere. And not all of us can be in the hospital setting, we're going to have to train the individuals who are used to seeing anything that walks through the door and tell them get over to the obstetric unit. Okay, there's someone there waiting for you.   48:06 Yeah, I totally agree. I mean, when I think back I remember as a student working in acute care and how we had someone who's dedicated to the ICU, we had someone dedicated to the medical floor, we had somebody who was dedicated to the ortho floor, and most of the time they had their OCS, their, their, the one for for, for ICU care, the one for NeuroCare, or they have a specialty. And I think it is just remnants of the bygone era of it's natural, your body will heal kind of BS from the past. It's just remnants of that and it's just, we don't need the APTA to give us permission to do this, this is internal, this is I'm going into a hospital, and I'm presenting you with a program. And here is what this what you can build this visit for here's the ICD 10 code for this visit here is here is here are two people who are going to give you know, one seminar to all of your PT OTs, to you know, so that you are aware of what the possible complications and when to refer out and that kind of thing. And then here are two therapists who are acute care therapists who are going to also float to the maternity floor one of them every day, so that we can hit the we can get to these patients at that point, and that is just that's just people who present a program who have an idea, who get it in front of the board that that it is not permission from anybody else to do it. And, you know, it really it fires me up to to create a world in which you know, when you know people who are the heads of departments and chairs and you know on the boards of directors You know, being in big, big cities or small cities, when you know those people, you know, you can, your passion can fire them up. And if you can fire people up, and you can advocate for your patients and you can in that can spread, you can make that happen. And this is, you know, I feel radicalized by this, I mean, I'm burning my bra all over the place with this kind of thing. And I just feel like, if we can, if we can get to young people, and if we can get to day zero, of delivery, day one, post delivery, or post trauma, then then maybe we can make a dent, maybe we can, maybe we can try, maybe we can really make a go of this for these people. Because, like I keep feeling and saying I, we are not prepared for the volume.   50:54 If individuals are going to be forced to carry a pregnancy, that they may not want to turn because it's affecting their health, we're going to have to be prepared for this. Again, this is not an option really, for us as pelvic health therapists, because we know what's down the road, we've seen mothers who have or you know, or individuals who have suffered strokes or preeclampsia or seizures, or, you know, honestly, long term health issues because of what pregnancies have done to their body. And now if they want the choice to say, you know, I'm not ready, they don't have it anymore. So we really don't have a choice. We have to start expanding our services into these other settings, making our neurologic clinical specialists in the hospital, see people before they have a stroke before they have a seizure actually provide services that can help someone monitor their own signs and symptoms after they've had now a procedure or given birth or even had, you know, a stillbirth, unfortunately, because the doctor had to decide, well, yes, now we will perform the abortion because you know, your health is like on the cliff, I mean, we're going to be seeing these and we just have to prepare. And if it's not our organizations that are laying the foundations, we will, we'll take it from here,   52:15 we need to reach out across so many barriers, like athletic trainers, they're gonna see the young girls, they're gonna see their track stars that is not reds, it's pregnancy. And it could be a very short lived traumatic pregnancy, in girls that are just not develop. They're developed enough to get pregnant, they're not developed enough to carry a healthy baby to term. Kind of just makes me like. But Rebecca is right as we don't get to have an opinion on the right or wrongness of this, we have a problem ahead of us now, that that is happening already, as we speak, that people are going to need help. I love that we have more technology than my grandma did when she was fighting this battle. And we have YouTube and we have podcasts and we have ways to get information out. But we need to use every single one of them in our sports colleague or athletic trainer colleagues. They need to know the signs. Because they may be the ones that see it first.   53:21 Yeah. And Sarah as being the most recent new mother here. What kind of care did you get when you were in the hospital?   53:36 I was sitting here thinking about that. And I mean, I will say that the care I had while I was there, that I had an uncomplicated delivery in spite of a very large baby. And I was fortunate enough to leave the hospital without needing additional help. But I wasn't offered physio. Nobody really they're just really curious to make sure you're paying enough. And that's about it if you're the mom and my six week visit was actually telehealth and that was the last time I had contact with a health care professional regarding my own health so it is minimal even if you're a very fortunate white woman in a large metropolitan area and but I'm working now further north and with a pro bono clinic clinic and in an area where we do a lot of work with communities of color and I'm I'm like I honestly don't even know the hospitals up here yet. But I'm gonna I have so many post it notes of things that are gonna start happening and start inquiring because Rebecca like we need to get into the hospitals like if if I can Do that. And honestly, up until now, like my world and entropy was, and pre this decision was it, there's so many people out there who need help with pelvic issues in general, like we can do this forever. And we set our clinic up so that people who weren't doing well in the traditional health care system could find us and afford us. At least some people could, I realized that it wasn't in companies, encompassing everybody who could possibly need help, but we were doing trying to figure out another way. And so again, like, like, again, the offer of assistance I got was minimal. But also I didn't need much. And I was in a position where also, I knew I could, I could ask for it if I wanted it. And I could probably get it if I needed it. And I'm just thinking about, again, some of the communities I'm interacting with now, in some of my other roles and responsibilities, and I cannot wait to take a look and see, how can we get in there? How can we be on that floor? How can we? What What can we make, make happen like, because it needs to happen, these are these, this is the place where I'm scared to start seeing the stats,   56:21 wouldn't it be amazing if you can get the student clinic part of that somehow somehow and get, you know, young beyond that bias, but younger, most younger but but like the physicians the the in training the PTs and training the PAs the you know, and get like Rebecca had said, let's get let's get the team up to speed here, because there aren't enough pelvic health therapists already. And they're heavens, we need, we need to get everybody caught up.   56:58 And there's so much I was telling you that being around student health care, providing your future health care providers is really energizing and also really interesting. I mean, the ideas that come up with in the in the connections they make and and the proposals they make are just amazing. But two things that I've noticed that I think probably we run into in the real world, real world, outside school world as well, is one. The that's being able to have enough people and enough support to keep it sustainable. So you have this idea, you have the proposal, you made the proposal, how are we going to keep it going and finding the funding or the energy or the volunteers to keep it going. Things ebb and flow, you get a great proposal, you're like yes. And then I literally today was like, I wonder what's up with that one, because it was an idea for a clinic to help was basically for trans people to our tree transitioning and might not have the support that they need. And also I was reached, they come up here for women's health clinic. And I'm going to reach out to them now. Because this again, this decision changes that because it is a pro bono clinic that they would like to set this up in and before it was going to be much more more wellness. And now it could turn out to be essential health care. So that's one thing. But then the other thing is still the education, that in school, we're not taught about what everyone else can do. And I think again, figuring out a way to make sure that future physicians really know what physical therapists have to offer, especially in this space. Most people know that if their their shoulder, their rotator cuff repair, they should send them to pt. But really, we need to get in with OB GYN news, we need to get in with the pediatricians. And I don't want to say unfortunately, but in this regard, unfortunately, we're going to have to really make sure that they know what we're doing. And again, I'm already kind of trying to think like how can we make this just part of how we do health care.   59:20 So I think I'm following in your footsteps by going into education and by by being a part of our doctor of physical therapy programs. You know, I especially chose the program in Washington state not because you know, of just the the the opportunity to teach doctors or incoming doctors but it was also an opportunity to teach doctors of osteopathic medicine and occupational therapy therapists. It was you know, very intimate program and opportunity to make pelvic health or women's health or reproductive health apart of cardiopulmonary content, a part of neurology content, a part of our foundations a part of musculoskeletal and not a special elective course that we get two days of training on, I had the opportunity to literally insert our care, our specialized and unique care and every aspect of the curriculum, as it should be, because we are dealing with, you know, more or less issues that every therapist generalists or specialists should be equipped to handle. So in the wake of Roe v Wade, to me, this is an opportunity unlike any other for pelvic health therapists to really get into these educational spaces where incoming doctors are, you know, MDS or PA programs, or NP programs are our therapy practices, and start where students are most riled up and having those ideas so that they can go out and become each one of us, you know, go into hospitals and say no, to obstetric units being ignored, go into hospitals and give and services to physicians. You know, we need to create more innovators in our field and education is the way to do that.   1:01:12 I just wrote down check Indiana and Ohio, and then I wrote border clinics, because Because Illinois is a it's like a not a prohibition state. Having so many flashbacks, because Illinois, is, is currently dedicated to maintaining health care access for everyone. We have cities that are on the border. And I was thought of that when you were talking, Sarah, because you're up next to Wisconsin now. But we have we have the southern part of the state and the western part of the state. And those those border towns are going to have a higher influx than I will see in Chicago, maybe. But I would anticipate that they would,   1:01:56 you know, and again, this is where laws are murky. Every state is different. It's I mean, it's a shitshow. For lack of better way of putting it I don't think there's any other way to put it at this point. Because that's kind of what what we're dealing with because no one's prepared, period. So as we wrap things up, I'll go around to each of you. And just kind of what do you want the listeners to take away? Go ahead, Sandy,   1:02:33 this is this is frustrating and new, and we're not going to abandon you. We're gonna figure it out and be there to help.   1:02:41 I would say that our clinics are still safe, it is still a safe place for you to open up and tell us what you wouldn't tell anybody else. It's still safe with us. And we still have you as an entire person with all of your history. We are still treating you based on what you are dealing with and not. We will not be dictated by anybody else. Our care won't be mandated or dictated by anybody. Sarah, go ahead.   1:03:22 What I would say is I would echo your safe. If you need help, there is help. And I'm sorry, that that this just made it harder than it already was. And I would say to healthcare providers, please let remember, let us remember why we're doing what we're doing. And, you know, we do need to stand up, we do need to continue to provide the best care for our patients. Because to be honest, I've been thinking like, I think it's a legal question. It's a professional question. But ultimately, if we can't give the best care possible, I'm not sure I should do this.   1:04:01 Ahead, Rebecca,   1:04:02 for our health care providers, in the wake of Roe v. Wade, being overturned, wherever we are, you know, as an organization or on our stance, if we believed in the autonomy of an individual to know all of the information before making a decision, then we still believe in the autonomy of an individual to know all of the information that is best for their body. And that is the oath that's the that's the that's the promise that we've made as professionals to people that we're serving, and to the people that we're serving to those who are there listening to this. You have safe spaces with providers that you trust and we're going to continue to educate one another, our field and also you we're going to put together resources that really bring During this education to your families so that you don't have to feel like you're in the dark and you're alone. This is not something that is per individual or per person. This affects everyone. And we're dedicated to advocating for you.   1:05:18 Perfect, and on that we will wrap things up. Thank you ladies so much for a really candid and robust discussion. I feel like there are lots to do. I think we've got some, some great ideas here. And perhaps with some help and some grassroots movements, we can turn them into a reality. So thank you to Rebecca to Sarah to Abby and to Sandy, for taking the time out of your schedules because I know we're all busy to talk about this very important topic. So thank you all so so much, and everyone thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.   1:06:03 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com And don't forget to follow us on social media    

In this episode, Founder and CEO of Practice Freedom U, Jamey Schrier, talks about hiring and retaining staff. Today, Jamey talks about changing how business owners see employees, the 3X rule, and digging deep to find clarity. What can business owners do to hire the right people? Hear about the importance of being inspired by your vision, successful marketing strategies, slowing down the hiring process, and get Jamey’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Besides you, your employees are the most important people in your business life.” “Meet your prospects where they are.” “Employees want to work for a company that has a purpose.” “The first person your vision needs to inspire is you.” “When clarity happens, you get power, you get confidence, and you get dialed in. When you have that kind of focus, that’s where magic happens.” “We’ve become infatuated with advancement. We’ve become infatuated with certifications.” “Hire for traits. Train for skill.” “If you are a business that’s growing, then you can never stop looking for talent.” “Having a process and slowing things down is critical.” “Be vulnerable. Be open.”   More about Jamey Schrier Jamey Schrier, P.T. is a best-selling author, speaker, and Founder and CEO of Practice Freedom U, a business training and coaching company. Jamey is a former private practice owner, and his book, The Practice Freedom Method has helped scores of practitioners Treat Less, and Earn More, and enjoy a life they deserve.   Suggested Keywords Healthy, Wealthy, Smart, Business, Hiring, Employment, Purpose, Vision, Values, Inspiration, Interviews, Focus, Strategies, Marketing,   Get $200 off Jamey’s Course   To learn more, follow Jamey at: Website:          https://www.practicefreedomu.com LinkedIn:         Jamey Schrier, PT Facebook:       Practice Freedom U                         Jamey Schrier Twitter:            @JameySchrier Instagram:       @JameySchrierPFU   Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:  https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hey Jamie, welcome back to the podcast. I'm happy to have you on I think you're quickly becoming my most regular guest and I'm really happy and thankful for it. So welcome back. Oh, thanks, Karen. I   00:14 appreciate being invited back and I am honored to be a regular it's like the old school while I'm dating myself here with the Johnny Carson Show. I mean, that's, that's going back and I don't want to date either one of us, but it's like, you know, the regular guests that's on there. They can't find anybody. There. Schreier. He's a felon. He didn't come in there and fill up some time.   00:38 Oh, that's so funny. I think I was watching Seth Meyers and Rachel Drac was on and that's what they said, Rachel Drac is like, you know, someone else was supposed to be there. But I don't know if they got sick, or they couldn't make it. And so they called her that afternoon. She was like, Sure. Tell me about her.   00:55 Oh, I've watched a sports show called PTI. Pardon the Interruption around it takes place right in DC. And one of the guys is called Phil and Frank. It's like, if they ever need anybody, someone's out sick. You know, Frank, I saw he, he jumps in and fills in at any, you know, at a moment's notice. So, you know, I don't know if I'll fill in Jamie. But well, well, you're   01:17 not, you're not filling in, you're just a regular guest.   01:22 Thank you, thank you,   01:23 not a fill in. It's just a regular guest. So today, we're going to talk about something I don't think I've really talked about on the podcast, at least, I can't remember talking about this in great detail. And that is, how to hire people how to retain staff, which, you know, as we were speaking before we went on is a problem, not just in physical therapy right now, but in a lot of industries across the board around the country. So let's dive in. So you have four surprisingly simple ways to hire and retain staff. So let's get to it.   02:03 Yeah, I mean, you know, as we know, it's a difficult marketplace. And I think, you know, this shift isn't just a shift that is, oh, they're gonna have a shift, and it's gonna be all fine tomorrow. No, I'm not gonna say it's not a permanent shift, as far as we're always going to have this difficulty, you know, really finding good people. But I do think it's a shift that is going to stay around as far as what people are deeming important, what people are deeming valuable. And I think it's important for us in the hiring marketplace, that we begin to shift how we as business owners, and that's kind of the position, I always come from being a business owner, and you being a business owner, is how we need to shift our way how we think about employees. You know, it's interesting, you know, I speak to so many people every day, every week, whether there are clients or, or just people out and about and in the business industry, and, you know, I can't tell you, Karen, how many times people talk about employees as a cost, right? It's like, oh, how much are they going to cost and, and I don't know if I can afford them, and all they care about is wanting more money, and this and that, and, um, you know, and it, it kind of, it hits me, because I think the first thing we have to do collectively, at least as a group of business owners is start to shift that your employees besides you, your employees are the most important people in your life and your business life. And if you don't mentally look at them as an investment, just like you look at any other investment you're doing, that will bleed into other things. It'll bleed to how you treat them, it'll bleed into some of the things you say are some of the things that you create or benefits or whatever the case is. And I've seen that so often, I used to do that, because I used to kind of think that way is they were a cost come in, do your job, shut up and just leave me alone type of thing. And you know, that is not the right way. It's never been the right way. But now more than ever, that's kind of the premise of all of this is shifting in these people are an investment. And investments are things that you want to nurture. You want to help you want to grow, you want to be assets. And I think it takes that fundamental shift before anything, because if not, everything just becomes an empty strategy or something but it won't hold. It won't have teeth to it. If there isn't that shift and how we think you know what I mean?   04:54 I do I do and I think that's a really great distinction that you made that you for employers to look at their employees as a real investment, because if that employee is nurtured and you help them grow, if they can help grow and expand your business in ways that you never thought could even be possible.   05:17 Exactly. And it sounds simple, it's easy to read in a book or listen on a wonderful podcast, but actually doing it in the moment is not as easy to do. Because we have wiring ourselves, we have thoughts, we have biases, we have upbringings and influences in our lives, as we all do. And these things, you know, whether you call them, you know, limiting beliefs or negative biases, we have all of these things that start to affect how we think and how we communicate. And how we ultimately, you know, put into action, some of these things. And if you don't feel that way, you don't think that way, it will come out, during how you interview how you post an ad. I mean, you know, I can be very honest with you, I know, you know, my ads used to be going on, I don't even know if it was indeed at the time, but going on whatever the latest thing was Craigslist or something, and just looking at another company and just copying their ad. I mean, I didn't know what to say, I didn't really know what I was doing. But I just thought, hey, if the hospital, you know, put an ad up, they must know what they're doing. Because they got you know, a lot of money and they hire good people. So my ad was basically a hospital ad. And what's interesting is, so many so many people continue to do that they, they put up some vanilla job ad on indeed. And they're like, well, this used to work, it ain't working anymore, you cannot do that anymore. It's not going to get you people, and it's certainly not going to get you the right people. You know, the real, the real thing right now is, you know, truly differentiating yourself leading with the positives. And, you know, I know we'll get into this in a second, but really looking at these people looking at these potential employees as investments and learning, how do you meet them? Where they are, right, there's an old marketing term is, you know, you know, meet your prospects, where they are joined the conversation they're having in their brain, which really means is, understand them, perhaps better than they can understand themselves, do your do your research. And, you know, I never knew anything like that. But I think that that's, that's what we all need to do is pause for a second and really understand the type of person that we're looking for, and learn as much about them. And when you're able to do that, you're able to put together what's what's called an employee value proposition, you know, you've we've heard and and we talk marketing, your unique selling proposition, all kinds of different propositions, but this idea of a an EVP and employee value proposition, yes, our job is to seek out and actually sell people on what we have to offer, why they should buy quotes, what we're selling. And it is a different way of looking at it. And for a lot of people, it's uncomfortable, and it's like, I shouldn't have to do that as as some of the things I've heard, you know, I shouldn't have to do that. They should want to work for me, you know, we give the greatest care and, and we're the best at what we do. And we really care about our people and all that it's like, yeah, but so does everybody else.   09:08 That's what I was just thinking doesn't everybody?   09:11 Yeah, I'm okay. And I know you care just a little bit more than I do about quality care. And I know that I mean, but that's, that's the mindset we come with. What we don't come with is we need to put our best foot forward. And we need to understand these people that we are trying I know we hate the S word. But we are trying to I'll say the P word and said persuade them for coming to interview with us. And then if we liked them, persuade them to commit to working for us. And you know what, when you have the ability to get pretty much any job you want out there, you put a posting out that you got 10 potential offers maybe 20 You're in competition with A lot of other people, and you have to realize that and have to do the work. It's not hard work. But it's focused work to understand more about who you're trying to get than you ever needed to do in the past. So that's kind of the premise of the whole thing. Yeah. Yeah. So   10:19 I was gonna say, Is this part of these, like, we mentioned the top kind of simple ways to hire and retain staff, is this part of it? Or is this the background you need to do to get to?   10:32 I think, I think it's the background. I mean, if I mean, you could put it in there. But you know, for this for this conversation, I'm kind of setting the stage of, of the background of where people need to be coming from. I mean, the bottom line is, why should they work for you? It's really that simple. Why should they work for you, because they can work for someone else, no matter what you say, one an hour to an hour. But there's, there's already 10 other people doing the same thing. So you know, one of the things that now we're gonna get into the specifics, you know, one of the things we talked about, you know, we need to treat them like an investment. But it goes beyond that, we need to understand number one thing that every owner needs to do is understand what their worth is. I did some research on this. There's a recent Gallup poll. And they said 60% 64% of employees said that a significant increase in income and benefits. Was there number one won't. Now, which is interesting. It wasn't necessarily number one, a little while ago, it was never number one. For many years, it was never even a top five money was not the focus. Well, it is now and you can't blame them. Because let's say education is a fortune. Right? Some people No, in our industry are saying, it's not even worth it. If you look on paper, just money, you invest in education. And when you get it back, you might be in debt for 20 years before you actually pay it off. Depending if you have 234 100,000, you have inflation, it just cost more to live in some of these cities like yours, and mine, it costs a lot to live wow, you know, you adjust for the insurance that you get, if you do take insurance. It's not covering that. So they expect the employer to do that. So this, this question of, you know, what is their worth? I've heard from so many people that say to me, you know, I can't afford that. And I say, Okay, well, what can you afford? Well, I don't know. And there's the problem. You need to know what this person is worth to your company at the level that you want them working. So for instance, I like to use a three multiple and a typical outpatient example. So if you're a typical outpatient, orthopedics, not, you know, insurance based, most likely, but it really depends. And your multiple of salary, not benefits, not taxes, and it just salary. It has to be at least three times, meaning that if you pay someone 75,000, that person should produce 225,000 in revenue, a three multiple it's just a ballpark. Could it be less than a three? It could be? It really depends how what your expenses are like, what's your rent, like?   13:42 You know, your other overhead and all that kind of stuff to make sure that you can cover all that and still have money for profit, let's not forget, profit. If it's greater than that, you should be really clear you should be fine. So it's our job to really dial in, what can this person generate? And then use that ballpark three times to determine what you can afford. So this shines a light. Karen and I and I've had some recent conversations with people and analyzing their business is shines a light on people's business models, some people's business models, they have this altruistic will I want to do one patient an hour, I'm like, hey, you know, we don't tell people what your model should be. We just tell you whether it's going to be profitable. And it's going to achieve the goals that you want, especially especially to financial goals. So if you do one patient an hour at $100 a visit, I can tell you right now there is no way you're ever going to be able to afford the people to work for you. That stay with you. It's It's literally impossible, because there's not enough money. Let's say it's one patient an hour that's at the greatest 808 A day Don't eat everyday, which is not going to happen. So let's say it's 30 or 35, you know, a week at 100 bucks 3500, that's 14,000 a month, that's 120 450 $160,000 Eat, you're gonna afford $50,000 therapists. And most people don't look at it like that care. And they go into this. And they look at it in the Yeah, but I want to deliver, you know, quality care one an hour, but they don't they haven't done all the numbers, whether they can actually build a business on that. Now, can they work for themselves and be like you and I were talking about before the show solopreneur? Sure, they can do that, you can just give yourself a job. And you might be able to make some decent money, but that's the job, right? That's just a self employed job. And if that's what you want, that's fine. But if you want to hire people and actually build a business, where gives you freedom, you're going to have to make a decision. But that's, that's so many times where people kind of have the wake up call and be like, oh, man, I need to change kind of how we're doing No wonder I don't have any money in the bank, even though we're 90% utilization. And that's a horrible feeling. When you're working your butt off, everyone's working their butt off, and there's still no money. That's a fundamental flaw. So that's, that's kind of the surprisingly simple way is just get clear on what you can afford. Use the three times as just a guideline and see what a you expect them, how productive do you expect them to be? Is it 80% 85%, whatever visits you want, multiply that by how much you get paid per visit, and just see what that looks like. That's where you need to start, then you can answer the question how much you can afford, you can answer the question what the therapist is worth to your practice, how much they can generate. And at least it gives you more data to know if the person says 80,000, and you never given anybody more than 72 You know what you might be able to afford that. And it might be a really good hire if they're a good fit. So anyways, that's that's kind of a the the number one thing that I'll start with?   17:13 Yeah, I think that's great, practical, easy to understand. What's next, what else can we do to hire the right people?   17:20 Yeah. So number two is a biggie. And this is, comes to Forbes magazine talks about this, I call it be on purpose, be on purpose. According to Forbes, employees want to work for a company that has a purpose, right. And we have a such a deep purpose. Us as as therapists, caregivers, we are healers. We're healing the world. And sometimes that message gets lost. Sometimes we forget that message about what we're really doing. Sometimes we speak about metrics and productivity, and we lose the message about what we're doing this for. And other times, it's all about the quality of the quality. And we have a business that is in financial instability. So how do we become on purpose? Well, the first thing is we have to get a vision, we have to get a vision as Simon Sinek talked about a vision as a just cause there was an interesting TED talk that he was talking about, or maybe it wasn't a TED talk, it was just a video, but he was talking about having a just cause a vision needs to be your Northstar. A vision needs to be inspiring. And the first person your vision needs to inspire is you. If you're not inspired by envision, like, you know, caring if it's like, what's your vision, you share a vision and you're like, so, you know, how do you feel about there and like, whatever. If you're not inspired, you're not going to share that vision to others. And if you don't have a vision, we'll put in values. Your values don't have to be these company values that you see in whatever commercials and they're on some rock outside the thing. Values are your beliefs. What do you believe in? What do you believe about the work that you do? Why is this work so darn important to you? People want to be connected to something they can get a job working anywhere. So why do they want to work for you? What are you about? What is your story in your business? I share my story a lot I've shared it on on your podcast many many times. And more people come up to me and say oh my god, I resonated with your story. I didn't have a fire and burned down my place but I've had some really difficult times. We are story people we love movies. We love plays. We love dying. Begin to stories. What is it about your business? How did you get started what it means to you, because during an interview, that's what people are going to connect to. That's what's being on purpose. So take some time and write down what your vision is, what your story is, what your values are, what does this mean to you? And use that with your current team, of course. But also you can use that in your interview process.   20:30 Yep, I love it. That was a huge part of what I did. You know, maybe two years ago, I was really being intentional and looking at mission, vision and values, and really understanding why I do what I do, why I started my practice, why I decided to go out on my own. And it was really enlightening, and made me appreciate the business that I have so much more. So if if you are a business owner out there, and you haven't, like maybe you've written down like a mission, vision and values A while ago, just to have it on your website, or just to do it, I would suggest go back, revisit it and really think about who you are as a person why you decided to start your practice what is really important to you. Another thing that I talked about at ascend, and that we did in the Goldman Sachs 10,000 small business program was they had us find like a totem. So this totem could be, it could be a phrase, it could be a physical object. It could be a mythical creature, if you will, whatever you want. That encapsulates why you do what you do or encapsulates your vision. And I remember thinking, told them, I don't know what I don't know what that what do I told them? And they're like, yeah, just let it. And then I was like, Oh, of course I do. Because it's been my sort of guidance for, I don't know, 18 years now. So even before I moved to New York City, before I started my practice, I was sort of obsessed with the cathedral by Rodin, which is two right hands coming together. So when you look at it quickly, it looks like a right and a left hand is actually two right hands. So it's two right hands coming together, not touching. So I always looked at that is like therapist and patient coming together with space in the middle to kind of grow and move. But you could take that into you and an employee, it could be you and a partner, but it's coming together, but not fully. But having that space in the middle having space for new things to come. So that was kind of my totem. And I didn't even realize it until I did this went deeper into this process two years ago. So I highly suggest people if you've already done it, do it again.   23:08 Yeah, you know it. I love I love your story in a lovely, what you're sharing, you know, I think that as as highly left brain analytical, very smart people. I think sometimes we have a difficult time going deep. Cal Newport, who actually is here in Georgetown universe, Georgetown, you know, talks about deep work going below the superficial. And we have a tough time with that. I don't know if we have a tough time being vulnerable, which I know we do. A lot of people do. But vulnerability is power. That'll be maybe my next talk here. But I you know, we have a tough time of going below the superficial and going into the real deep, where the real work happens. The feelings, the emotions, the connections of why do you do what you do? You don't have to you can do anything you want. Why this? You don't have to start your business. No one forced you to why it's bigger than I didn't like my boss. That's why he started. It's bigger than that. You have to go deeper. And when you do you get such clarity. And because when clarity happens, you get power. You get confidence and you get dialed in. And when you have that kind of focus, that's where magic happens. Because other than that, it's a noisy world and it's easy to get distracted. I mean it's easy to get distracted by everybody else's stuff. So, so important, because here's the thing when you when you are dialed in on your your vision, your story, what who you are I'll tell you what One thing is going to happen, these people are going to come into your world candidates or whatever they're going to know who you are, they're going to know what you're about, they're going to know where you're headed. Now, whether they choose to be a part of it or not, that's their choice. But there's not going to be a confusion about what you're about. And you know what, give me that every day of the week, because what I don't want is there. They're just there. It's kind of like, everybody else, stand for something, draw a line. And it starts by doing that deep work. So that's number two. My next one is, is one of my favorites. It's higher for traits train for skill. I feel as as an industry, that we have become infatuated with advancement. And I don't, and if   25:52 you mean all those initials after your name,   25:56 well, we'll carry on, let's just say it we've become infatuated with, with with certifications, with initials with with almost to say, Karen, I got 28 initials. Karen, I'm better than you. I'm a good person. I'm a great therapist, because I'm really, really smart. Well, guess what, Karen, you were smart, when you graduated, you're smarter than better than 1%, you know, then the other 99% of the world, you were already smart? How much more do you need for you to look in the mirror and say, You know what, you're good enough. You're okay, because you can't remember 90% of the stuff that you're learning anyways, I don't know where that certification and that more and more is better. I mean, there's definitely a financial part there. Because, of course, people get paid for the more education and there's people that are doing that, that are highly paid. But you know, this idea of the more letters the better all be. Now, here's the problem with hiring with that, because you're like, Jamie, we're gonna how's the connection? The connection is this. Because you can get enamored with a resume with someone that has two things, one, a lot of experience, we love that. And to a lot of initials, because in our head, we've taken that, and I've had people tell me that on so many occasions, well, will they have experience in a ton of certifications? I go, and well, I just assume I go, Yeah, I just hope that they would, I thought that they would what? Well, I just thought that because of that they would just be this amazing person that walked in, and they would do things the way that I would do them. They would just own it. And they would just be amazing. And I said, yeah, no, that's not what makes them amazing. You see, being a professional is not about having all that stuff. It's okay to have it if you want to have it if you want to learn, but you know, what? What are the traits, the characteristics that you're looking for with a person? Whether it's a front desk, whether it's a therapist, whether it's a clinical director? Who are they? Who are you looking for, because that the person that's going to walk in, and that's the person you're gonna get. The other aspects the skill, let's face it, we can train someone for any skill that's out there. There is a course for it. There is of course, a certification for him. There is a continuing ed for which you can't really change who someone is. If they're not a timely person, then they're not a timely person. If they're an introvert, they're an introvert. I mean, if you want an extrovert people person and you hire an introvert with a great resume, you're gonna get an introvert with a great resume. But if you hire someone hungry, if you hire someone that just has the, the, the, the characteristics, the character that you're looking for, who believes in what you're doing, who shares your values, of integrity, of timeliness, of commitment of just doing what's right. Give me that person every day of the week, and I will train them on the other stuff. But Karen, here's where some of the challenges occur. What if you don't actually have a training process?   29:33 What if you don't really have a hiring and onboarding process it's kind of some I don't know just something you kind of do. Their lair lies the problem. The real challenge is you don't have that. And if you don't have that you do the hope and pray method. I hope I the worst that kill me is Jamie. I think I hired a rockstar and I go oh boy. Here we go. Because hiring a rockstar is the hope and pray method. In your mind, they're a rockstar because you are hoping that they are because you don't have time to deal with this. Because you need to move on to something else because you are overwhelmed. Give me someone who's passionate about playing the guitar, and I will turn them into a rock star, but a rock star at my place. I don't need a rockstar at someone else's place. Because rarely, if ever, does that convey in someone being that a player at my place. So that's the biggest thing. really sit down, write down what are the characteristics that you want for this position? Are they outgoing? Hi, Quickstart, you know, talk about their emotional intelligence, are they detailed oriented, they follow through communication skills, you know, relational skills, like really get clear again, on the type of person that you want. And if they're not that person, no matter what their resume says, then maybe they might fit another position. But you want to be really careful about bringing them in, because it's an expensive endeavor that you're making. You don't want to make the wrong investment.   31:14 Yeah, absolutely. And I think I'm just gonna repeat that one more time. Hire for traits train for skill, just so people have that embedded into their freight train for skill. Yeah, yeah. Excellent. Okay, what's the last one? Last   31:31 one, expand your reach? Look, marketing is about awareness. The more you create awareness out in the world, the more opportunities and people come to you, we are in the marketing, of looking for candidates. So we have to use that same mentality, we're trying to find good people, we need to ramp up our efforts. So we need more effort. And we need to expand our reach, we need to explore every channel and open every door that's out there and apply a massive amount of action for a long period of time, this doesn't end we are all Talent scouts, it never ends. As long as you're trying to grow, you're always looking for talent. And if there's a if you find someone, you'll figure out a way to bring them in, because you'll know what they're worth to you. So what are some things you can do LinkedIn, had a friend of mine do LinkedIn strategy, which is basically connect with with people connect with I mean, LinkedIn is a 24 hour, seven day a week networking site, they just connected with people just generally connected with people. And then, you know, said, Hey, by the way, you know, I'm looking for this particular type of person. Do you know of anybody? Would you mind sharing the this as sharing his job description? With your network? I'd really appreciate it. They're like, sure. Now, all of a sudden, he had 567 people 10 people sharing this. Within a week, he had someone in Texas, saying, actually, you know what, I'm just finishing up my rotation, which was kind of weird, because it was at the same place that he actually did a rotation at, you know, some massive sports place in Texas. And the person's he's flying them up for an interview here. I mean, that costs nothing. It costs nothing. So LinkedIn, your staff, if you have a decent staff, they like working there, well guess what their staff there, your staff has a network of people, especially your therapists, give them a referral bonus. Ask them to reach out to their people, you know, great way to network. And we've hired lots of people through people that already worked for us. Your past patients, your contact lists, you know, again, sounds simple. Put it out there, hey, we're growing we're looking for and be specific. We're looking for someone to join our team, someone that has these qualities. If you have to every state has a list you can purchase. Right? I did this several times I purchased a list. It wasn't very expensive. They give you addresses, they don't give you email addresses. It's funny, I can actually go to your home right now, Karen, because you're on that list. I can go to your home in New York. But God forbid I can email you. And you can just you can just say unsubscribe or or just delete me, but I can go to your house. I never really understood that one. But that's the way it is. You can purchase a list, you can send them a letter, hey, put your best foot forward send them a great letter about the position. Are they interested? Do they know someone and guess what? Nobody really gets any good mail anymore. They're going to open up your letter. So that's a little more expensive, but it's still worth it. And of course your network pass candidates students. A longer term approach would be have a student program it is the best way to do a 12 week interview with them. And then you know, you know, obviously there's there's companies out there, there's recruiters out there, definitely a bit more expensive. But if you know what the value is of them of the person that you're going to bring on board, then it might be an investment that's worth it to you. So the key is, if you are a business that's growing, then you can never stop looking for talent. And once you do that, you will start to bring in people quality people, look, most of us aren't these massive companies that need 1020 therapists, one or two people can make all the difference. So let's shift your mind out of the idea that there's nobody out there, there's no good people out there, there are, you don't need a million people, what you need is to get very clear on who you're looking for. And you need to put a massive amount of effort behind it into networks. And I promise you'll find somebody a lot quicker than you think. But don't just put an ad on, indeed, that you got from another person. And think that's all you need to do. It definitely takes a lot more effort these days.   36:11 Yeah. All right. So I'm gonna recap. So yes, understanding what would their worth is. So that's that three times, rule. Be on purpose, make sure you have a purpose, be clear on your vision, values and mission. Hire for traits not trained for skill, and finally, expand your reach. So in all great ways, for owners of any business, of course, here, we're sort of talking about physical therapy. But I think great advice for any business owner in this atmosphere that we are currently in, in an economic downturn in a time where it seems like man, I cannot find good talent, right? So it's looking inward at yourself as to what you're putting out into the world and then putting yourself out there to find those right people?   37:08 Absolutely. I got a fifth bonus one if you want. Yeah, let's do it. Bonus one here, slow it down. Kind of contrary, to put massive effort, but hear me on this. So the biggest challenge we have right now, as people, especially as business owners, the biggest challenge we have is a lack of focus. If we could just focus on what we wanted to get done, we'd get it done, because we're doers, and we can get things done. But we can't because of all of the distractions that's going on. Well guess what, most people hire out of reaction of something else happening. Either someone quit, or Oh, my God, we have an influx of people. So you're reacting to that. And when you react to something like that, this becomes emotional. And when it becomes emotional, we basically just want to solve the problem and move on because we're overwhelmed. When you slow it down, you slow it down in the form of a process. It's a hiring process. Right? One of the one of the most important things that I learned that I did is have actually a clear step by step process and not miss any of them. Because when I did this before, quick little story, I didn't have a process for a long time. You know, I had an ad and I put it out there, whatever, and I hired people. But when I was interviewing people, I wasn't interviewing them. I was basically trying to sell them to come in, I would literally ask them a question and give them the answers to it. Hey, Karen, you know, our values is integrity and honesty. And, and you know, we like to have fun. Is that is that? Do you believe in that too? I mean, that's an IQ test. All you have to do is say, Yeah, I do. I don't I thought you did. Hey, this is a great place. I'd love to have you would you want to come on board? I'll give you whatever you want. Like, just, I don't have time for this crap. I got other things to do. Let me bring in probably one of the most important people that I'm ever going to hire. This was for a clinical director job that I did a half hour interview and that was it. That was the entire interview process, half hour hire the person. Unfortunately, the person ends up getting arrested six months later. Why? Because let's see person improperly touched a woman during a screening process. Well guess what my board found out in Maryland. And I was called in an investigation and asked 156 questions and learned a lot about HR learned a lot about having processes, learn a lot about having policies and procedures. And then I started doing much more of a background check than I ever did. Oh, I did his check to see if he had a license in Maryland. Oh, guess what? In another state. He was on probation for doing something very similar. But he didn't report it to me which was on him. He was supposed to but I didn't even check right out of the have, you know, I just assumed that his references were good? So it sounds like well, Jamie, you're a moron. Well, maybe so. But what I ended up creating was a very clear step by step process that slowed me down to make sure I did a resume review, and did a checklist on it. I made sure I did a phone interview, knowing what questions to ask, then I did an in person interview, then I did a work interview on a work shadowing, then we did background checks. And then we did, I slowed down everything to a process. Now you can go through the process pretty quickly. But you're still checking the boxes, because it was a protection for the company. You see this person getting arrested and doing this stuff. That's on me that's on the owner. And then I come to find out that he was a little creepy to the rest of the staff, who of course, never told me anything, because I was very high on this person. So having a process and slowing things down is critical. Because once you do that, you then can continue to do that for every person you're hiring. And eventually, you can delegate that. So that's my fifth thing is, is slowing it down and creating a process in this. Yeah,   41:20 great advice. That's a crazy story. Holy cow. Oh, yeah. So it definitely behooves you to do a good background check, and really make sure this is the right person for your practice. Wow. All right. So as we wrap things up, what do you want people to leave with?   41:37 Well, I mean, look, this, this is not easy, right now in our world. And, you know, I gave you I gave you, you know, five actual things that you can do right now. And, you know, it's, it's hard. And you know, one of the things that I've that I've created during my turmoil as a business owner for 15 years is I created my own process. And I turned that process, actually into a program into a course called the right fit hire course. And I've used it in my own business ended up hiring really great people, you know, quadrupling my business and ended up selling it. And now I've used it with hundreds of other people. And what I'd like to do is I like to offer that to your audience. The courses is normally for 497. But I'd like to offer your audience take $200 off, you know, just just, you know, you'll, you'll you'll put the link up there. But you know, it's, this is going to save you a ton of time, ton of energy. It's already split up into how to, you know, recruit great people attract great people qualify them, what the interview questions are, how to do the checklist, it even adds job description, sample, job description, sample ads, sample offer letters, it has all the done for you templates, I did all of that stuff. It even has an onboarding process, and even a training process. So it goes through all four of those components, how to bring in people how to qualify them, and onboard and train them. So it's, it's 297, you'll see you'll see all the things that includes on there. But that's, you know, I want to help people during this trying time, and it's just something that I've used, and so many other people have used successfully that I think would be very beneficial   43:26 to your people. That's incredible. So again, if you're listening, head over to podcast dot healthy, wealthy smart.com. In the show notes of this episode, we'll have a link. So one click will take you right to this, this is a great opportunity. So if you are in the hiring mind, I highly suggest for you to check out this course from Jamie, thank you so much. Now, Jamie, where can people find you?   43:49 Oh, they can find me at Jamie at practice freedom. you.com. If you want to email me personally, you can go to the website, which is practice freedom you the letter u.com You can check that out. And yeah, and I'm all over social media, you don't have to look far. And you'll see me all over there. And yeah, if you want to reach out, say hello, feel free to do so.   44:11 Perfect. And again, we'll have all those links in the show notes as well. So last question, what advice would you give to your younger self? Now you got to keep coming up with new pieces of advice.   44:22 This is the hard part. No, I mean, the pieces of advice is you know, and I think about this more and more. It's like, Jamie, be vulnerable. Be open. One of the books I read, you know talked about being a broken, broken, open heart warrior. Be a broken open heart where we all are broken, we're not perfect, but just open your heart allow the good stuff coming in. There's a lot of great people in the world who want to help you. But it's hard to be helped when you think you know it all and you're closed off and you're and you're just resistance and And I've been like that for so long for so many years and my world changed when I just started to be open and vulnerable and saying, You know what, I don't have all the answers. And that's when so many good things started coming in to my life. And I always try to remind myself when I start to get a little bit of too much ego and remind myself a little bit of, you know, be vulnerable. It's a powerful thing.   45:22 Yeah, I love it. That is excellent advice. Jamie, thank you so much for coming back on the podcast. I know this information will help so many people. So thank you so much.   45:33 Thank you, Karen. Appreciate being back. Absolutely. And   45:37 everyone. Thanks so much for tuning in. Have a great rest of your week and stay healthy, wealthy and smart.

In this episode, High-Ticket Mentor, Coach, and Founder, Michelle Hext, talks about creating successful high-ticket offers. Today, Michelle talks about her story from running Martial Arts studios to high-ticket coaching, the reasons why offers don’t sell, and the importance of keeping it real. What counts as a high-ticket offer? Hear about avoiding market research and analysis, determining your pricing, the pandemic’s effect on business, and get Michelle’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “The biggest thing that you can do to avoid competition, just always be 100% yourself.” “They don’t want you to look like every other person on social media. They want you to be you. They want you to be real.” “Go into your bubble, and don’t look left or right. Look within because everything you have is inside of you.” “Usually it’s not about the price, but people think it’s about the price.” “If you have to do the mindset work, something’s not right.” “Become a specialist and focus on one thing.”   More about Michelle Hext For over 30 years, Michelle Hext has been a mentor, and since she was a child, the business of creating, growing, and scaling high-value products has been a part of her DNA. Michelle has a history of building successful brick-and-mortar businesses and online companies. Her area of expertise is helping entrepreneurs create high-cost brands. This involves launching, growing, and scaling high-cost offerings. So, her clients can only choose to work with high-end clients who want results. Michelle’s regular audience is people who want Launch & Scale, a high-ticket coaching brand. She’s trained hundreds of coaches and experts a year with her mentor program. So, Michelle has a pretty good idea of the kind of content they listen to.   Suggested Keywords Healthy, Wealthy, Smart, Business, Success, Offers, Social Media, Branding, Packaging, Confidence, Monetization,   Special Offer: 5 Days to 5K   To learn more, follow Michelle at: Website:          https://www.michellehext.com Facebook:       Michelle Hext Instagram:       @Michellehext   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hey Michelle, welcome to the podcast. I'm happy to have you on. Thanks for joining me.   00:07 Thank you so much for having me. I'm happy to be here.   00:10 Excellent. And before we get into, I'm sure what a lot of people are tuning into here is, how do we create and sell high ticket offers, which I promise we will get to. But before we do, let's talk a little bit more about you. So tell the listeners a little bit more about how you got to this point of where you are helping coaches and entrepreneurs create, sell and position their business for high ticket offers.   00:37 Yeah, so I started, you know, my very first business was back in like, we're going back to the early 90s, the very early 90s. And my first coaching was in the form of martial arts, I owned martial art schools, and along the way, developed a bunch of other things to bring to my skill set. So in 1991, I started instructing Taekwondo, the martial art of Taekwondo. By the mid 90s, I had my own schools. And, you know, you get to a point where you're instructing and teaching people to fight for contact, and grade for a high belt levels, like black belt and things like that. And you know, you're alive as a coach, because a lot of resistance comes up for people. And so I always, am really happy that I had that that early training in coaching about helping people to overcome resistance. Resistance is resistance, it doesn't matter whether it's whether you're going to launch an offer, or whether you're going to go and fight or grade for about, it's all very, very similar. So it really taught me to help extract the best out of people. And it also really taught me that people are very, very different. And you could instruct one person in a certain way or say things to them in a certain way and draw out the best of them. And it would have zero effect on somebody else. So really got a good education in human nature, and how to read people and how to get the best out of people. So I had my martial art schools for a number of years, still trained today. So it's still a very big part of my life, but it's no longer part of my business life. I outgrew the bricks and mortar business model, it just didn't challenge me anymore many, many years ago. And so along the way, I've always been a bit of a natural entrepreneur. So even when I had my martial arts schools Tibo was the thing. And so I decided I was going to create my own Tibo type program. So I called it power. And I had somebody come in and film me. And this was before even DVD. So they recorded them. And I was selling these in martial arts magazines as cassette tapes, like video cassettes with a with a manual, because I wanted to bring that type of workout into martial arts school safely. I wanted them to be able to leverage this new phenomenon, but I wanted them to be able to do it in a way that they felt confident to deliver it. So I created this syllabus and branding and all that sort of stuff and sold that through magazines. And I was always doing different things like that looking for different angles. I became a personal trainer, I as well, to add to my martial arts school, I, I had a full time center and I added a personal training studio was always just looking for ways to increase my bottom line, and to keep myself interested and inspired in the work that I was doing. And in around the 99, I think it was coaching became a thing, it became an actual industry that was making a noise in the US and it filtered its way back to Australia. And I thought, This is what I do anyway. So I'm gonna go ahead and do this. So I went and got myself qualified as a coach. And I've been coaching ever since. So at one point, I had taekwondo school on one side of the street and my business coaching offices on the other side of the street. And I was juggling both and young children and all that sort of stuff. And just over the years, it's been a very I guess I've followed my nose, but the business that I have now, where I work with, you know, high level clients, they invest quite significantly in me because they they want to create some success pretty quickly. And it's all just been an evolution of the same sort of thing. So my first high ticket offer was off of the back of a book that I wrote called The Honorable martial arts entrepreneur. And it taught people how to niche their coaching business, sorry, the martial arts business, how to market it and all those sorts of things. And that was off the back of me launching a women's only martial art school that was very successful.   05:00 And then I moved into the female entrepreneur space and launched a 27 and a half $1,000 mastermind, within like four weeks of launching that brand, and had a $200,000 launch, it did really well, it was a lot easier to sell to female entrepreneurs than it was to martial art school owners. And then I've been doing very similar work ever since that was 2014. But I've just really narrowed my niche now to work with coaches and consultants, because they're, they're the people that I had the most impact over and in this industry specialists who want to move into that coaching consulting space. And so now I work with clients from kind of all around the world. My fee these days is 10,000 us a month for four weeks, which is a long stretch from when I first started, I think I was charging 1200 for 12 weeks or something like that. So it's not necessarily been very strategic, it's just I paid attention to when it was time for me to grow and expand into the next kind of level. And I've just done that, without too much fanfare or drama or anything like that. I've just yeah, really just trusted my instincts along the way.   06:16 That's quite the evolution of being an entrepreneur, you know, starting with the martial arts studios to where you are now. It's quite a journey. And thanks for sharing that. And I think it also at for me highlights, what one bout of let's say, education or position, you know, as a fifth degree black belt, correct? Yes. So your training as a fifth degree black belt has really spilled over and helped to, I think inform you going forward. And a lot of people who listen to this podcast are physical therapists, their trainers are entrepreneurs. And I think it's so important, like, you don't give away your let's say, in my case, I'm a physical therapist, I can use that physical therapy education, to improve coaching programs, and to inject it into coaching programs, because of the years of experience as a PT, just kind of like what you did as a coach.   07:23 Yeah, and nothing is ever wasted. You know, I, I had online fitness businesses as well. And I remember there were women who were coming along and participating in my online fitness programs. And one of them was in my business mentorship program. Last year, we're talking a span of close to 20 years, you know, these women come along and they they participated in my programs, then they became personal trainers, because they were interested in the fitness space. And then they were using me to help them grow their businesses. So it's, yeah, and all of the things that I've learned, whether it's the fitness stuff, whether it's the martial arts stuff, whether it was the taking myself back to school stuff, and never using the course that I enrolled in and, and things like that nothing is ever ever wasted. And I know you're gonna ask me a question about competition, you know, and saturated markets and things like that. And I'm going to kind of segue into that if you're okay with that, oh, for the what, what, I don't believe there is any competition, I don't believe I have competition, I just don't consider that I never have regardless of the business type I was running. And the reason is exactly what I just spoke about, nobody's had the same education experiences, life experiences, or anything else that I have had, nobody is going to have my unique take on things, or my unique approach to the way that I do things and see things and, you know, am I able to take a big picture and simplify it into the, you know, a three point to do list sort of thing, because that's just the way that I've consumed information and processed it and how I you know, all of the different things. And it's the same for any coach, any consultant, you can have, I love to use this, this example. So you can have somebody that is looking for, let's just say a social media coach, right? Say somebody is in the market for a social media coach. And I want you to imagine that there are 20 Social media coaches all lined up sitting at a sitting in a row. And we have 20 people coming along to hire a social, social, social media coach, and they all sit down and it's like speed dating, they get to go and you know, have a conversation with every single social media coach and choose the one that they want. They're not going to pick the same one. Because what's going to come into play is, oh, you've got young kids as well. Oh, I know what a handful that is. Oh, you like martial arts as well. Oh, wow, I trained in martial arts, they're going to connect with the human being and human beings experiences and things like that. And so the biggest thing that you can do to avoid competition is trying to be like everybody else. Just always be 100% yourself and let all of the weirdness and the quirks and, you know, all these parts of you that make you up, be there, you know, I, I would never say, Well, I'm just not talking about martial arts anymore, because that's just not what I do. Like, people remember that I have a fifth degree black belt, you know, it says something about me. It's not relevant to my business these days, but it's something that people will remember. And so yeah, that's my little kind of rant on that.   10:43 Yeah, no, I think that's great. And I oftentimes, we don't, we, we feel like revealing too much personal information could be detrimental. But like you said, that's the way someone's going to connect with you. So it's okay to reveal some personal information, some background information, I'm like, obviously, you don't have to give away like your personal medical history if you don't want to. But it's a way that people can make a connection with another human being.   11:15 They want you to be real, you know, I have this this phrase that I, I'm writing another book at the moment, and it's what I say something along the lines of, they don't want you to be another instance step by step and printer, you know, where it's like The Stepford Wives sort of thing. They don't want that they don't want you to look like every other person on social media, they want you to be you, they want you to be real. And if we have a look at people like Celeste Barber, the comedian and we have a look at in Australia, we have a woman called Mia free, Friedman, who has she hosts a website called Mamma Mia. And she's always looking like a hot mess. You know, she's doing her live streams, putting makeup on and the washing powder in the background and things like that, you know, people I mean, you've got to choose your market, right? Mike, you're not going to see that in my space, because I'm operating in a you know, a different brand. But people love those women, you know, they love the relatability. And so, you know, we've got to walk that fine line between depending on our brand. But for me, it's like wanting to be aspirational and inspirational, but also keeping it really real. So people understand that, you know, I'm just a regular being like I'm wearing I showed you before, I've got a lovely top on and earrings, and I've got my workout gear on down the bottom. So I can race out and go to the gym. And I don't hide that, you know, I talk about that. And so I want people to understand that sometimes, you know, things look so polished in brands, that they just not people feel like it's not attainable. They feel like it's just an overload overwhelms people. So we want to be able to keep things real.   12:52 Yeah, excellent advice. And now let's get into talking about high ticket offers. First question, what is a high ticket offer? What is considered high ticket?   13:03 Yeah, so, um, you know, there are all different, I guess, explanations of what a high ticket offer is. For me, there's no magical figure that you crossed, that puts you into high ticket territory. It's very, very much subjective and individual to the person. So I've worked with clients who were charging $100 for a coaching session. And suddenly they have a two and a half 1000 or $5,000 coaching package, that's high ticket for them. I also work with clients like a client recently sold an $85,000, US dollar paid in full upfront coaching package. And that was a 12 month package. Amazing. She's an E commerce coach. But within about two weeks, I messaged her and I said, we've got to cut that back. That's going to be a six month course you can't be doing that for 12 months. And she's like, Yep, cool. But we sometimes play around with timeframes and things like that to get used to charging the higher prices. And for my clients to feel really confident in selling it because the confidence is a big thing. But coming back to the high ticket offer thing. For me a high ticket offer is a price point that feels really big for the for the for the coach putting it out there. And oftentimes for the prospective client as well. It means that you're purchasing or you're selling a premium offer. The client is expecting a premium level of service and because they get that you have the ability to work more closely with those clients, give them more thought time even if you're not with them. And so the results are better. Always. You know, I had a client sign up. I was in Fiji a little while ago. We had our first session on Tuesday. By Thursday, she had sold two coaching packages two days, you know, which is incredible. So she hit her coaching sorry, her revenue goal within two days. That was the monthly revenue goal that we had set up And so yeah, it's giving them the confidence and all of those sorts of things to go out there and know that they've got a rock solid offer that's going to impact people and all that sort of stuff. And then they, they sell.   15:13 And I'm sure that you work with your clients, looking at market research, and whatever the niche it is that you're trying to sell this high ticket offer in? Do you know what I mean? So, you don't   15:28 know No, no, no, I don't want my clients looking at anybody else. I don't want them doing any research. I don't want them doing anything like that. Because what that does is it distracts them from what is their zone of genius. So it's almost like, if you imagine my, my clients come to me, and they're a glass of perfect water, you know, it's very crystal clear, it's in a clear glass. And then they start to look outside, and they start to get ideas. And every one of those dumb ideas they bring back is like a drop of black ink that goes into the water, you know, and it muddies the waters, and we don't want that. So it's my job, whether it's one on one or through my programs or whatever to help them extract what is unique and special about them that they can deliver into the market. And then we you know, we shape it into a monetize product. But I want them to get clear about what are they love to do? Where do they have the greatest level of impact? Where can they produce the best type of results? What's the work that feels effortless to them? And then the biggest hurdle, the resistance is helping them to understand that that is enough. You know, because typically, they want to add bells and whistles or go learn something or something like that, but they don't need to. Right. So if we look at, for example, your physical therapist, you've created a an incredibly successful practice. Or maybe it's you've created an incredibly successful podcast in this space. And so if you said to me, you know, I want to, I want to teach this, I want to work with clients so that they can do this as well. I'm not going to send you to do right market research, hell no. I'm going to say, Okay, let's figure out, you know, all know, if there's, if it's the offer makes sense or not. Or if there's a market for it or anything like that. And I will tell you straight away, no, that won't work, or no. Like, I've seen that before it doesn't work or whatever it is, but I'm going to help you figure out how we get to harness what you have. How you would do it. And then yeah, create a way to monetize it.   17:41 Yeah, so you don't get into that wheel of like analysis paralysis, right? Where it's just or worse, comparing yourself to others and then get, then maybe you might run the risk of giving up 100%. So   17:55 my client that sold two packages within two days, she would never have done that. If she went around and tried to figure out how other people are doing it. And then getting into this comparison itis because somebody's website's prettier. You know, it's like, no, that's not what we want to be doing. So yeah, my advice to your listeners is go into your bubble, and don't look left or right, like look within because everything, everything you have is inside of you. And if you don't know how to get it out of you, in a way that makes sense in a way to package it. That's when you get help but, but ensure that you you find somebody that's going to help you pull out the best of you not say, Hey, I've got this system, let's just mold you to fit this system over here. We don't want that.   18:41 And, you know, I was gonna go into sort of five reasons why your coaching offer or your high ticket offer isn't selling, I feel like we might have gotten number one, I think we might have one that we just talked about. Right? Is not looking out and looking towards everyone else.   18:59 Yeah. So there are a number of reasons, right? So the first reason is, it's not clear. So they're not clear about what it is that they're actually selling. And the content, whether it's a sales page, whether it's an email, or whatever it is, it's not giving enough detail about what this is about. So we can get in our own head, right? Because we know what we do. We know exactly. And so if we take shortcuts on the explanation, people will miss the point. Another reason people aren't putting enough of themselves on the line. So what I mean by that is you've got to go on, make a big promise and then just back yourself that you're going to be able to back up that promise you're going to be able to deliver it. And so one of my programs is called the for 5k formula for coaches, I first launched this in about 2016, or 2017. It used to be a $5,000 coaching package, four week coaching package. And the way that I sold it is create and sell your first $5,000 offer in four weeks or less. And 90% of the people did, some people didn't, but like, that's the industry we're in, nobody has 100% success rate. And so people were buying that I couldn't keep up with the demand, I had to leverage it as a group program. After that, I couldn't keep up with the demand, because the promise was really frickin clear. Pay me $5,000, I'm going to show you how to make you know, at least that in the first month, most people saw between two and four packages. And like, that's a no brainer, right? It's a no brainer for people to do that. But if I said to them, Hey, you know, I'm gonna teach you how to price and package and position your offer over four weeks, like it's kind of compelling. But it's like they want to sell it like what they want, ultimately, is to make money, they want to be selling this thing. And so for me, that's the big promise, I'm going to show you how to, I'm going to show you where to find that first client and make that first sale. And so a lot of times that that big promise isn't anywhere near compelling enough.   21:19 Yeah, got it. So not enough detail of what it's about which I you know, I've seen so many times I'll be on I'm like, What is this? I don't yet, it's just you know, it's the sales page that keeps scrolling and scrolling. And you're like, I don't know what's happening here.   21:37 So even if people have spent money on copywriting, the copywriter hasn't got the instruction that you've given them about what this is what this isn't, this is what people get when they do it. Like they're gonna wishy washy it all over the place and have beautiful language, but nobody still has a clue what it is   21:52 no clue. Not enough. So not delivering on the promise. Right? So making them not miss making the promise.   22:01 Yeah, right.   22:03 What else? What are some other reasons why your offer isn't selling?   22:09 Usually, it's not about the price, but people think it's about the price. So they'll tell themselves things like, Oh, I think I should charge less for this. And then it still doesn't sell. And it's because of another reason. It's because it's not clear. Or it's because you're not confident in your ability to deliver the offer. And the energy is a little bit funky. And you might be saying one thing, but if all your energy is saying something else, and people pick that up on the internet very, very easily. Yeah, why else be because they're not asking for the sale. It's like, they're creating content to Wazoo all over the place. And they just expecting that people are going to make the the leap from Oh, she's telling me this nice thing that's very useful. Oh, let me go find out if I can work with her. And if there's a way to work with it, and that doesn't happen, right? We're busy, we're scrolling. We've got to stop the scroll. We've got to engage people with our content. But then we've got to say, go buy this thing. Go buy this thing or jump on this call or whatever it is. So yeah, no call to action. There just isn't a call to action.   23:18 Yeah, yeah. And circling back to having this funky energy or, you know, not feeling confident. So, in my mind, I think mindset issues. So how do you work with your clients, when they're in that mindset mind set of maybe not being confident and feeling bad about charging money for their services? I'm sure you've heard that in the past.   23:47 Yeah, yeah. So I'm just gonna add one more thing, and then I'll jump on to that. The other thing is the sales process. So I saw an offer the other day, and it was like $5,000, for four weeks or something like that. And it was a Facebook ad ran directly to a sales page and a Buy Now button. And it's like, people don't buy like that, like, you know, give them a you know, warm them up with a lead magnet or some sort of content, have a on the on the sales page, have a, you know, book a discovery call, or, you know, message me to find out more or something like that. But it's like that sales process is screwed up. And it doesn't make sense. So the higher the offer, the more usually time you're going to have to spend letting people know especially if you're dealing with cold traffic, warm traffic is different. But a lot of people are trying to point $5,000 sales pages at cold traffic, and it really doesn't work. You're just wasting money. So that's that. And when it comes to the mindset stuff, and you were asking me, so if a client, you know, they're not confident and all that sort of stuff. My clients don't pass go unless they're confident. So there's a reason and it's just because I've been doing this such a long time and I see it so so we've got a client and we've got a package So the one that sold to in within 48 hours, like we could have gone with a $5,000 offer, because that's typically where I start my clients. And she's like, oh, yeah, it's definitely worth 5000. I'm like, I'm not convinced that you're convinced. And I said, How do you feel about just selling the first two for two and a half and just get some sales in? And then we can put the price up? She was like, yep. So she went and sold it. Like, it was like nothing, right? And so sometimes I want to manipulate it so that if they feel like 5000, like, I can do it, I can do it. Yes, I believe it. But it's like, I know, they're gonna have to labor emotionally, and do you know, get themselves riled up to be able to go and do that price? Whereas when I create a $5,000 package, and they're all in with the $5,000? And I say, how about we knock a couple of 1000 off, and you just get some quick sales? They're like, Oh, yeah, I can do that. Because it's not the price. It's the, it's the confidence around the deliverability. And sometimes, if this is the first time you've sold this package, you're going to be telling yourself things like, what if I can't get a result, and I always say to my clients, well, I can put that fear to bed right away, because there are going to be clients that don't get results. That's just the industry we're in. So you're gonna have people who don't get results. So we're gonna stop worrying about that. As long as you can put your hand on your heart and know that you did everything that you could to provide the right framework and to provide the right support to get people help you, you can charge that price, and you can make that offer. So yeah, well, we're sorry, what was your   26:37 question? Yeah, that was that was the question. You're talking about mindset? And, and what do you do? If you you're Yeah, you know, you don't want to charge or your Oh, so hesitant?   26:52 Yeah. So I guess it's a combination of mindset work, and practical work, right. So sometimes it is more mindset, where it's just like, you know, I feel really, you know, I feel a bit like awkward about reaching out or during discovery calls and like, well, let's not do on like that. Like, I can make use journal and like, you know, try to get your head right for the next week over this, or we just change it so that you feel good about it. And so they might say, oh, yeah, okay, well, I don't want to do this. And I'm like, Okay, well, how else can we do it? And so oftentimes, the resistance, I think this is really important. The resistance and the mindset work. If you're having to do the mindset work, here it is, if you have to do the mindset work, something's not right. It means you're not confident on some level, you don't feel confident in the sales process, you don't feel confident in your offer, you don't feel confident in your messaging. So figure it out. Because 100% confidence will tell you that you've got you're on the right track. And don't be okay with 70%. You know, do the work to get clarity on your offer and to feel really good about it.   28:03 Yeah, excellent advice. And here's another question, when do you raise your price? Right? So I'd say okay, I'm really confident, I've got an offer at $2,500. And I had this offer up for six months, people are purchasing it. When do you say okay, I think it's time let's raise it to 35, or four or five, whatever it may be.   28:28 Yeah. And so, with regards to my client that I said, let's just go sell a couple, like, the next one will be maybe three and a half, maybe four and a half before we get her up to five, unless she's fully ready. So for me, that's part of my strategy, and she's just going to run with it. But if it was, like me, personally, so back when I was charging 5000 US a month and selling the 5k formula, when people were selling two, three, and for these packages, it's like, I feel like I'm being ripped off charging people $5,000 When they're making this, and then they're gonna continue to make it, you know, they're gonna 20 $30,000 months. It's like, that doesn't feel like enough. So I put my price up to seven and a half. And yeah, and then so my client recently that sold that $85,000 package, I'm looking at my $10,000 a month fee, and I'm thinking it's about time to put it up. So, yeah, I want to get a handful of like, super, super, super high end, ridiculous results, because then that's the same philosophy. I apply to my clients. I want to feel confident, it's like, I know, I'm gonna give them 100 grand, I know they're gonna get 100 grand back in the first couple of months of working with me, so I feel okay about charging 20,000 a month. Yeah,   29:46 got it. Got it. So it's sort of based on what results are you getting for your clients and your How comfortable are you moving to the next level? Yeah, for math. So yeah, yeah, got it. And now over the past two years, obviously we are we have lived through the COVID 19. pandemic, we are still in it in most parts of the world. I don't know where Australia is at the moment, but here in the United States, we are still in the thick of it for sure. So how do you think that COVID has changed the online? Offer space? Right? Because you had a lot of people moving online.   30:32 Yeah, it was incredible. It was like the early days of the Internet was amazing. So you know, I, I've had a lot of people following me for many, many years and had a lot of people that were not reliant on online, who suddenly had to be like this whole online thing you've been talking about, you know, can we have a conversation, so my business definitely picked up, it was easier to sell anything. There are just a lot more people online. And it was easier for me to, or it was easy for me to attract more clients and feel more programs and things like that. But it was equally as easy for my clients were doing new launches, you know, they weren't launching themselves for the first time, because they had eyes on them. It seems it's settled back down to not quite pre COVID. There's still a lot more people online and a lot more people wanting to move their businesses online, or be, you know, all online now and things like that. But definitely it created, it created a massive boom. And the other thing was, you know, the ads were a lot cheaper. The traffic was a lot cheaper, too, because people just stopped. So yeah, it was it was a great time, business wise, for sure.   31:46 And we sort of touched upon this earlier in the interview. But do you think because of that things have gotten overly saturated?   31:55 I don't believe in saturation, I really don't. And I look at the amount of people that move into coaching every year. I don't know what the numbers are. But there's hundreds and hundreds of 1000s of people that are coming into the coaching space. Many, many, many, and you know, there are going to be a lot of coaches out there who fail are going to be a lot of them, you know, but they're going to try and they're going to be needing services. And they're going to need coaching and mentoring and things like that. But yeah, I just don't, but I don't believe in saturation for the reasons that I spoke about before. Like, I'm a business, essentially, I'm a business coach, Online Business Coach, but there's not a lot of people that can compare to the way that I do things. Because there's only one me and people will you know, there are business coaches out there who are focused on lots of different things, right. So there would be business coach, as you spoke about earlier, yes, you've got a business coach is going to send you out there to do market research, and all of those sorts sorts of things. And there are going to be clients who are very attracted to that, because they want that information. And that data to make decisions on my people are not those people. My people are very, they feel their way into decisions. You know, they trust their instincts and things like that. And so those people are never going to be attracted to me in the way that I do things that would freak them out. So yeah, it's, there's always going to be people for your market. So rather than thinking of saturation, think about okay, I own a corner of the internet. This is my show, how do I show up on my corner of the internet, with my people on the internet in a way that helps them to pull the trigger on reaching out on whatever it is like, show up, share your message be consistent about the message. I just had to kick a client's but this morning because I'm like, Who are you? And what are you doing? Like two weeks ago, we were this? Like, we need to get back to you know, focusing on this, this? And so give things time. So work out what do you want to be an if you want to be an influential leader in a space, what is your space? What is the message? What are the things that you're saying? Who are your people get clear about all that and show up for those people? And they will come?   34:23 Yeah, yeah, yeah. Perfect. And you know, we do the same thing in physical therapy. Right? And we kind of use a lot now in physical therapy. People are niching down. So you're, you know, you work specifically in sports or pediatrics or pelvic health and people come?   34:41 Yes. Yeah. I've had three hip surgeries. I'm not going to anybody who doesn't specialize in hip rehab, just aren't doing.   34:49 Sure. Yeah, absolutely. Now, before we begin to wrap things up, is there anything we missed any points that you want the listeners to to to drill into their brains when it comes to crafting and selling these high ticket offers.   35:08 Yeah, I think the first thing that the timing I think is the thing. So if we talk about the steps, the first thing that you want to do is get clear on like, what is your zone of genius? What is your skill set that we can monetize. Then, from there, create a package that you feel excited about, you feel like it's well priced, you've made your big promise, like spend the time developing the offer concept, until you feel really good about it, and then start talking about it. So don't be showing up on social media and all over the place, sharing a wishy washy washy message with no call to action, and people don't really know what you do. Be clear about, okay, I am the face of this, this is who I am, this is the space that I'm leading now and show up there, then you can talk talking about your offer is very, very easy. So you know, right now I've got a pricing and packaging challenge that's going to come up in a few weeks. And so all I'm going to be talking about is how important pricing and packaging is. You know, that's all I'm going to be talking about. So if you're a social media coach, and you specialize in tick tock, don't talk about other things. If you're an E commerce coach, and you only work on Shopify, don't be talking about other things become the Shopify specialists, be the specialist in the space and keep your messaging narrow, so that people know Oh, that's that person that does that. And 100 people in your space might not need you, but one will. And if you're a high ticket coach, you don't need very many clients to make a lot of money. So forget about having hundreds of 1000s of followers, focus on you know, the 10 that you've got, because your your first client is going to be there. And then build from there.   36:52 And love it. So get clear on your zone of genius. Create the package, talk about it all the time. Don't be afraid. And really focus on the audience that you have. Yes. Perfect. All right. Well, that's great. So listen, where can people find you? What do you have coming up? You just mentioned a pricing and packaging challenge. So please tell us all about it and when it starts, and how can people find   37:20 you? Sure. So you can find me on Instagram. So I met my name, Michelle hEXt. My website is Michelle headstock calm. And the challenge is it's your 5k, offering five days, create your signature high ticket offer in less than a week. And it starts on the 21st of July. It's going to be it's $97. So it's just a taster program. And over five days, I'm going to be helping people to unpack all of those different bits and pieces so that by the end, even on day five, I talk about building out your digital assets and things like that, like how to sell it how to onboard. So we're going to start with broadly what is your sweet spot uncovering that, we're going to be covering things like building out your offer framework. So the six, the success pathway your clients will take, we do this first, then we do this, then we do this. I'm going to be talking about copywriting and sales page concepts. And so it's very practical. We're going to start from, like the mind set stuff. And then we're going to work all our way down to being really free. Yes, which is Get ready to make that first sale. And we'll do that over five days, and I can't wait to launch it.   38:34 Sounds amazing. And I think I may take you up on that. That challenge. So again, that starts on the first of July. And we'll have links Sorry, sorry, 21st 21st of July. And again, we'll have links to all of it in the show notes over at podcast at healthy, wealthy smart.com. So if you didn't write it all down, just go to the website, and it will have everything on there. Now, last question, it's a question I asked everyone knowing where you are now in your life and in your career, what advice would you give to your younger self?   39:08 I would have focused on one thing instead of 27. Like figured out like what is my one thing, and then I would have taken it all the way because when I did that, that's when everything turned around for me when I was trying to juggle too many things. And I had 75 Facebook pages and 75 accompanying Facebook groups and you know, all that sort of stuff. I was very busy and I was making money but I was exhausted and I wasn't a specialist in anything. So figure out you know, become a specialist and focus on the one thing, take it all the way nothing bad will ever come from that because when I did that with the honourable martial arts entrepreneur, I had my first $30,000 a day it was a it was a massive jump up from what I'd been doing. And then when I went to do it next time with another brand I had called The Art of kicking us elegantly. It was faster, you know, because they'd already done it. And I'd learn. So focusing on one thing is, what is my offer? How am I going to sell it? What is the marketing? What is the lead magnet? You know, I just built that system and took it as far as I could take it until it was time to pivot. And then I knew how to do it. Just change the branding and things like that. So yeah, focus on one thing, take it all the way, don't quit, just keep going. Because you know that that image we see where the the man's like got the Pekinese in the cave and they miss it by just an inch. You never know how close you are. So my rule of thumb is give it your full commitment for 12 months. And don't waver, just figure it out. If you love your offer, and it's not selling, figure out why it's not selling, if it's selling, but it's not selling enough thinking, Okay, how do I get more people to buy it, be thinking about how you can make this bigger, better, stronger and more successful? Not this isn't working, I need to try something else. Like be committed, if you know the offer is solid. And you know, you're good at what you do. Stick with it until you get where you want it to be. Because it is just a matter of time.   41:07 I think that is great advice. And I think another takeaway for me, as you were saying all that it's okay to pivot your offer. It's okay to have a different offer. And once you've got the framework in place, it's a little plug and play, right. But it's like you don't have to go to the grave with just one offer.   41:25 No, no, no, no. But you've got to make you've got to know how to make that one offer work. And we've got to know how to make that one offer work and be profitable before we start to scale it or bring other products on board. Yeah,   41:40 yeah. Yeah. What great advice. Well, Michelle, thank you so much. This was great. There, I took so many notes so much so much for the audience to dig there. dig their heels into here and and really, hopefully start to make a change. Because I know a lot of people that listen to this podcast are in this world of trying to figure out how to make their mark in the digital world. And, but but not only that, really find a, an offer that's unique to them that can help others. And that's where I think a lot of people that listen like they just you just want to help other people succeed.   42:19 Yeah, and it's creating that win win, you know, so you're winning, you're signing clients, and they're winning because they're getting the result that they need. For sure.   42:28 Exactly. So going in with a win win attitude is everything. And so with that being said, thank you so much for joining me today, and I'm excited for your pricing and packaging challenge. So thank you so much for sharing that.   42:45 You are very welcome. Thank you so much for having me.   42:47 And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.

In this episode, sports chiropractor, certified strength and conditioning specialist, pregnancy and postpartum athleticism coach, and level 2 Crossfit coach, Dr Karlie Causey, talks about exercise during pregnancy and the postpartum period. Today, Dr. Karlie talks about planning home exercise programs and preparing athletic women for the postpartum exercise phase, and the idea that every mom is an athlete. What are some postpartum conditions or barriers to getting back to fitness? Hear about setting expectations about postpartum conditions, the story behind Jen & Keri, and get Dr Karlie’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “You don’t need to wait to the 6-week mark to start doing what we consider rehabilitative exercises.” “Tie small rehab activities into your daily life.” “Just ask the patient what works best for them.” “Walking in the postpartum phase is exercise and it does count.” “Starting off slow to get back to where you want to go is always the right choice.” “You can continue being who you were before motherhood.” “If I would’ve had more fun, I probably would’ve been more successful, but also maybe it would’ve been a little bit of a smoother ride.”   More about Dr. Karlie Dr. Karlie is a sports chiropractor, a certified strength and conditioning specialist, pregnancy and postpartum athleticism coach, and a level 2 Crossfit coach. More importantly, she is a mom to two, who is ridiculously passionate about helping postpartum athletes and moms-to-be restore their bodies and move with confidence. This obsession led her to establish Jen & Keri, a postpartum activewear brand for athletes, and create her wildly successful Postpartum Restoration Plan. Beyond being a mom and a competitive fitness lover, she has spent the last 17 years of her life studying the human body and learning how it moves. Earning her doctorate of chiropractic and a master's in human biology were just a start; she doesn't plan to stop learning any time soon! She is certified in the Webster technique and BirthFit, and has served as the team Chiropractor for the Seattle Seawolves and as the local medical director for AVP Seattle.   Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Pregnancy, Postpartum, Motherhood, Exercise, Rehabilitation, Athletics, Training, Empowerment,   To learn more, follow Dr. Karlie at: Website:          www.karliecausey.com                         www.jenandkeri.com Instagram:       @drkarlie                         @jenandkeri   Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                       https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:  https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hey, Dr. Carly, welcome to the podcast. I am happy to have you on and excited to talk about exercise during pregnancy and the postpartum period. longtime listeners of this podcast will know that that this is a topic we talk about a lot here. So I'm really great to have you on to get a fresh perspective of things. So welcome.   00:23 Yeah, thank you so much for having me. I'm excited for for our chat.   00:28 So before we get into the nuts and bolts, can you give the listeners a little bit more insight into you and as to why you chose this sort of subset or niche of folks to see?   00:42 Sure, yeah, well, I've been a sports chiropractor now for Gwent, this is a will be my 12th year. So I've been doing that for a while. And I've always loved working with women in general, all walks of life, all stages of life. But when I became pregnant, I really as I feel like it happens for many, many healthcare providers, you really start to embrace the stage that you're in a little bit. So I really started to learn a lot about how how women progress through pregnancy, how they can continue working out how we can minimize, sort of, you know, things that can happen to that are detrimental after the baby comes. So I just really, really dove into that area of expertise. And it just hasn't stopped since then. So I found it very helpful to to have someone walk alongside me during my pregnancy, pelvic floor pt. And so now I try to be that person for a lot of my patients, too.   01:46 That's great. And listen, the more help we can give to women pregnant, and especially in that postpartum period, or that fourth trimester is, as it is called, I think the more people who can offer help, the better because it's not like people are not going to ever get pregnant again. So yeah, have that help. It's really important, and a lot of women just don't know. Right? They don't, I don't know what you don't know. And so if you're not in the healthcare field, there are so many questions, the body changes so much you're feeling maybe Weird Things You Didn't feel before. So getting back to exercise can be a little nerve racking. So   02:26 Oh, go ahead. No, go ahead. I think that, um, you know, it's becoming much more common to talk about this, and that women are wanting to work out more. And what's one of the benefits of social media, you know, is that we're seeing some of this stuff and able to get more info, you know, I talked to friends who had kids 10 years ago, and it just, it doesn't exist at all really, you know, and as far as like, information that was readily available. So I'm happy that, that we're trending in that direction, at least.   02:54 Yeah, absolutely. And now, let's get let's get into the nuts and bolts here now. So can you give us some practical ways to introduce rehab, introduce exercise, after giving birth, and I love the that were practical, right? Because we're talking about women who maybe don't have a whole heck of a lot of time, because they have a newborn to take care of. So I'll hand the mic over to you.   03:25 Yeah, exactly. Um, I think one of the things that I really liked to stress is that we don't need to wait until the six week mark, to start doing what we consider, you know, rehabilitative exercises. So if with an uncomplicated birth, I often have women starting, you know, day two, day three, especially with just breathing exercises. And what what I see very often is, as women are pregnant as their belly is growing, what happens a lot of times is that diaphragm really gets crammed up there. And so we start to see that they're not breathing as deeply, they're not able to belly breathe. And that diaphragm, we have to remember is the top of the quote unquote, core, right? So their pelvic floor is the bottom, we have our diaphragm on the top, and then all the muscles surrounding but I just like to remind women of that, because that muscle getting so kind of constricted throughout pregnancy is really a big deal. And really, starting on the breath work early on can be really, really helpful. So that's one thing that I really like to emphasize is, you know, at day two, day three, even if you had a C section, you can be laying in your hospital bed, doing some deep belly breathing, diaphragmatic breathing, and you're actually doing a lot more than than you think you are, you know, you're actually starting your rehab journey right there. So that's my first tip that I always like to give. I'm sure you as a PT would would agree with that, right? Like there's just so much we can start with so. So yeah, that's number one. And then the other thing that I really like to emphasize is time small rehab activities. into your daily life. So getting away from the mindset that we have to like set aside 3045 minutes an hour, whatever you used to do, or whatever you think you need to do, and say, Okay, I'm going to do 10, diaphragmatic breaths, and 10, air squats. And every time I set the baby down, or every time I change the baby's diaper, or whatever it is, you know, you can kind of pick what works for you. But I like to do that. Because then it's, it's adding in movement throughout your day, it's giving you a sense of control of like, having these pieces of rehab that you can add into your day and feel like you're working towards a goal. And it's taking away the stress of like, okay, you have to have this time set aside, everything has to go perfect, you have to have the perfect workout outfit on and your water bottle ready and the right tunes and like it just doesn't happen with a newborn baby, you know. So I think taking that stress off is another helpful tip.   05:57 Yeah, it's funny, I just did a social media post about this subject when it comes to a home exercise program that, you know, ask your patient in front of you, I because I have a woman who said, you know, I can squeeze in a couple of five to 10 minutes a day. So if you give me two exercises that I can do in between patients, she's a psychologist in between patients, I'll do it. Right. She's like, but if you say, Oh, you have to set aside, like you said, half an hour, 40 minutes to do that. She's like, it's just not gonna get done. Yeah.   06:32 Yeah, it depends on the person, right? Because then you also have people who want that 30 minutes, like, give me, I am used to working out an hour every day, whatever it is, I want my 30 minutes of things to do. And so it's yeah, it's just knowing your patient and like taking the time to ask them those questions of what's going to make them more successful. And the other thing I like is, if you've read the book, habit stacking, that's basically what I'm recommending to is, you know, tying an exercise to something else that you're already doing. So you don't have to think about when am I going to do this when you know, it's like, I always tell new moms don't tie it to brushing your teeth. Because sometimes that doesn't happen, you know, if we're being honest, sometimes doesn't happen on a on a day, but, you know, tie it to something like, okay, when you pick up the baby, change the baby's diaper or hand the baby to your partner, those kinds of things that you're you know, you're going to be doing, then that seems to be a recipe for   07:24 success, too. Yeah. And like you said, most importantly, just ask the patient what works best for them. Right? We're not them, we're not in their shoes. Maybe this woman gave birth, and she's got a ton of help at home. Right? We don't know. Or maybe it's a single mom who gave birth who doesn't have a ton of help. So always just ask, that is the easiest way to come up with a realistic and like you said, practical home exercise program. Okay, anything else, any other practical tips to introduce exercise in rehab after in those first couple of weeks or months, let's say after giving birth?   08:06 Yeah, I think another one is, you know, include the baby is always a good one, right? We tend to forget after we have a baby, depending on the activity level of the person beforehand, we tend to forget that walking is actually exercise, especially in the postpartum period. So I like to remind my patients of that I have a lot of patients who are pretty active, pretty high level of athletics prior to being pregnant. And so I have to remind them that walking in a postpartum phase is exercise, and it does count. And you should be finding time for it. Whatever that looks like with a stroller with a front pack, you know, even if you can get out for a little bit on your own is always nice, too, but not often as doable. But so I like to I like to remind people that and also that we don't necessarily need to jump into walking right away. So it's not something that you know, day 234, walking, probably still doesn't feel very comfortable, whether you have a vaginal birth or a C section. And so remembering that that's just like anything else, you want to work into that slowly, just like any other exercise program, you wouldn't jump right into lifting super heavy weights or, you know, join a competitive athletic league of some kind. So, starting slowly there, too, I think is important. Yeah. And   09:27 you hit on something that I want to kind of circle back to is, you said a lot of the women that you work with tend to be really high level athletes. I know you're also a crossfit coach, right. So you're seeing a lot of these high level, athletic women. So how do you kind of prepare them for this postpartum phase where they're not really going to be able to go back to that heavy lifting right away? Because from a psychological standpoint, I would think that would be can be quite difficult.   09:59 Yeah, it is yes, good question, I think what I tried to do is really lean into what I sort of call the negative side of it. And I try to stress to them that the things that are going to get them back to where they want to be, are really boring. And they're really slow. And they're going to be annoyed by them. But if they do them, in the short term, it's going to pay off in the long term. So starting off slow to get back to where you want to go is always always the right choice in postpartum with postpartum women. So yeah, that's, that's what I start with. And I really explained the breath work because again, that sounds like boring and sort of silly to a lot of people. And before I had a baby, I think I was less, I was less into the breath work, because I just found it so boring. And I would listen, you know, to pts and chiropractors, and, you know, ortho, all kinds of Doc's talking about how important breathwork was. And I was always like, gosh, it's so lame. But then once you feel how that diaphragm really doesn't expand like it used to, and you can't connect your breath with your body, like you use, do you realize, okay, this is actually where we have to start. And once we get this down and get this kind of Mind, Body breath connection down again, then we can start to progress from there. So yeah, I always start off people really slow. I developed a postpartum restoration plan. That's eight weeks. And it's more developed for the type of person that needs like, you know, they need their 20 to 30 minutes of like, here's my rehab, here's my, this is going to substitute for my workout for the day, you know, since I'm not doing a cross a workout or, or hit workout, or whatever they do. But I think that's been helpful to have those exercises, have kind of a game plan. And then, and then I can kind of shift those things around for people that want to like, you know, kind of fit things in here and there. So,   11:50 yeah, yeah, great advice. So really setting those expectations even before the baby comes so that they know what to do. So they know what's coming. And that's huge expectations are everything. Okay, so how about any conditions or barriers to getting back to fitness that maybe some postpartum women may experience?   12:17 Yeah, I always like to talk about this. Because there's, there's some things that people aren't really anticipating, you know, I think a lot of women during pregnancy, they sort of anticipate, okay, maybe a little bit of low back pain, maybe some pelvic pain. Even if they're thinking ahead, some upper back and neck and shoulder pain from being sort of hunched forward and nursing and that sort of thing. One thing that people don't anticipate that obviously isn't like a, you know, life ending condition or anything, but I'm sure you've heard of it, and seeing patients with it is the mommy thumb, you know, mommy wrist, however, we want to call it but that's when it really catches people by surprise. And basically what it is, is, can be pretty severe pain and either the wrist or the thumb and it comes from the forearm extensor muscles, and just from holding that baby and kind of that flexed position. So often, women are generally carrying a lot on the on the same side, if you bet shear, they end up sleeping kind of with the arm curled around the baby often, so then they can kind of get stuck in that position. And those muscles get really, really tight. So I like to tell my patients sort of warn them about that prior to giving birth and have them start on some wrist roller, you know, some eccentric, concentric strengthening of both the flexors and the extensors. And nothing crazy, you know, couple of minutes a day, four or five days a week will make a huge difference in that area. So that's one thing that I like to warn about. And if they with new moms that they're starting to feel that right away, I have them try to start some of those loading exercises, because that will, you know, if we catch it early enough, it can nip it right in the bud. But if we let it go, it can be pretty severe, you know, and people end up getting cortisone shots to take care of it and and there's a time and a place for that. But if we can take care of it beforehand, then let's do that.   14:05 Yeah, absolutely. I once had a woman who she was like, I think in her early 50s. And she started experiencing you know what they call mommy thumb or deeper veins. And hers was from they just gotten a new puppy. So her kids were grown and she's like, it feels like it does. She's like my thumb feels like it did after I had my second child. And so I look at how she's carrying this dog around the whole time. That's why   14:33 Yeah, there you go happens to the best of them, I guess. Yep,   14:36 absolutely. So even even to the moms of new moms of our furry, furry children, our little fairy children, it can still happen. So be prepared. What else what other complications or errors have you seen?   14:50 Yeah, I think one that gets a lot of you know, buzzword right now gets kind of a lot of play is talking about diastasis recti time and I'm glad I'm glad that it becomes So much more common to talk about it talk about what it is how it happens. But I think there's also a lot of fear mongering that goes on with that. Again, on social media, there's, you know, whoever can post whatever, right, so I do see a lot of stuff about about diastasis recti, what not to do. And what I always like to remind people is that it's, it's a normal, natural thing that needs to happen for that baby to grow and for the abdomen to expand. So I think that's really important to tell our patients and make sure that they know that it's supposed to happen, it's going to happen, you know, some studies show up to 100% of women have diastasis, recti, I think, like, week 36. And so, so just reiterating that, like, it's okay, it's gonna happen, we're gonna, we're gonna rehab you out of it, you know, but I think, you know, learning about it is great, and then understanding, okay, it's the separation of those abdominal muscles, what's gonna cause more stress on those? Okay, well, any of the flexion exercises, of course, so sit ups, and across the world, toes, the bar, that kind of thing. Any sort of kipping motion, anything where you're losing control, right down that linea alba down the center of the core, so are dancenter the abs. Also with heavy weights, like that's another thing that a lot of people don't anticipate as heavyweight overhead. Can Can just overstrain that tissue. And so there, I usually recommend people switch to dumbbells, you know, that's a pretty common recommendation, switch to dumbbells from a barbell, if you're using a barbell, they're just more forgiving, and allow you to, you know, move a little bit more efficiently and keep your core a little bit more stable. And then talking about in the postpartum phase, what we're going to do to rehab that. And understanding that, you know, nothing you do during pregnancy is going to, it's not going to hurt, it's not gonna hurt the baby, it's not going to hurt you, it just potentially makes it harder to rehab it later. Right. And so, we're always talking about minimizing those activities, seeing what we can substitute in, so you can still keep moving and doing what you want to do. But, but, you know, kind of playing that game of like cost benefit analysis, like, is it worth it to be doing this exercise? Is there something I could do that's a little bit safer, and just sets me up for a little bit more success down the road? So yeah, I think it's important to really talk during the pregnancy about that. And then in the postpartum phase, talk about where do we start, you know, and again, it goes back to the breathing, I hate to harp on it, but it does. And then there's some really simple diastasis recti exercises, that sort of work on engaging the transverse abdominus, you know, that big flat abdominal muscle that kind of wraps around and, and then from there, kind of retraining your core that okay, we can stay stable. And we can keep, you know, a nice pressure throughout while we start to learn to move our extremities and move a little bit of weight. And just like anything going through kind of progressive overload. But with with the core.   18:06 Yeah. And would you mind giving the listeners maybe a quick example of an exercise that you might work with a patient postpartum? Like, let's say that now, like you said, like 99% of women will have a diastasis after pregnancy? So would you mind giving a quick example?   18:27 Yeah, of course. Yeah. So there, there's tons of them out there. And it really depends on what phase of postpartum she's in. Right. So if it's really early on, like I said, we're going to work on some breathing, and we're going to have her one of the cues I really like is, when we're thinking about kind of trying to, to create tension throughout the abdomen, I like to think of kind of pulling the hip bones together, that's one that seems to work well for a lot of people. So you have them take a breath, and let's say they're lying on their back on the ground with their knees bent, have them take a big breath in, feel right on the inside of their hip bones. And then as they breathe out, they're gonna think about trying to pull those hip bones together. And that can start to help engage that transverse abdominus. And of course, you want them in like a neutral spine, in this position. And from there, then we can progress obviously, you know, with some, like heal slides with the leg lifts. Those are pretty sort of traditional exercises. I also like to incorporate when we start talking about, you know, healing through the entire Corps, I like to incorporate some glute work because that's one thing that gets missed a lot. We, we forget that the glutes are connected to the pelvic floor. So when we're trying to heal this whole barrel that is our core, it's really important to, you know, start with some really basic just even if it's glute bridges, some hip thrusts, those sort of things. I think those need to go hand in hand as we work that posterior chain along with the anterior abdomen.   19:57 Perfect. Thank you so much for those examples. Just gives people a little taste. So let's talk about Jen and Carrie. I will throw it over to you. Why don't you talk a little bit about Jen and Carrie and your company's logo?   20:16 Yeah, thank you. So my company is called Jen and Carrie, and it's sort of funny. My name is Carly, obviously, my partner my business partners name is Jess. So Jess and Carly. But whenever people get our names wrong, which is a lot they call us, they call her Jen. And they call me Carrie. And so as we were talking about what we should name the company, we were like, Jen and Carrie, they sound like you're fun mom friends that like know all the deets and have all the advice. So that's, that's our company name. And unfortunately, it's only further that probably problem a little bit because now you know, email and correspond with people. And they just immediately cost Jen and Carrie, but that's fine. We started the company after my first son. And I was, I believe it was, it was a couple months two or three months postpartum. And I was just getting back into the gym and trying to go back to CrossFit class, I'd done all my rehab, and I was really slowly kind of reintegrating, and I was complaining to her that I just hated all the nursing sports bras out there, I hate the clips, I hate the zipper, the button, like all this stuff, I just hated it. And you know, and across the class, let's say you're doing you're working with a barbell you like kind of dig the barbell into those clips with a PowerClean or a front squat or something or you're running and they pop open. It's like, you know, everyone every mom's worst nightmare. And so we started kind of looking scouring the internet for a sports bra that didn't look like a nursing sports bra, we just didn't find one. So we started kind of toying around and, and playing with a bunch of sports bras, cutting them up and, and it grew into basically the sports bra that we developed, which looks just like a regular sports bra, it has a sort of different technology that you pull up the top layer, pull down the bottom layer, so there's no clips, no zippers, none of that stuff. And really, the reason was, I just wanted to be in my workout class and feel like everyone else, like I wanted to have that hour of time for myself, I love being a new mom, I love being a nursing mom, but I just didn't feel like I needed to be advertising it to the world and my like, one hour class, I just wanted it for me. So that sort of spawned our company. And our goal is basically to just empower women to get back to whatever activities they love. And this is just one way we're doing it, we just feel if if a sports bra is gonna make you feel more comfortable and more confident in your postpartum body, and that's gonna get you moving then that we're all for it. So that's sort of how we started.   22:48 And, and the logo, every mom is an athlete. So controversial take may be right, some people may think I totally get where you're coming from, but go ahead and kind of explain that.   23:02 Yeah, so we have a couple of different reasons for are a couple of different meanings behind our logo, every mom is an athlete, we, first of all, we want women to feel like they can be whatever they want to be. So they can continue being an athlete, if they were before having kids, they can become an athlete, if they want to, you know, whatever that means for them, you know, whether it's running or Jiu Jitsu, or strongman competitions or whatever, we don't care, we just want to support you in whatever you want to do. And we also the other thing that we think about that is that being a mom is a really athletic job. So when you think about the stuff that moms do, you know, you think about the mom, carrying the car seat on one side with the toddler on the other hip with the coffee and the hand with the backpack with the all the stuff and that takes a lot of athleticism, whether you consider yourself an athlete or not. Putting your baby down in a crib is a hip hinge, right? Picking your baby up to put them into the car and the car see is is a press and a lift. So everything that we're doing, we try to we try to think about okay, what, what our moms doing and how can we support them in active wear, you know, as just one of the many ways to support them. What can we do to help support them in in this really athletic endeavor? That is motherhood?   24:21 Yeah, I love it. I think it's great. And I agree I do. I do think every mom is an athlete as well. So not so controversial, although I could see where people are coming from on that. So currently, as we start to wrap things up, what would you like the audience to take away? What are your takeaways from our discussion?   24:45 Yeah, that's a great question. Um, I think I would love for them to take away just that. You can continue being who you who you were before motherhood in whatever context that means for you And, and, you know, an entirely different version of that maybe, but like you can continue all the athletic pursuits you had before. That I want women to feel to feel empowered in the postpartum phase. And I try to do that in a lot of different ways, right? Like in my clinic, with my postpartum plan, but doing things like these to just like, talk about, here's some simple things you can do to help reintegrate your core and start building your strength back and just feel stable and confident, comfortable in your new body. That's my goal, really. And so that's our goal, Jen and Carrie, that's my goal, personally, and I think that would be my takeaway.   25:42 And where can people find you? You can list social media websites, where can they find Jen and Carrie?   25:50 Yeah, so Jen and carrie.com, it's JdN and ke ri. We're also on Instagram at Jen and Carrie. And then I'm also on Instagram at Dr. Carly, it's KR, li e. Those are probably the best places. Perfect. And   26:04 we'll have links to all of those in the show notes for today's episode over at podcast at healthy, wealthy smart.com. So if you forgot you didn't write it down. Don't worry, just hop on over. And we'll have direct links to everything. So, Carly, last question. And it's one I asked everyone knowing where you are now in your life in your career, what advice would you give to your younger self?   26:27 Yeah, I know, you asked that question. And I've been like really thinking hard about it. Um, I think I would give the sounds so cliche and sort of silly, but I think I would tell myself to have more fun, because the research shows when we're having fun is when we actually enter that flow state more right? We can talk about that for hours, I'm sure. But I think I would tell myself that because I look back and see the hard work of school, you know, education, but also in sports athletics, through high school college. I just think I if I would have had more fun, I probably would have been more successful. But also maybe, you know, maybe it would have been a little bit smoother ride. So that would be my advice.   27:09 Yeah. And, and as an entrepreneur as well, right? So sometimes, yeah, gets so wrapped up into the day to day that we're like, all stressed out and forget, like, wait a second, we got into this as a business owner, as an entrepreneur, to do things our own way. So why can't that involve having some fun every day as well?   27:31 Yeah, exactly like this. Right? We get to just sit and chat about stuff we love to chat about. This is a good time. This is fun. So yes, great point. Even in the entrepreneurial life, especially.   27:41 Yeah, especially anyway, and you're Listen, I'd love to have you come back on to talk about that aspect of, of your life as well. Because I love having successful female entrepreneurs and talk about their business and, and how they got things off the ground. Because I know people are always interested in that. So you'll have to come back. I love it. Yeah, I think you'll have to come back. And you'll have to talk about your sports Cairo business as well as the Jen and Carrie. So you know, being in that space of a retail space, which I know is not easy. So, so much to talk about. So we will put a pin in that and we will discuss that maybe in a couple of months. So Carly, thank you so much for coming on. I really appreciate it. This was great. I think you gave people a lot of practical easy tips that they can start integrating whether you're a postpartum mom or someone who cares for them. So thank you so much for coming on.   28:44 Yeah, thank you so much for having me. My pleasure. And everyone. Thanks   28:47 so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, Principal Research Fellow at Latrobe Sport and Exercise Medicine Research Centre, Dr Joanne Kemp PhD, talks about hip pain treatment and research. Today, Joanne talks about the common causes of hip pain, the difference between men’s and women’s hip pain, and the outcomes for patients that “wait and see”. How can PTs design and conduct evidence-based treatment programs? Hear about treating overachievers, referring out and using other treatments, and the upcoming Fourth WCSPT, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “It’s important that patients understand that exercise is good for them and is not going to cause damage.” “With any strengthening program, you only need to do it 2 or 3 times a week to be effective.” “It’s probably going to take 3 months for our rehabilitation programs to reach their full effect.” “If you don’t get it right the first time, and if it takes you a little while to find your space, that’s actually okay, because it’s about the long journey, and you’ll get there eventually.” “Don’t stress about failure. It’s about what you learn from that failure and how you adapt and change what you do.”   More about Joanne Kemp Associate Professor, Dr Joanne Kemp, is a Principal Research Fellow at Latrobe Sport and Exercise Medicine Research Centre and is a titled APA Sports Physiotherapist of 25+ years’ experience. Joanne has presented extensively on the management of hip pain and hip pathology in Australia and internationally. Her research is focused on hip pain including early onset hip OA in younger adults, and its impact on activity, function, and quality of life. She is also focussed on the long-term consequence of sports injury on joint health. She has a particular focus on surgical and non-surgical interventions that can slow the progression and reduce the symptoms associated with hip pain, pathology, and hip OA. Joanne maintains clinical practice in Victoria.   Suggested Keywords Healthy, Wealthy, Smart, Pain, Hip Pain, Pain Management, Injuries, Research, Osteoarthritis, Exercise, Physiotherapy, WCSPT, To learn more, follow Joanne at: Email:              j.kemp@latrobe.edu.au Website:          https://semrc.blogs.latrobe.edu.au/ Twitter:            @joannelkemp ResearchGate   4th World Congress of Sports Physical Therapy.   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hey, Joe, welcome to the podcast. I'm so happy to have you on. I've been wanting to have you on this podcast for such a long time. So thank you so much.   00:10 Thanks, Karen. It's great to be here, finally.   00:13 And of course, today we're going to be talking about hip pain, hip pathology, that is your zone of genius. So let's just dive right in. So let's talk about some common causes of hip pain in adults. And does this differ between women and men?   00:36 Yeah, look, it's a great question. And I think probably, we, I think we're starting to change our perspective on that difference between men and women and the causes of hip pain. I think that previously, we've sort of been very aware of the burden of hip pain in men and particularly young male athletes that there's been, you know, a growing body of research that's looked at at the prevalence and burden and causes of hip pain in young men. And probably that's led to a misconception that it affects men more than women. But it's only really that the research has been done in men, less and less so in women, like we see across, you know, the whole medical space. So if we think about the common causes of hip pain across the lifespan, when we're looking in sort of the adolescent and young adult population, you know, typical causes can be things like hip dysplasia, and that's actually is more common in women or young girls and women than boys and men so probably affects three times as many girls and women as it does men. And I think the prevalent when we're you know, the prevalence is perhaps higher than we previously thought. So, some studies are suggesting that up to 20% of adults have some form of hip dysplasia are shallow, hip socket shallow, so turbulent, and, and that that does lead to an increased risk of developing hip osteoarthritis in later life in later life. And even as young adults, sometimes we see patients with hip dysplasia, presenting with arthritis who need to go to hip replacement at a really young age in their 20s and 30s. So, hip dysplasia is a really common one. Another one that we've heard a lot about in the last 10 years is femoral acetabular, impingement syndrome, or FAI syndrome. So that's traditionally thought to be where there's impingement between the ball and the socket, either due to extra bone on the ballpark of the hip, which is can morphology or deep or retroverted socket, which has pencil morphology. And that's probably where a lot of the studies have been done, particularly in that young male adult adult population. But what we're now seeing when we look at the big cohorts, particularly of patients that end up presenting to hip arthroscopy is that it's about 5050. It's about 50% men and 50% women. So that burden is pretty equal across men and women. And that's another thing that does lead to an increased risk of hip osteoarthritis in later life. But the risk is not quite as high in FAI syndrome as it is in hip dysplasia. And it certainly is, it tends to be a slower burn. So these patients present for their hip replacements probably in their 50s and 60s, whereas hip dysplasia, we're seeing these patients in their 20s and 30s, with hip osteoarthritis. So that's probably the second most, the you know, the second cause in that younger age group. Then as we move into older adults, so sort of, you know, people 35 Plus sort of middle aged and older adults, that's where we really see hip osteoarthritis presenting itself, and it can be due to dysplasia or FAI syndrome. But it can also just sort of be that idiopathic arthritis that might be due to occupation, lots of different things. And again, that's reasonably equal men and women, but we do see women probably having a little bit more arthritis than men and more women going to hip replacement than men. And the outcomes for hip replacement are not as good in women as they are in men. So that burden is still probably skewed towards being higher in women than men. And then the other cause of hip pain that we see particularly in the middle age and older women is other gluteal pathologies or lateral hip pain, sometimes called you know, TRAQ, enteric, besides gluteal, tendinopathy, gluteal tendinitis, it has lots of different names. But that's a burden that definitely disproportionately affects women, over men. And particularly, once women get into that perimenopause, or menopause or post menopausal age group, there seems to be a relationship with with with hormones and with estrogen levels and the likelihood of gluteal tendinopathy becoming symptomatic as women sort of transition through that change. And so that's another really common cause. And we're now starting to be aware that often these women will present with combined hip osteoarthritis and gluteal tendinopathy. And that's where it can get really, really, really tricky as well. So yeah, look, it does. There's different, you know, different things that you see across the lifespan, but the burden is definitely I think, disproportionately higher in women than in men in a number of those conditions.   04:58 Yes, and I am firmly In the last group that you mentioned, I am just getting over, if you will, getting over gluteal tendinopathy, where I have to tell you it that is some serious pain. And, you know, when you're a physical therapist and you have people coming in, and they're explaining their pain to you, and you try and sympathize or empathize now I'm like, it is painful. Like I couldn't walk, I couldn't stand for more than like, four minutes. Yeah,   05:29 at least I've had the same thing. And, and I've been lucky that mine, I was sort of able to get on to it, knowing what it was and what to do fairly quickly. But it's very, and I think this is the thing with hip pain until you've had hip pain, whether it's glute tendinopathy, or intra articular, hip pain, it's really disabling. And it really affects everything you do in life, you can't sit without hurting, you can't walk without it hurting, you can't stand without it hurting, you can't lie on your side, without it hurting, you're getting in and out of the car, getting dressed, you know, trying to put your shoes on, it just affects every aspect of your life. And you know, and the pain can be quite intense and severe. So it does. You know, for people who are affected by hip pain, the burden is huge. And we see it reflected in the studies as well, where if you look at outcome scores for quality of life, young people with things like displays your FAI syndrome, their quality of life scores are as bad as people who have hip arthritis who are waiting for hip replacement. So it does, it's very, when you've got it, it's very, very impactful. And I think people until you've experienced it, perhaps people underestimate how bad it can be.   06:33 Yeah, and it can be really, like you said, it's very, very disabling. And it also can can make you very nervous. So you know, when these patients come in to see you. So as the physio, when these patients come in to see you, it really behooves you to sit and listen and really get that whole story so that you can make that differential diagnosis as best you can, if you don't have the diagnostic test to back it up, which often happens. Yeah, absolutely.   07:01 And I think that's the thing when the patient's present to you, and they're complaining of pain in that hip area, you can't just go to one test or one scan and say, Oh, it's definitely these, it's actually there's lots of pieces of the puzzle puzzle that you've got to put together, it can be really complex, and you absolutely have to listen to the patient. And I think fear, like you just said, is a huge thing. And we've seen this in our some of our qualitative work that's currently under review, but others as well that these patients are terrified to move, or to do exercise because they think it's going to hurt more. And they're really scared that it's going to cause more damage. And, and the irony is that exercise is the thing that we know is like is going to make them better. And once they get moving, they do feel better, but they're so scared to move because they're scared, they're gonna break something or make it worse or end up needing a hip replacement that they they don't they don't move. And it fear is a huge problem, you know, with these people.   07:53 Yeah, I mean, even myself as a physio I knew I needed to exercise, I sort of outsource my physio exercises to a friend of mine, Ellie summers, who's on the, on the west coast here in the United States, and she sent me exercises and even doing them, like it's not super comfortable. But within a month, I felt so much better. And now, you know, I'm back to running on the treadmill and doing all the things. But oftentimes, these patients and I may be wrong, but they're not sort of picking up on this within the first month of pain, you know, they might say, Oh, um, it'll go away. Let me give it another couple of weeks and have a couple of weeks. Whereas I was like, Okay, this is really painful. I'm getting to a doctor asap and starting these exercises ASAP. So what have you seen, even through the literature about when patients start to seek out care for this? And how can that affect their outcomes?   08:52 I think it's one of the things with hip pain that patients often will just leave it and they'll wait and see. And so we do know that in the younger age group, like if you think about FAI syndrome, for example, people will often not present for two or three years, they will pull up with the pain because it kind of comes and goes so they'll have a flare up, they'll be bad for a few weeks, it'll go away for a few weeks and have another flare up. And so because it's coming and going, they, I guess remain optimistic. It's human nature to be optimistic that it's going to get better by itself. And so it can often be a couple of years. We see this in the literature, you know, two or three years, but I see that in my clinical practice. And I'm sure you do, too, Karen, that patients, they'll come to you and they'll say, oh look, I've had this for two or three years, I was waiting for it to go away and now it's you know, suddenly getting worse and that's when they seek out care. And I think too, you know if we think coming back to what we were talking about with women is that these problems affect women who are really busy so they are often have busy careers. They're looking after families often, they they might be studying as well. They're juggling lots of things. So for them to try and fit in the medical care or, you know, physio care or whatever they need. It's really hard for them to find to make the time to do that. And I think that that's probably why they potentially delay seeking, seeking treatment as well.   10:12 Yeah, so many factors go into it. But bottom line is it hurts. Now, how let's talk about the physio side of things. So how can PTS design and conduct an evidence based treatment program? For, we'll say, for adults with hip pain? Yep.   10:31 So I think we probably the first thing is to set really good expectations for the patient. So often patients will come potentially looking for the quick fix. And so I think it's important that right up front, we say to our patients, that it does take a while for things to work, you should be starting to improve over that time, but they need to be committed to an exercise program that we know needs to be now at least three months long. So I think both the therapist and the patient need to be prepared for that longer term commitment as well. So I think that's the first thing is setting expectations, right. And then around those expectations, it's also really important that patients understand that exercise is good for them and is not going to cause damage. So you're really trying to get the confident to be able to exercise part of that is an understanding that it will like you just said like when you did your exercises, it's not super comfortable. But that's okay, they need to they don't want to be in a lot of pain, but they will probably have some pain and that that's actually okay and normal to have that. And it doesn't mean that they're causing more damage. That's just a normal part of the body adapting to the exercise process. Sometimes I find with patients to you in order to convince them of that, because sometimes they're a bit skeptical, they don't quite believe you that they give you know, they will do exercises for a week, just look, just have a week off the exercise and see what happens to your pain. And what they find is pain is no better when they're not exercising. But sometimes it's worse, it's usually worse or the same. And so then they're like, Oh yeah, now I understand the exercises and actually making my pain any worse. And so sometimes you might need to do that to get them to buy in. So I think getting them to buy into the timeframe the commitment that they're going to need to do and the fact that they will have a bit of pain, that's probably the biggest thing, then once you've done that, then you can start to develop your exercise program and the foundations of our exercise program. I like to think of it as being sort of two pronged. So the first one is the local exercise that we're doing for the hip joints. So that's where we do a lot of our strengthening exercises. So strengthening up the muscles around the hip. So the hip abductors, and the adductors flexes in the extensors. But then also really focusing on the core and the trunk is important because that controls the acetabulum, which controls the socket. So putting that in and then you know functional exercises as well. So teaching them how to do things like squats and lunges and going up and down stair. So our local rehab exercises should have primarily a strength focus, they might also need to have a range of motion focus as well. But we need to be careful with ranges of motion because sometimes those ranges of motion might be provocative for patients. So going into a lot of rotation or a lot of flexion could provoke pain. So strength is probably our big biggest focus. But then the second prong of our rehab program should be around general fitness in general activity. So you know, we know that the physical activity guidelines say that everybody should be doing 150 minutes of moderate activity a week or 75 minutes of vigorous activity, then that's just to be a healthy person, regardless of whether you've got a sore hip or not. So I think trying to get them to do general fitness, cardio, whatever you want to call it alongside their hip specific rehab is, is the thing that you need to do. And then what I try and do is I try and make that hip specific rehab, sort of normalize it as fitness training, rather than rehab. Because people get, they're going to be like, don't want to do rehab, everyone gets bored of rehab, you know, at home with your little bands. So trying to get them to do things like you know, incorporated as part of their twice a week strength training, where they go to the gym, for example, is really important. And with any strengthening program, you only need to do it two or three times a week to be effective. So people don't have to do it every day. So I think that's important too to for them to know, they'll get they'll have days off where they don't have to do it. But to find two or three days a week where they can commit to this the strengthening component of the program, the cardio fitness component of their program can fit in around their schedule. And something that I really like to do with patients is to sit down and actually look at their weekly schedule and help them schedule it into their diary. So don't just say to them, you go do this, you know, five times a week, you actually have to fight help them find those chunks of time where they can do it and they can find 30 minutes in their day to be able to commit to that exercise program.   14:50 Yeah, I really love that you said to emphasize that the strength thing has to be done two to three times a week, because oftentimes Well, I mean, I'm in New York City where you have a lot of is like very driven, sort of type A folks. And they think if you're not doing it every day, then it's not working. Yeah, you know, so to be able to reframe that for them and say, Hey, listen two to three times a week is what our goal is, and be very forceful on almost holding them back. Do you have any tips on how to hold people back? For those folks? Who are the overachievers?   15:26 It's hard. Yeah, it's really tricky, isn't it? I think sometimes I think people have to learn for themselves. So you kind of have to let them find out the hard way, maybe, and be prepared with some painkillers to settle things down. But ideally, you don't want to do that, if you can help it, I think, I find that presenting the evidence can be really, really helpful. So you know, talking about the strengthening guidelines that that show that two to three times a week is where you're going to get the maximum effect of strength. And if you do more than that, it's not going to really add to that you'll have already sort of hit that ceiling, and potentially give them something different to do on those other days, if you don't want them doing strength training two to three times a week. If there's someone who wants to do something every day, helping them find other things on those other days, so perhaps, you know, mixing it up with some cycling, walking or jogging, if they are able to do that some swimming, you know, sometimes, you know, it might be appropriate or safe for these patients, if they enjoy things like yoga or pilates, they can do that if it if it doesn't hurt in addition to their other things. So I think those type A personalities, you might need to fill the space on those other days. Give me something else to do.   16:33 Yeah, I think that's great advice. And now, sometimes, as physiotherapist we have to refer out. So when is it appropriate to refer out or to use other treatments such as surgery? How do we navigate that as a physio?   16:50 It's tricky. And I think the most important thing is that that has to be a shared decision that we make with our patients. And at the end of the day, they will have their beliefs and their priorities that will probably take them in certain directions. Having that three month rule is a good rule, I think that we know it's probably going to take three months for our rehabilitation programs to reach their full effect. But but it doesn't mean to say you keep doing things for three months, if you're not getting any improvement, we really want to see them starting to head in the right direction, probably within around about four weeks. Within, you know, two or three treatments, you should be starting to see some change even though we know it's gonna take longer than that to get the full effect. I think that if you're not seeing change within that first month or so, you have to start asking yourself questions about well, why why why aren't I getting changed? Do I need to look at this and red flags here? Do I need to potentially refer the patient to their GP? For some imaging, we know that, you know, people have a history of cancer, that breast cancer and the gynecological cancers and prostate cancer really caught the hip joint is a really common point from you know, where the cancer metastasizes. So, I think bearing in mind our red flags, you know, women with guide other gynecologic non cancer, but other gynecological issues, you often get pain in that same area. So, being open minded about some of the non musculoskeletal causes of pain and being prepared to refer on if someone's not improving in that time is important. Imaging, you know, we don't want to jump to imaging straightaway, it's not always necessary, but it is sometimes it is necessary. And I think don't be frightened to refer for imaging. If someone's not improving. The one thing that I and it's different in every country and our health systems are all different. But here in Australia as physios, we can refer for imaging, but I if I'm if I'm suspicious that there's a red flag, that's a medical thing that's outside my scope of practice, I will refer them to the GP for the GP to refer for imaging. And the reason for that is I if you refer for imaging, you need to be able and confident to tell the patient the results of their imaging and interpret them and then refer them on for appropriate care now, for those medical things. I think as physios that's way outside our scope of practice and we shouldn't be you know, if the scan comes back with cancer, like we can't that's way outside our scope and we shouldn't be having to to explain those results to patients, I think only refer for imaging yourself with your confidence of what you'll be able to interpret those findings. So don't be afraid to refer to the doctor. Some patients often need pain relief as well or anti inflammatory. So that's, you know, if you're not getting improvements in that four weeks, you may need to refer them to the doctor to get pain relief or anti inflammatory medication. Things like injectables again, we don't want to inject give people lots of injections but we know that the hip joint is often sign up at green flame. So you know a judiciously used cortisone injection can be helpful in in some cases. So I think it's been not afraid to refer on you know, when you just turn the video off, when you need when you need to, to, you know to those other things and then surgery is probably your last resort, but There are a small number of people who will potentially need surgery as well. So, but you wouldn't actually be looking at surgery until you really finish this full three months of rehab.   20:09 Yeah, that all makes perfect sense. And now as we kind of start to wrap things up, where there, is there anything that you know, we didn't cover, that you would really like the listeners to know, or to take away, whether that's from the literature or from your experience when it comes to hips?   20:31 Yeah, I think, look, I think we've covered most things. But I think what it is, is just being really confident to prescribe a good quality exercise program. And if you don't feel like you have the knowledge or skills to do that, don't be scared to either refer to a colleague who who might have more knowledge or skills, or to, you know, to look up the evidence with, you know, that the evidence is has really grown in the last couple of years. And we published a consensus paper in V jsme, 2020. That was a consensus paper on what physio treatment for hip pain in young and middle aged adults would be. So that's a really good resource, it's got some some good examples in that paper of the types of exercise that you should be doing. And then my colleague from the US might Raman also lead a consensus paper in that same series on the diagnosis and classification of hip pain. So that's another really good resource that you can go to that will help you clarify the different diagnosis in the hip and what what what sort of things you can do to confirm your clinical suspicion and your diagnosis.   21:34 Perfect. And now, you will also be speaking at the fourth World Congress of sports, physical therapy in Denmark, which is August 26th, to the 27th, you're doing to sort of 15 minute 15 minute talks repeated twice. So one talk repeated twice. On the second day of the conference, can you let the listeners know a little bit more about that. And if you have any sneak peak that you want to share?   22:04 Yeah, so I'm going to be doing that talk in combination with a with a great colleague of mine, a Danish colleague, Julie Jacobson. And so we're going to be talking about hip pain in women specifically. So looking at the common causes of hip pain in women and as as physios, or physical therapists, what we should be doing to manage to manage that, because it's a congress of sports, physio, or sports, physical therapy. It'll be slanted probably towards the younger, more athletic population. But I think there'll be some really great takeaways for anyone treating women in particular with hip pain. So we're going to be really, I think, trying to focus on what it is about women with hip pain that's unique and different to men, and really helping the therapist develop a rehab program that really targets the things that are important for women. So the impairments that women have the physical impairments, but also really targeting some of those, you know, we've got to think about the biopsychosocial model. So some of the psychological challenges that people with hip pain have that we've sort of touched on in terms of being fearful to move, but then the social challenges too, because we know that we do live in a gendered environment. And it's no different for women with hip pain, where they might face additional barriers to, you know, in this the way society is constructed to be able to access the best care. So it's also helping helping the clinician really become an help patients navigate some of those challenges as well.   23:27 I look forward to it. It sounds great. Now are what is there anything that you're looking forward to at the conference in Denmark? Have you looked through the program? Are there talks that you're looking forward to?   23:40 I look, there's there's going to be so many great talks there. Like it's such a I can't believe how many how much they've packed into two days, like for two day program, I'm actually really excited. by so many of the different tools, I think the thing I'm most excited about is after two years, it'll be nearly three years by then that we've actually been able to see each other face to face, just to have the opportunity to catch up face to face with so many great colleagues that I've worked with before, but also meet new colleagues as well, and have the chance to travel to beautiful Denmark. You know, I haven't been to the conference venue, but it looks amazing being on the coast. In summer, it's going to be beautiful. I know the conference Organizing Committee has got a great social program as well organized and the Danish conference dinners are always a highlight, I think of any program. So I'm really excited about that as well. Yeah, I just I just can't wait.   24:31 Yeah, it's it. You have the same answer that so far everyone has said as they just can't wait to be in person and to network and to hang out with people and to meet new people. So you're right along with everyone else that I think a lot of the other speakers that are going to the conference, and now where can people find you if they have questions, they want to see more of your research, where can they go?   24:55 So, um, so I'm on Twitter, so my Twitter account is at Joanne L. him. So L is my middle initial. And you're welcome to send me a message via Twitter. But you can also contact me via email. So my email address is the letter j.camp@latrobe.edu.au. And then our sports medicine allotropes sports and exercise Medicine Research Center has a has a webpage and a blog page where a lot of our research is highlighted there as well. So if you just Google up Latrobe, Sport and Exercise Medicine Research Center, that's the first thing that will pop up as well. And we have a lot of, you know, a lot of really good information. We've got a really our Research Center has a really strong knowledge translation arm and so a lot of my colleagues, which credit to all my colleagues who work in this space, have developed a lot of really great resources to infographics, videos of exercises, lots and lots of different things that can be found on our on our research, our centers, webpage and blog page as well. So lots of good resources there.   25:57 Excellent. And we'll have links to all of that in the show notes for this episode at podcast at healthy, wealthy smart.com. So one click will take you to all of the resources that that Joe just mentioned. And last question that I ask everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self? So maybe straight out of physio I pick pick a year, any year you'd like?   26:22 It's great question. And it's funny because I was actually talking to my son's girlfriend the other night, who's at university, and she's finding it stressful and hard. And I actually shared with her something that I'm not afraid to share that I actually nearly failed my first year of university, because I was too busy enjoying the social aspect of uni life. And I think what I would say to my young, and that stressed me out and really upset me at the time. And I think what I would say to my younger self is if you don't get it right the first time. And if it takes you a little while to find your space, that that's actually okay, because it's about the long journey, and you'll get there eventually. And so if you hit hurdles and bumps and you don't, you're not always successful every time, it actually doesn't matter. Because as long as you keep on trying, you'll you'll get there in the end. So don't don't stress about failure. It's about what you learn from that failure and how you adapt and change what you do.   27:12 What excellent advice. Thank you so much. And thank you for coming on to the podcast. This was great. And I think the audience now has a better idea of what to do with their patients when they have hip pain. And if they don't, they can head over to Latrobe, they can go over to the website and get a lot of great resources from from you all and also look up a lot of your research. And if we can also put your Research Gate. Yeah, we can put that up in the show notes as well if that's okay, so that way people can kind of get a one stop shop on all of your research because it's extensive. So we'll have that up there as well. Thanks, Karen. Thank you so much. And everyone. Thanks so much for tuning in listening and we hope to see you in August in Denmark at the fourth World Congress Sports Physical Therapy again, that's August 26 and 27th. If you haven't registered, I highly suggest you get on it and hopefully we'll be able to see you in Denmark. So I look forward to seeing you then. And everyone have a great couple of days and stay healthy, wealthy and smart.