In this episode, 39th Governor of Wisconsin and Advocate for Alzheimer’s Caregivers, Martin Schreiber, talks about the importance of advocating for Alzheimer’s caregivers. Today, Martin talks about his book, My Two Elaines, and his experience as an Alzheimer’s caregiver. What can the community do to support Alzheimer’s caregivers? Hear about therapeutic fibbing, Elaine’s own journals, and get Martin’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “If Alzheimer’s is bad, ignorance of the disease is worse.” “You cannot do it alone.” “Alzheimer’s is a tragic disease. We can’t cure it, but we certainly can learn to live better with it.” “More than 6 million Americans live with Alzheimer’s or Dementia, and more than 11 million people are their unpaid caregivers.” “If people can simply better understand this disease, at that point, they can be more helpful.” “Live and understand, and grasp, and appreciate, and be thankful for the moment.”   More about Martin Schreiber Martin J. Schreiber grew up in Milwaukee, Wisconsin. Inspired by his father’s example as a member of the Wisconsin State Assembly and the Milwaukee Common Council, Martin ran for public office even before he had completed law school. In 1962, he was elected as the youngest-ever member of the Wisconsin State Senate. He was elected lieutenant governor in 1970 and, in 1977, became the 39th governor of Wisconsin. He recently retired from his public affairs firm in Milwaukee and now is an advocate for Alzheimer’s caregivers. In addition to caring for Elaine, Martin is passionately committed to speaking out to help caregivers and their loved ones live their best lives possible. He and his wife, Elaine, have four children, 13 grandchildren and seven great-grandchildren.   My Two Elaines: Learning, Coping, and Surviving as an Alzheimer's Caregiver The Alzheimer’s Association. 24/7 Helpline: 800-272-3900 Suggested Keywords Healthy, Wealthy, Smart, Alzheimer’s Disease, Dementia, Caregivers, Awareness, Grief, Advocacy, Ignorance, Support, Mental Health,   To learn more, follow Martin at: Website:          https://mytwoelaines.com Facebook:       https://www.facebook.com/MyTwoElaines   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:  00:03 Hi, Governor Schreiber, thank you so much for coming on the podcast and taking the time out today to come on and talk about Alzheimer's disease, which we are in the month of June. It is Alzheimer's Awareness Month. So I thank you for coming on and sharing your story and experience.   00:22 Well, thanks, Karen, I want you to know that I'm very grateful for the opportunity to be with you. Because there's so much important information that people should be aware of relative to Alzheimer's disease, both for the person who was ill, and also for the caregiver.   00:41 Yeah, absolutely. And now many people listening to this podcast may know you for your service to the people of Wisconsin in the state senate, then you were lieutenant governor, and ultimately, the 39th, governor of Wisconsin. So like I said, Today, you're here to talk about Alzheimer's. So can you tell us a little bit more about the work you're doing as an advocate for Alzheimer's caregivers, and kind of how and why this is personal for you, and how you found yourself here?   01:11 Well, very soon. It I tell you, if if I go, my wife humane is now in our 18th year since diagnosis. And if we you and I go back 18 years, at that time, this disease could not be cured, delayed or prevented. 18 years have gone by and this disease still cannot be cured, delayed or prevented. So what happened was, because I didn't understand this disease, I made my life more miserable. For my dear wife, who was losing her memory, I made my life more difficult for myself, as well as for many other people, because I didn't understand this disease. And so I conclude now, that if Alzheimer's is bad, ignorance of the diseases worse, and when I say ignorance of the disease, I don't mean ignorance of the disease just simply by lay people, but I'm talking even the medical profession, I'm talking even caregivers themselves. I'm talking about churches and congregations and temples and so on, there is just not an awareness of this disease, as it relates to how it should be dealt with. Because you can't fight it, you can't beat it. And so if we can learn a little bit more about it, we have a better chance of having our loved one with the disease, living their best life possible. But also we had the chance of having the caregiver also receive their best opportunity of living their best life possible.   02:51 Yeah. And you wrote about this in a new book that is published this month in June, called my two lanes. So you depict your wife your wife's battle was with Alzheimer's. And you know, like you said, This disease is progressive. And the person definitely transforms from probably the person you knew into, into maybe someone else. So can you talk about how you dealt with that as, as her husband and as the main caregiver?   03:22 Well, first I dealt with it very badly, X extremely poorly. And because of that, we missed out on many moments of joy. What I tried to do in the beginning, because I didn't understand this disease, what I tried to do was to keep her in my world, knowing Lena, it didn't happen on a Wednesday, it happened on a Thursday, it wasn't the Joneses, it was finally, I got the understanding that it is important for me to join the world of the person who now is. And one of the most difficult, difficult challenges that any caregiver has, but which has to happen is what I would call the pivot. And the pivot is when the caregiver gets to the point where you let go of this person who once was. So you can now embrace and help the person who now is because if we don't, first of all, because this disease is incurable at this time, you cannot fight it. There is nothing you can do. And I found out that all of the navies, saline, and all of the armies marching and all of the liquor that's that's distilled and all of the beer that's brewed is not going to stop this disease. And so rather than how do we fight this disease, the question is how can we fight to give our loved one their best life possible? And so within that framework, then there's A number of things that is important for for us to understand about this disease and for us to understand about the challenge of, of caregivers. So as I said, one of the things I learned was to join Elaine's world. Then another thing that I learned was the importance of what I call therapeutic fitting. And again, look here, let me let me just back up before we go into therapeutic fitting, if we can envision a funnel, and if we put the small part of our funnel by your eye, and of course, because the funnel expands, as you look up, you can see the blueness of the sky in the hope of tomorrow. But what happens is, as the disease takes its course that funnel becomes inverted. And now the large part will be by your eye, and you look out and all you see is a little bit that then becomes the world and the life of the person who now is they are not aware of what happened five minutes ago, five hours ago, maybe five years ago, nor are they concerned or aware of what can happen five minutes from now, five hours from now or five years. So it's it's a different world. Now. When I wrote this book, I felt really proud of myself, that I had finally put some of this into perspective. And lo and behold, before we're ready to go on for print, I find a series of notes and diaries that Elaine had been keeping since her diagnosis. Well, I want you to know that we had prayed together. And we had cried together. But Never did I understand the courage that it takes to be diagnosed with this illness, and then that can continue forward. So as Elaine is going through this transition, and now we're here we get to therapeutic phibian. As Elaine is going through this this transition this journey, she asked me once, how are my parents? Oh, I said, Elaine, your parents are both dead. The shock on her face when she realized maybe she didn't say goodbye. The shock on her face, maybe even not attend the funeral. I promised myself I would never put her through that again. So then when she asked me the next time, she said, How are my parents? Oh, I said Elaine, I said your mom is just really doing well. She likes working at church and volunteering. Your dad likes sports. He likes it that makes me feel so happy. Well, that's therapeutic fitting, therapeutic fibbing joining the world of the person who now is now I want you to know that I tried this therapeutic good in the first year of my marriage, but it didn't work so good then, but certainly at this moment in time. But then another experience to give me a sense of this all   08:12 the feet, when he lanes still was able to be mobile. We were having lunch at the assisted living memory care. And we're talking and then she starts to cry. I said, Elaine, why are you crying? Well, she said, I am beginning to love you more than your husband. Well, I didn't ask her what's wrong with your jerky husband. I didn't do that. But I tell you what I learned. I learned that it is not necessary for her to know my name in order for our hearts to touch. And so many times, as I talked with caregivers, they become initially so distraught about the fact that their loved one may be married for 5060 years, children so forth. That person with Alzheimer's does not remember their knees. I would tell them understand that your loved ones mine is broken. And sometimes there's no more of a chance to have our loved one remember our names and a person with a broken leg winning an Olympic championship, a gold medal. And so we we just simply have to understand the importance of joining the world of this person who now is one one of the challenges of caregiving, and there are a number of them. But one of the challenges of caregiving is that you work so hard to try and help your loved one but here let me let me just back up a little bit here. So we go back 18 years. The First Tee lane. That was the girl I met when I was a freshman in high school. School, I fell in love right away. We dated and we went steady and we got engaged, and we got married and four children, and 13 grandchildren, now seven great grandchildren. That was the first Delaine, I would run for public office, you will be the hardest working campaigner. If I would lose, she would never let me feel defeated. She was everything in the world. To me as it relates to any good thing that happened. The second lane began to appear. As I said, some 1819 years ago, when she would get lost driving to and from places she had been going to and from for the past 10 years, the second Elaine began to appear when as a great cook, she messed up her recipe so bad that she would cry, she would be so embarrassed. So that was the beginning of the second lane. So now we get this diagnosis. And I took a marriage route to death to as part I'm going to do all these things. And when Elaine was first diagnosed, she was given the mental mini test. And basically the mantium. The mental mini tests is a simple test asking for example, what day it is. When is your birthday? so forth? Very simple questions. And if you scored 30 or above you would be considered Okay, pretty normal. If you scored 30 or below, what the situation would be is that maybe at signs of early onset, well, Elaine's test score at that point was 28. They say that the average person loses four to five points going down almost every year. And it doesn't happen, you know, arithmetic Li from 20 820-726-2524, it may stay at 28 for a while, then maybe drop down to a 25 and then stay at that point, then maybe jump down to 21 and so forth. Well, what is important here is that you then test it out first at one year, you lose four to five points every year 18 years ago, it gives you a sense of where Elaine's life now is. But with that understanding with the understanding that the mentee meant a mental mini test   12:42 goes down. What what happens to the caregiver is you devote your time and your talent and your energy and your love to this person. And you just step out thank you have this answer. And then what happens is you wake up the next morning, and it's a new challenge. Well, what am I doing wrong? So what happens then is you devote more time and more talent and more energy. And you Okay, flow and all of a sudden, no. So what am I doing wrong? And so I have seen many instances where caregivers develop this so significant guilt, that they're not able to to help their loved one no matter how hard they work, what are they doing wrong? But here's the other aspect that comes along with it not only the self questioning about what am I doing wrong, but the caregiver is also going through a type of depression, and also what I would call an unacknowledged meeting. So I had a dear friend who retired and enjoying retirement, had dinner one night, laid down on the couch to watch the baseball game. Tragically, he died massive heart attack, just gone. Well, there was a funeral. And friends stopped by to express their sympathy to acknowledge the passing of this of this wonderful person. And there was closure. So what happens in the life of care giver is that there never is closure. You see your loved one dying a little bit every day. You begin to feel just so horrible about your guilt not being able to do anything but you're also getting to the point where you're saying, My my my loved one is is leaving me and then that that grieving, you know, just does it's not acknowledged and that's really one of the challenges that caregivers have to face. And that is to face up to the fact that yes, you are going to be grieving. And you should acknowledge the fact that you're going through this grieving at this moment in time, then there's also the depression that comes with it. And knowing what is the future and worrying about that also breeds anxiety. And so you take the guilt, you're not doing enough, you're not maybe getting enough sleep, you're not necessarily going for the walk, you're not getting any visit with friends, because you're focusing and focusing and focusing? Well, I try and have caregivers understand one of the most important facts about this disease, and that is you cannot do it alone. I do not believe, well, first of all, we men are sometimes really stupid. You know, we're not going to ask for directions, because we know it all, you know, I was going to take care of Elaine and so forth. And I let my ego, my own self centered. passion to do Z to defeat this disease, I let that take control over what was really best for Elaine. Because I did that we really missed out some, some great moments of joy. And   16:34 at the time of diagnosis, the doctor said there were four things that we should be doing one of the two drugs, drugs called the Menda and erysiphe. They do not stop the disease, they just simply delay the symptoms. So that was point number one, point number two socialization, you do show to socialization continuing, and then also getting exercise going for a walk, for example, and then also a glass of red wine every evening. Well, you then got three weeks ahead and the glass of red wine every evening and four weeks behind and in the walking. But here, here's the the situation about not joining the life and the world of this person who now is. So I knew we should go for a walk. So in my mind, half an hour walk is sufficient. So we started walking the lane with say, all look at that flower Kimani lane, you gotta get this throw, you know, our look at the bird, no, come on Elaine. And so my focus was not on the here. And the now my focus was getting this work done. So I could go about some other type of, of activity, whether it's trying to work with my business at the same time, and so forth. And the lesson here is Alzheimer's is a tragic disease. We can't cure it. But we certainly can learn to live better with it. And so had I known, then what I know now, I would have stopped with the lane. And we would, we would have admired that flower, watch the bird, we would have even maybe even just stood in the sunshine for a while and felt the warmth of the day. So the life of a caregiver is extremely challenging. We have to know that we can't do it alone. We have to understand that if we if you want to show real courage and real manliness that is shown by asking for help. So gosh, I think you asked a question a while back and I think that that was about maybe three days ago and I still?   19:03 Well, I think I think what you have done is your as you were speaking I said okay, I was gonna ask that I was I wanted to talk about that. But I think what you did you do is you really clearly laid out some real big challenges that caregivers have to face and some really great lessons that you've learned that you've passed along and I know that those lessons are some practical takeaways in the book in sections called kind of what you said what I wish I'd known or what I would have done differently. But it sounds to me like if you're a caregiver, you need to check your ego at the door. You need to be present with the person you need to join their world. And and it may perhaps be a more pleasant or at ties would be a happier existence for not only the caregiver, but for the person living with Alzheimer's as well. And, you know, as someone who like we'd spoken before went on the air Mike grandmother had Alzheimer's. And I can only assume my parents feel the same way that you're feeling now that we used to always Correct, correct, correct her, when in fact, we just should have said, Where's where's your grandfather? Oh, he'll be home in a little while, instead of saying no, he died 15 years ago. And then, like you said, it just can make the patient agitated and confused. And if you want to continue to have those happy times, it's best to be in their world. So I think you really outline that very, very well. And I do want to go back to something that you touched upon, but didn't go into great detail, and that is Elaine's journal. Now you, you put this into the book, some of her excerpts where she detailed her feelings and emotions as she was struggling with this diagnosis. So why was that important to include those? And were there anything in those journals that surprised you?   21:09 There were a number of things. First of all, I wanted to put Elaine's words into the book. I wanted to do that. So. So caregivers and their families would understand this. Great in internal turmoil, being diagnosed with it, but still knowing your mind, then having my your mind sort of slip as I said, you go from a 28 score, maybe down to a 26 score, but you still think you're sort of all right. But then some days, you're not all right. But with her journals. As I said, I learned the courage that it takes to be diagnosed with this disease and continue forward. But I also learned, we talked about the pivot, where the caregiver gets to the point of letting go of this person who wants was to join the world with a person who now is the person with Alzheimer's also has a pivot. And it's almost by the grace of God. And that pivot is when the person with Alzheimer's finally leaves the real world and enters their own world. And I've got, well, let me just read one or one or two of her of her excerpts, of course, in the book, but I wanted to make sure that the reader would understand that the challenge is that that a person has with Alzheimer's, but also how important I was in her life as her lifeline. And I really didn't know that. And I think that if a caregiver understands how important they are as a lifeline to their loved one, they will take better care of themselves. I was lacking sleep, I was lacking exercise. I wasn't eating well, I was like, My daughter, Christine, gave me an article on moderate drinking. And it wasn't because she thought I was drinking too little. That's for sure. So but anyway, so with her excerpts, I want to give you just just a few examples of, of what what she's going on. So she starts off at when she was sort of diagnosed, she wrote a letter to her to your loved ones. And she writes, it wasn't until a few weeks ago that I really had to say, Yes, I do have Alzheimer's, I read up signs that indicate Alzheimer's, like getting overly upset for no reason, and having trouble with names and directions. But I still didn't think it was a problem for me. But in hindsight, for too long, I've been getting lost driving, having trouble keeping days straight, and difficulties with names and schedules. Still, I still felt like I could handle it, it won't get worse. But this morning, I started reading about the mid stage of Alzheimer's, in hopes of preparing myself better and realize I'm not very far away, that is most scary, but I have to accept it. And so also in some of these pages, she talks about how important I was to her life. She said, Please take care of yourself, for me as well as for you. So then, you know and again she is in a process of, of of losing her memory. And she's in the process of getting to this pivot where she loses the reality of life and goes into her world. But to give you a sense of, of the tugging that's going on within in her she writes this, she writes, I am not enjoying my role anymore as Marty's wife because of his Hammond concerns about My Alzheimer's, he doesn't let me be me. He doesn't let me go for a walk if I want to, or the other store loans, I used to appreciate him what I thought was concerned, but he holds me captive much too much, I'm going to try to have a second opinion because I really don't think I have any problem. I know how to drive or walk anyplace I want to, but he doesn't believe me. And I hate the control he has placed on me, I don't even think I have Alzheimer's, per se. And so we see that, and again, my my, we see a human being going through that kind of turmoil. And we think we could have done a better job, or I think I know I could have done a better job. And because of that I wanted to write the book, so that I could help caregivers learn, cope, and survive. Just I want to just read one, one more here than   26:01 that. I don't have the exact date on this one here. But she writes, I wish my Alzheimer's would dissipate. I'd like to be the smart wife and mother I used to be. Now I have to waste so much time just trying to figure out what I should be doing. without seeming as smart as I used to be. I need to rely on Marty for everything. And I'm very lucky, he continues to keep me life gets more difficult every day. So it's it's a bummer of a disease. And again, we can't beat it, we can't fight it. It's not curable at this moment in time, it can be delayed can be prevented. And so what we want to do is fight was our best weapons possible and that is to better understand the disease and better understand the world to which our loved one is passing into. So we can help them on their journey as much as possible.   27:02 And you know, According to the Alzheimer's Association, more than 6 million Americans live with Alzheimer's or dementia. And more than 11 people are their unpaid caregivers. So how can people listening right now support those who are caring for Alzheimer's patients and support the patients as well.   27:23 One of the best things and most important things I think a friend or family member or neighbor can do for a caregiver. Number one, simply acknowledge what they're going through. And that acknowledgement in and of itself is so important. Because people really don't understand one. And because people don't understand Alzheimer's, they they shy away from it. Now. I call Alzheimer's, not a chicken casserole disease. So hypothetically, I get an operation of my, you know, maybe a higher operation. And so I come home, and I'm laid up people will bring me a chicken casserole, I've fallen I break a hip, I'm recovering, they'll bring me a chicken casserole. Alzheimer's, people don't bring chicken casserole, we a person, a caregiver and their spouse may have had friends that they did many things over a period of 3040 years together as the children would grow up. And let's just assume hypothetically, that it would be camping and canoeing. So for 3040 years, they, the families did this together and the children grew up and so forth. And that was the bind holding them. That was the binding thing for them. So what happens is now the spouse gets Alzheimer's. And because the friends don't know about the disease, they don't know how to handle it, and they withdraw as they withdraw. The caregiver not only is trying to deal with this depression, this anxiety, they are grieving the guilt. Now, the caregiver is also feeling abandoned, abandoned by friends at one of the most challenging times. So if you want to help any caregiver, or even work on creating a dementia friendly community, we have to understand this disease and have to understand how we can best deal with the disease. But then, rather than saying, call me if you need help, because we caregivers won't do that. What we will do however is respond by someone saying oh maybe I could pick up medicines from the drugstore. Maybe I could go shopping for you or maybe in other words specific kinds kinds of things, or maybe even taking the person who was ill for a walk so that the caregiver can get some, some respite. But as I said, if Alzheimer's is bad ignorance of the diseases worse and ignorance of the disease by the medical profession, caregivers, as well as family, friends and neighbors, and if people can just simply, hopefully better understand this disease, I think at that point, they can be more helpful in people living their best lives possible.   30:32 Yeah, and thank you for that advice. I think that's wonderful advice for people that are, you know, in the community and in this fear of people living with Alzheimer's. And I also want to mention that there is support online@alz.org, and that's provided to the Alzheimer's Association, or by phone at 800-272-3900. So if people are looking for more resources, they can find them there as well. And of course, your book. Let's talk about that. My two Elaine's, learning, coping and surviving as an Alzheimer's caregiver release is June 13. So we're perfectly within that Alzheimer's Awareness Month and people can get the book, I'm assuming wherever books are sold. That's my understanding. I would assume that wherever books are sold, it's printed through Harper horizon, which is an imprint within HarperCollins. And one last question regarding the book. And this is a more personal question for you. Is it upon writing the book? Did it give you time to reflect? And did it feel cathartic for you? Did it give you any sense of closure around your living with a person living with the disease?   31:51 It certainly was cathartic with without a question. But I think that one, one of the main things I got from this book is much I wanted to do something to help other people not both through what I as ignorant caregiver went through, and also what I might be able to do to help caregivers help their loved one with with dementia live their best lives possible. And the because I think back again, on our past 18 years, and I think how it could have been easier, as difficult as it was, it could have been easier. And it's not a matter of getting enough money to fly to the moon and back. It's it's a matter of just simply understand some some some basic factors and, and dealing with some unknown quantities, but no, it was it was quite an experience to write that book. And I'm glad that we were able to do it. And I want to tell you that I'm grateful for for being able to talk about this. And and also grateful that I think, hopefully we're going to be able to help some more caregivers learn cope and survive.   33:16 Perfect. And where can people find you? Let's say they have questions they want to talk to you they want to get in touch with with you, what is the best way to do that?   33:26 We have a website. That's right, my two Elaine's all one word.com And guys should anything and I have been up until COVID giving talks around the country learning and really everything that I shared with you about what caregivers go through, I can tell you, whether it's it's Newmark, Minnesota, Florida. St. Louis, I don't care where it is, that is simply an overlay of almost every single caregiver as how they're trying to cope with this disease. So but I also wanted to mention you gave the 800 number for the Alzheimer's Association. That's a 24/7 number. And so there are going to be some moments where you're just not going to be able to figure out how am I going to cope with this? Well, if you give them a number, I mean, give them a call, they will be able to help either give you an answer or point you in the right direction.   34:32 Perfect. And before we wrap things up. I have one last question. It's a question I asked everyone who comes on the show. And that is knowing where you are now in your life and given your illustrious career. What advice would you give to your younger self, and that may be that younger self was that freshman in high school when you met your wife or maybe it was in the midst of your being the governor? What advice knowing where you are in Now would you give to yourself as a younger man?   35:05 Live in the moment. And we, you know, it's not only the fact that I didn't enjoy looking at the bird with the lane, it's probably the fact that I was too busy to take time to enjoy playing ball with my sons are too busy to take time to go to the museum with my daughters, and, you know, just, you know, being with them. But really my mind is someplace else worried about some other kind of thing over which I probably had no control over anyway. But I think to, to, to live in and understand and grasp and appreciate, and be thankful for the moment.   35:52 I think that was wonderful advice. Well, Marty, thank you so much for coming on the podcast and sharing, sharing this book with us. And so everyone, again, the book is called my two lanes, it is sold everywhere where books are sold. So I highly encourage you, especially and I'm gonna say this, especially for people in the health care profession. I'm a physical therapist, a lot of physical therapists listening to this, I think, especially for those people, because oftentimes we're with the patient, but we're not with the caregiver. And I think it's really important to get a full view of what the what life is like for everyone surrounding this patient. So I highly encourage you to go out and get this book and read this book. So Marty, thank you so much for coming on.   36:42 There. And I'm very grateful. One one thing, as as we, as we sort of parted company here, when I talk about joining the world of this person who now is to make sure that caregivers as well as healthcare professionals know and understand truly that you cannot argue with this disease. If when I took Elaine to daycare, and we would drive up to the door, and she said that she's not going in, there was no way that I would be able to with wild horses drag her out of that car so she could go into, you know, the daycare. And so it's a matter of redirection. So we would drive around a little bit. Some of the neighborhoods come back, here we are, and she would do that. Sometimes we would be at dinner, and she would reach across the table and grab someone else's wineglass. That's not yours. Put it down. No, it's Elaine. Thanks for finding that wineglass. If you wouldn't have grabbed it, it would have fallen off. And now we're able to give you Lena good feeling about being helpful, but at the same time, not creating an awkward situation. No, you can have that scarf. It's not yours. Well, thanks for finding the scarf, and so on. So, anyway, carry on. I'm grateful to you for what you do. I know that you help out people and that's really special and an honor for me to be with you. Thank you.   38:10 Well, thank you and everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart

In this episode, Founder of Focus.CEO, David Wood, talks about his new book, Mouse in the Room: Because the Elephant isn't Alone. Today, David talks about the importance of naming your mice, the hurdle of instant gratification and being unapologetically authentic. What does it mean to have 30% more courage? Hear about the art of dealing with rejection, when not to follow your courage, and get David’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “A lot of us are putting on, unconsciously, an act for the world because we don’t want to get in trouble, and we don’t want to be uncomfortable, and we don’t want to make the other person uncomfortable, so we say what’s going to fit into a nice box.” “You can choose the discomfort of wearing a mask or the discomfort of telling the truth.” “If you don’t ask, you’re already starting with a no.” “Every time you name a mouse, it gives you a chance to increase your confidence and belief in yourself.” “You can have anything you want in life if you’re willing to ask 1000 people.” – Byron Katie “Start writing things down, knowing that you don’t have to do anything on those pieces of paper.” “You’re already doing things right. You got this far. You don’t need fixing.” “At times it’s going to get very hard. It might get so hard that you don’t know if you’re going to make it, but you do.”   More about David Wood David is a former consulting actuary to Fortune 100 companies. He built the world’s largest coaching business, becoming #1 on Google for life coaching and coaching thousands of hours in 12 countries around the globe. As well as helping others, David is no stranger to overcoming challenges himself, having survived a full collapse of his paraglider and a fractured spine, witnessing the death of his sister at age seven, anxiety and depression, and a national Gong Show! (https://www.youtube.com/watch?v=YgKwAJieQes). He helps business owners and leaders become the badass leaders people want to follow, creating more authenticity, connection, confidence, and revenue.   Suggested Keywords Healthy, Wealthy, Smart, Courage, Challenges, Confidence, Discomfort, Authenticity, Rejection, Persistence, Commitment, Awareness,   Get Your FREE Gift Mouse in the Room Book.   To learn more, follow David at: Website:          https://focus.ceo Twitter:            @_focusceo Instagram:       @_focusceo Facebook:       @extraordinaryfocus YouTube:        https://www.youtube.com/c/ExtraordinaryFocuswithDavidWood LinkedIn:         https://www.linkedin.com/in/focus-ceo   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, David, welcome to the podcast, I am happy to have you on to talk about, amongst other things, a new book release that's coming out today, which is for people not listening. Today is June 13. So we will definitely get to the book, and we'll get to a lot of other things. But thank you so much for coming on.   00:23 My pleasure. And it's nice to meet you.   00:25 Yeah, it's great to meet you as well. So I guess I let the cat out of the bag a little too quickly. We're gonna get to the book towards the end. But let's get to the book in the beginning. And at the end, how's that sound? Yeah, so tell us the name of the book. And I will hand the mic over to you to give us a little snippet.   00:42 Sure. And the I would have mentioned the book because it's going to fit in with the topics we want to talk about, like courage, and practicing deliberate discomfort. The books called the mouse in the room, because the elephant is not alone. And I'm writing this book, because we all know about that expression, the elephant in the room, you see it, I see it, no one's saying anything. Well, that's just weird. And I think we should all address the elephant in the room. But for most of us, many creatures in the room are much more subtle. They're not as huge as an elephant, maybe it's something that I see in you don't see it, or I don't know, if you see it. I think a lot of us are actually putting on unconsciously an act for the world, because we don't want to get in trouble. And we don't want to be uncomfortable. And we don't want to make the other person uncomfortable. So we say what's going to fit into a nice box. The problem is when we do that, we can feel disconnected from the world, we can feel more isolated, lonely. And people won't trust us as much, they won't know why. They'll just know something's off because this person isn't being real. So we're writing, we wrote mouse in the room, so that people can start to notice their mice and go all I'm actually upset about that. Or I have a desire I haven't mentioned or I have a confession mouse over here, or you know what, there's some appreciation I need to bring into this space here. When people identify their mice, and then artfully name them, so that they can come into more connection, more intimacy. And then through more trust, there's good business application to people are going to want to work with you and buy from you and, and follow you as a leader. They may not necessarily know why. But they'll be like, Oh, this person's real. This is someone I can count on. So there's the short version of mouse in the room.   02:37 Excellent. And maybe we'll get into a little bit of those mice later on. But before we get into that, as you were speaking, you had mentioned the word courage. And it I always think that it does take courage to speak your mind. And should we always be speaking our mind? And should we always be using our courage? So why don't you talk a little bit about how would you say 30% more courage? can double your happiness? We have a lot of people who are entrepreneurs who are listening, so we double your revenue. So what does that mean? Can you break it down?   03:14 Yeah. Something my co author said recently that stuck with me was, you can choose the discomfort of wearing a mask, or the discomfort of telling you truth. It's one or the other. And there's a lot more upside associated with one of those things. So I love the concept of courage I found as a kid, whenever I didn't do something that felt right be out of fear. I would like myself a little less. So if I didn't ask that girl out, or if I didn't confront that bully, or if I didn't stand up for myself, I would I just feel smaller. And it's an icky feeling. I don't want anyone to have that. Conversely, I discovered that when I am willing to take a risk and do something that's a little scary, even if I don't get the result that I wanted, I feel better about myself. It's like I went for it. An example of this I went to a conference where I was awestruck by the people that I was hanging out with there was like Jack Canfield from chicken soup and John Gray from Mars and Venus and Don Miguel Ruiz is a member and I'm like, Oh my God. And when I left the event, I look back on it and I realized I made four bold requests that terrified me. Like I asked Jack Canfield if you'd be interested in writing a book together. That was very scary. I figured he probably gets about 100 proposals a day for something like that. I asked someone if she wanted to go out with me and have our first date be a trip to Colombia. I asked an obstacle when Oscar winning producer if, like what it would take for me to do a ride along on his next film shoot. These were all scary things. Now. I didn't get a yes to Everything that I asked for, but I felt complete. I felt like yes, I went for it. They say if you I'm gonna butcher this quote it's, it's something about the trivial quote is, if you don't ask, you don't get you're already starting with a novel. That's the default answer. So I think it behooves us to find our edge like, what is our edge? Is it? If you're an entrepreneur? Is it asking a celebrity to endorse your product? Is it asking 10 people to be affiliate partners that that you think would never give you the time of day? Is it calling 10 people and asking them to become clients? Because you think you could serve them? I don't know where your edge is. But each listener needs to find their own edge, like what would feel uncomfortable and a little scary, but could have some great upside. And again, I'll say the main benefit is you get to feel better about yourself. And as a bonus, you may actually get some yeses, which might surprise you like, Oh, my God, someone said, yes. That's a bonus.   06:12 And do you feel like even if you fail, or even if you get these nose, or even if people don't give you the time of day? Does it help to boost your confidence? Because you're asking the question, and you're putting yourself out there?   06:28 I think it absolutely does. And this ties into the book really well. Because if you're going to name a mouse with someone, you're going to sit like that what I just mentioned at that conference with desire mice, I had like four desires. And so I named them, I felt better about myself, I felt more confident. And I actually got a yes, one of those four questions got me a yes. And was like, Oh, my God, that's really cool. So yeah, and what what we did have as a subtitle is, this is your pathway to connection, confidence, and becoming a badass leader that people want to follow. Because if you hide what you're tolerating, if you hide what you desire, if you hide what you're ashamed of, then those mice get to breed, and you get more and more of them. And that's where shame can really thrive. Whereas if you bring yourself to the world and say, Hey, this is who I am, every time you do that, every time you name a mouse, it gives you a chance to increase your confidence and belief in yourself. Because it's you. It's like, this is my desire. You don't want to grant that. Okay. Thanks. Hey, this is something that's bugging me. Can we change that? No. All right, gave it a shot. We want to get back to like that. That confidence of when we were five years old, for many of us, and we're able to just go for stuff and we hadn't been beaten down by life. And people get back in touch with what's going on inside and then artfully bring it. Now you brought up earlier on? Do we shall we name everything? No. If you go to someone's house, and it looks like a pigsty and you're uncomfortable there, maybe you suck it up for 20 minutes until you leave. And maybe they don't need to know that. Or maybe if you got a gift from someone, maybe you don't have to tell them. But hey, if they've given you that thing, three years in a row, it might be a kindness stood due to speak up. Well, in one of the chapters of the book, we give you a test to work out. Is this worth naming? Is this something that I should bring and could bring? And if yes, how will they artfully do it so that I'm unlikely to trigger a huge response in the other person? And they can be like, Oh, alright, I get where you're coming from. Yeah, let's, let's work that out.   08:49 And what do you say to people who may think well, okay, I can have the courage, I can ask all these questions. But I keep getting no, no, no, no, no, no, no. You know, is that going to kind of reinforce this? I don't want to say, lack of confidence, but maybe reinforce to people that oh, it's not worth it. I keep asking these questions. I keep getting nose and it reminds me of, let's say, actors or actresses who go out for parts because they get a lot of rejection. But they keep doing it. Right. So yeah, what do you say to those people who are like I've gotten enough nose and I don't want to get any more nose.   09:38 Did you know that eight months ago I started acting now and I started acting eight months ago and in three weeks I'm moving to Los Angeles to pursue acting so I know a bit about this by I have two answers two broad answers to this one is if you're getting it so you ask Katie says Byron, Katie says, you can have anything you want in life if you're willing to ask 1000 people. So I think there's real value in asking 1000 people. And if you ask 1000 people and get 1000 knows, there might be something wrong with the question. So that might be where some coaching can come in. It's like, how am I asking? And is there a way that I'm, am I selling the sizzle? And this am I like, you know, so there's two answers, and they're both true. You want to ask in a way that's enrolling. But be careful about getting attached to the outcome. This is what people collapse, and I got this from landmark education. A long time ago, people think it's one or the other, you can be committed to something, I am going to make this happen Martin Luther King, I'm going to free the slaves, Gandhi, I'm going to free India, you can be committed to something. Or you can be unattached, but you can't be both. And so as soon as they get committed to something, they think they have to get it. And if it's not coming straight away, or early on, there's a problem. And I'm going to collapse, I'm going to make it mean something about me. Landmark helped me distinguish the two is that there's commitment, and then there's attachment. And they're two separate things. What if you could be committed to something and how you show up every day is aligned with that? And yet you're unattached, or if the universe says yes. Now, that's a powerful place to stand.   11:44 Yeah. And that's something that, you know, I'm a physical therapist. So as a physical therapist, you know, I often tell younger therapists that you can't detach yourself to the outcomes of your patient. So you can't be judging your success as a therapist, wholly on the outcomes of your patients. Because sometimes people improve, and sometimes they don't, which may be wholly out of your control. But you have to show up and do the best you can based on the evidence that you have. So kind of the same line of thinking great.   12:22 It's a really good example. And I heard an expression recently that I decided to steal because it spoke so well to this. You know, a friend of mine said, Oh, well, it sounds like you're moving the ball further down the field. And I was like, I love that. Because that I can control. I can't control the goal. I can't control what other people say or do. I can't control if I make the sale. But I can move the ball further down the field, I can position it in the best possible way. And I can own Don't ask 500 or 1000 people. If, if, if they want to buy what I have. Recently, I decided to Oh, it's happening in acting all the time. Now, if I was attached to getting a yes to every audition, I'd have to give up after two days. Totally. But the way I'm reframing it for myself is those auditions are my performance that is my acting. And so I'm submitting to 100 plus things a week around the country, and most of them I know I'll never hear back from but I'm playing the long game. I'm playing the law of large numbers. And in the last eight months, I've had a yes to playing the lead in a local paid production of Dracula. I got a yes to doing two commercials that I got paid for six short films for them free to have them paid. Now I had to do a lot of auditioning and submitting because I don't have a lot of experience. And so some of its luck, is keep going until someone says oh, I like the look of you. Let's get that guy in. And when Jack Canfield came to my live event, he got up there and he spoke about the law of large numbers. You need to ask enough people now sure you ask 1000 people you get to know there's something about how you're asking. But don't give up after five or 10 or 50 100. Don't be like that kid in the playground. Say hey, do you want to ride on my tricycle? No. Okay. Hey, do you want to ride on my tricycle? No. Okay. Hey, do you want to ride on my tricycle? Be you that's what the books about like, express yourself. Express your desires. I think at some point someone's gonna be like, Oh, that sounds pretty cool. Yeah, I'll do it in you're like what? Really? I didn't think I get a yes. And then the next time you won't be as surprised and you are you'll hide the shock better.   15:00 Yeah, at some point that key fits the lock, right. And I also love kind of that concept of moving the ball down the field a little bit at a time. And I know for myself, I have always been like, well, it needs to happen. If it's not happening now, then it's never gonna happen. Or if it's not happening, the timeline, I perceive something to happen, then that means Oh, well, it's not going to happen. It's not for me, and I used to kind of tend to give up a little too easily. But now, I have come to the realization that, like you said, if you move the ball down the field a little bit at a time that it doesn't have to happen all at once. But as long as you're making forward progress, and you're working towards the goal, it'll happen. Because let's be honest, we're living in a now everything has to happen quickly, this social media, quick, quick, quick decisions. And if it doesn't, then we're losers.   15:54 And that's a problem for people who want to be successful. Because if there are any good rewards to doing something, let's suppose you're going to start a big business selling widgets. If there are any good rewards for their business, it's not going to be easy to do. Because if it's easy, then the first three people into the market are going to take all those rewards and, and it's going to be flooded by people doing the easy thing. And there'll be less rewards, the rewards are gone. Seth Godin wrote a wonderful book on this called the dip. And if you're not prepared for any kind of a dip, it might be hard to get any good rewards. Now, don't go overboard, you might not decide on brain surgery as a career. Because that's, that's a really big dip. But if you want to start a business, or go and get a better job, or switch careers, or find a life partner or something like that some of those things are going to have a dip to them. And it's good to just know that going in and say, All right, roughly, how long are we looking at? Like, if you're going to start any new business, if you do it well, and work hard, you're probably looking at at least three years to turn the corner and make a profit. Now, know that going in? And then have someone to remind you, when things look bleak, yeah, this is gonna take some time, you gotta keep going at it. I've been doing podcast interviews for three years now. I think I've done 300 interviews. And I think I might only just be starting to get some some traction and to get get known. And people like, oh, yeah, that guy from that, you know, from mouse in the room. And now I'm about to launch a book. And, you know, I'll do six months of beating the bushes, just Yes, a few days ago, I said, decided to reach out to my colleagues and thought leaders and influences. Some of those people are never going to get back to me. They're not even going to respond and give me the time of day because they're busy, or I'm not big enough on the totem pole. That takes something to reach out to all those people. I got to screw up my courage and be willing to be uncomfortable, and then put it out there. And then be surprised by who says yes. And who says no.   18:08 Yeah. And as we're talking about courage, are there times when maybe you shouldn't be following your courage? When are the times that that you say, hey, well, let's pull back for a second?   18:22 Great question. When I was growing up, and I realized I didn't like feeling small. I started leaning into my fears, and is a name for it. Apparently, it's so counter phobic. So if you're afraid of something, you lean into it, and that's my style. And that produced a lot of benefits and rewards and a lot of growth. But I didn't know when to say when I didn't know how far was too far. And you can traumatize yourself, you can burn out, you can push yourself too far. I would go into paragliding and hang gliding because I was afraid of heights. And I've had a couple of accidents and even had a slight compression fracture in my spine. Doing a couple of things that were out there. I was afraid of abandonment. So I thought well, let me see what open relationships is like in dating more than one person at once and see if I can conquer this fear. I found that I have limits my nervous system or my psyche has limits that I need to respect and be humble about. So I think it's about finding your sweet spot. You don't want to stay in the comfort zone your whole life it gets very uncomfortable over time. You need to find your edge but don't go way past it to the point where you might be like, you know killing yourself in a motorcycle accident or doing something completely reckless are going on national TV to speak if you haven't even spoken yet, like find your edge. There's a sweet spot for each person. Here's a wonderful exercise It's very practical, you grab a piece of paper, and right at the top of it, if I was fearless, the big capital I f, if I was fearless, what would I do? And you're gonna have one page for business and work. This is what I do. This is who I asked, this is what I go for I do a TED talk, I get to blah, blah, blah, blah, and then another page for personal. This might be what I'd say to my partner. This is what I might say to my kids, this is what I might ask for. This is what I might do, I might move to Brazil, I might go cross country and move to Los Angeles to start acting like whatever it is for you. Start writing things down knowing that you don't have to do anything on those pieces of paper. That's important. Because otherwise your mind might hide these things from you. You just want to find out what would be edgy. And then you don't have to do any of it. But you might like to circle two or three things that would be in the right at that edge like yep, that would be uncomfortable. And I think I'd feel proud that I did it. Do those, you can start with those and work your way up to the biggest stuff. Or if you like me do the scariest one first. And everything else is easier after that.   21:15 Right? Oh, that's a great exercise. I have it written down here. So I am going to do it. And it's almost like a way to open up your mind to more possibilities. Maybe things that you you you didn't think that didn't think you could ever even imagine doing but I like that you said listen, you don't have to do it. But let's write some stuff down. Just see what comes out of your mind. Because you never know. We start   21:40 with awareness. And it's the same with mouse naming with mouse in the room. You want to become aware of your mice? What are what is going on in your body? What are the confessions that might be looking? What are the desires that haven't been named? The tolerations. The appreciations, you want to become aware of these? Now you have a choice? Am I gonna name it? Well, let me go through the paint by numbers system in the book and oh, okay, yeah, I could do that. And then you're gonna name that mouse, there might be another one. You, you weigh it up, and you're like, alright, I can see the upside. There's also a downside. Like, if you committed a crime, you might be prosecuted, you might be arrested, you could do jail time, your if you if you cheated on your partner, and you decide to go and name a confession mouse, it could be consequences. So it's not for the faint of heart to tell your truth. And you don't have to name all of them. But the book will help you weigh it up and go, Alright, here's the upside. Here's the downside. And here's the downside. If I never seen anything, that's often what we don't address. And so then you can factor it and go, Alright, I think I'm just going to call call this person, we're going to have a chat about it. And we'll see what comes out of it. Even if it doesn't go well. Does that mean it was the wrong move? Just because the first round didn't go well? No. Maybe they need to have their reaction. And then you felt uncomfortable, and you have a bit of space? And then you might say, Hey, can I have a round two? I feel like I could have listened better. And I'd really like to work this out with you. Let's have another one. And then maybe you surprise yourself and you're like, Wow, I feel really close to that person. Now, if you really connected now we've got a great working relationship. Now for closer to my kid. Now I feel lighter. Because I'm being me in the world. That's what I want for people.   23:40 And can you give an example of maybe a mouse or two that you've named for yourself? Just so people have a better idea of like, what is he talking about? When you say saying name name, these mice are named this mouse? So can you give an example or two of maybe a mouse that you've named for yourself?   24:02 I'll give you an example of one from last night that I wish I had named earlier. And I kept it to myself for too long. I had a poker game, had some friends over and at one stage someone else arrived to the game and there's so much commotion and people getting up and noise and whatever. I got anxious. I had a panic feeling. And so, but I didn't say anything. I just tried to deal with it. I went outside I calmed down a little bit on my own. And then I had the resources to say hey, yeah, I got really activated. And I think I'm okay now but I could have said that in the moment. I said wow, really activate I'm gonna go outside for a little bit with someone come out with me. I could have said that. But I was a little bit too triggered to do it. That's, that's um that's what I would call a maybe a medium sized mouse. was pretty big in the moment effect in the moment was huge. We call them rodents of unusual size. For any Princess Bride fan.   25:07 I was just gonna say the RT R O SS. R Us is yes,   25:12 yeah, I'm just gonna restart my video because it went all fuzzy for a second. Then there were, you know, bigger ones that might have stayed with you for years, you might have had them for a long time, I was asked by one of my coaches to make a list of anyone I wouldn't want to pass on the street. Anyone I'd feel uncomfortable seeing or anyone I, I still harbored resentment for. And initially, I'm like, oh, there's no one. But as we dug in, you know, over time, I came up with a few people, and one of them was a bully from high school, like 20 years earlier, who had just really not treated me well and made fun of me. And we used to be friends. And the coach said, All right, call him. You know, we didn't have the terminology, name that mouse. But the coach was like, call him and clear it up. And I said, Hell, no. I'm not gonna call this guy after 20 years, he's gonna think I'm an idiot. And she said, and I'm going to translate it to this language. He said, basically, well, that's another mouse. So start with that. And I was like, oh, okay, I could do that. So I tracked down his number, and I called him and I said, I'm so worried you're gonna think I'm a complete idiot for calling you about this after 20 years? And he got curious. He said, Oh, well, what is it? What do you got? What's going on? I said, you always pushed me around and one off to me, and I tried to one up you, but you were better at it. And I really resented you, and I'm letting it go. You don't have to do anything. I just thought I'd let you know. And he said, the most mind blowing thing. This was the jerk. Like for 20 years, I'd been treating him as a jerk in my head. He said, Well, what could I say or do now to help you or us move forward? It just blew my mind. And if I can call him and call the girl who dumped me twice in high school, and call the guy who ran the company that I sued, to see if there are any ill feelings, and cold the person that I committed a crime against when I was younger, and I could have been prosecuted by saying, hey, it was me. And I'm sorry, can I make it right? I've done that twice. Actually, if I can do that, then just consider what could you do? It might be uncomfortable. And you don't have to do it without the paint by number system we outlined in the book that'll make it so much easier for you. But there are really beautiful things on the other side of that discomfort.   27:56 Right, so So these, these mice are the mouse that you name is just sort of this discomfort or this uneasy feeling that you've been harboring about topic XYZ or person XYZ, you naming it so that you can confront it and move past it.   28:13 Yeah, that might be a there might be a healing for me involved. Maybe the other person's got something going on it that you don't even know. I had my my brother was getting coached. And they gave him homework to call somebody and name a mouse. And he couldn't think of anyone and the coach. And the coach said to him, it doesn't matter how small it is just trust in the homework, go and do it. So he called a girl that he broken up with a year earlier, and said, Look, I just I don't know if you made it mean anything about you. But I want you to know, that was everything about me. I was not in a space to be in a relationship. And I really think you're awesome. And just in case you were thinking anything else. I wanted to let you know. And he said the impact on her was unbelievable. She started crying. And she said she'd been thinking that she was a loser because of that whole thing. And he came back to me and said, Look, I got no money. But that call was worth $10,000 to me. This and he was like 22 at the time. He's like that call was just unbelievable. So the upside of sharing your truth in an artful, ideally blameless way can be extraordinary. Everyone wants to be human. They want to be human and they want to open their heart That's my belief. That's my story. Now it's not going to happen every time you talk with people but even that boss that I called where i i sent a letter of demand and was threatening a lawsuit. We got chatting and he said all look back at the time. It didn't feel very good. I didn't Like, depart with the money, but that's water under the bridge. And I said, Well, how you doing? He told me we never had a personal conversation. He told me about his divorce and what was going on, I felt so close to that guy, I hung up the phone feel like we're buds now, all of it because I just called to say, is there any hard feelings from them? I'm hoping, hoping not. So it's it's a gateway courage in general. And I think particularly courage about the things where we have a bit of charge can be a gateway to connection, confidence, and being the badass leader that people want to follow.   30:37 I love it. And where can people find the book gets out today, which is again, yeah, June 13. In case you're listening to this on the 14th, through the 15th, or whenever,   30:48 or whenever, whenever, yeah, go to mouse in the room.com. And there'll be a link there for you to go to Amazon and get your book, we've got a special going. Special going, we're going to do the Kindle for like something crazy, like 99 cents, because we want to just do a best seller campaign. And so you could get the book for almost nothing, or pay for the you know, pay the 1295 or whatever, whatever for the book. But we'd love you to support the best seller campaign. And the way you can do that is get the book posted on social media that you got the book because it's good idea to have your friends naming mice with you. It's hard to do in isolation. But if your friends and the people around you are like, oh, yeah, this is what can I name a mouse with you? Oh, you got a mouse to name with me? Yeah, shoot. That's what I want for the world. And if you think it deserves a five star review, please leave one because that's what will help us climb in the rankings and hit that lovely bestseller title, which is really just an excuse to bring people together for a party.   31:53 Absolutely. And if people want to get in touch with you, if they have questions, maybe they want to work with you. They want to know how you know where you are in life, where can they find you?   32:05 Yeah, there's a contact form on my website. So mouse in the room.com, might even redirect you to my other website. But then you'll be able to see contact form, you can request coaching from me, I usually get on the phone with people and we see if, if we're a fit. And if it makes sense. If you're interested in mouse naming for your team, or your company, I'm particularly interested in that because we can start shifting the culture and have people sharing their desires and actually not letting things fester. I think it's wonderful for team building. And so you can reach out through the contact form about corporate trainings, or team team trainings.   32:45 Perfect. And before we wrap things up, is there anything that maybe we missed or that you want to really leave the listeners with?   32:56 You're already doing things, right? You got this far, you don't need fixing. And there can be a lot more connection in the world for each of us. And I found if you can just go through some of those scary places of discomfort and just screw up some courage. There are some beautiful things waiting on the other side. And I will, I could almost promise you that on your deathbed. You're not going to go I should have stayed quiet. You're going to say I'm glad I read that book. And I'm glad I spoke up my truth more and more often. And I went in that direction. That's how to live. We don't want to watch movies about people hiding their truth and staying small. We want to watch movies about people being themselves in the world. And that's what I want for the world. I think this is what can really heal the planet is people being more of themselves.   33:55 Awesome. And last question I asked everyone and that's knowing where you are today in your life and in your career. What advice would you give to your younger self?   34:10 At times, it's gonna get very hard. It might get so hard that you don't know if you're gonna make it. But you do you know, even because it's even though it seems like you just can't make it. You're stronger than you think. And you will find something new, you will learn a new way to cope. And then you'll go on and the universe is going to bring you something else. But try to remember when you're in the middle of it. Okay, it feels like life and death, but usually it isn't.   34:42 I love it. That is great advice. David, thank you so much for coming on to the podcast. I really appreciate it and again, everyone run out, get the book, get it on a Kindle, get it in and something in your hands if you can as well. The book is out today the mouse in the room. David, thank you so much for coming on.   35:03 Sure. I'd also say read it to your kids. You want your kids naming mice, you want to name mice with your kids. So, we didn't talk about parenting, but I think it's very as a chapter on on mouse naming for parents. So, thank you. I am excited and I appreciate the chance to talk about it.   35:20 Pleasure and everyone. Thanks so much for taking the time to listen. Get out there, start naming your mice and have and stay healthy, wealthy and smart.

In this episode, President and CEO of Sports and Spine Physical Therapy, Inc., Leon Anderson III, PT, MOMT, talks about AAPT. Today, Leon talks about the history of AAPT, working with his father, and AAPT’s networking opportunities. Hear about AAPT’s mission, encouraging minority students, and clinical research related to health conditions found within minority communities, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “We are still less than 3% of the profession.” “If you can expose a child and broaden their horizons, it gives them more options of what they can do and what they can be when they’re older.” “Just being associated with this network affords you such a wide array of opportunities and possibilities.” “We’re all connected, and we all need one another at some point.” “You won’t know what hits you until it hits you.”   More about Leon Anderson Leon R. Anderson III, is a native of Cleveland, Ohio. He graduated from The Ohio State University Fisher School of Business with a Bachelor of Science degree in Management Information Systems. His first job was as a Systems Analyst/Summer Intern for his fathers company Centers for Rehabilitation, Inc. There he discovered a passion for patient care. Subsequently, he pursued a degree in Physical Therapy at the University of Connecticut. After graduating, Leon was selected for a two year manual therapy residency program earning a masters degree in Orthopedic Manual Therapy from the Ola Grimsby Institute.   Leon is president and CEO of Sports and Spine Physical Therapy, Inc. (SSPT) The company operates three clinics in the greater Cleveland area and one in Charlotte, NC. Leon was inspired by his pioneering father Leon Anderson Jr. who was considered a vanguard of the profession for over 40 years. SSPT’s company culture and core values of providing high quality rehabilitation services are a direct result of Leon’s life long tutelage by his father.   Leon is a charter member of the American Academy of Physical Therapy. He served as a Subject Matter Expert for the American Physical Therapy Association's Orthopedic Clinical Specialist Exam. He also served as an on-site reviewer of the Commission on Accreditation in Physical Therapy Education. (The accreditation agency for entry-level physical therapist and physical therapist assistant programs in the US and UK).   Suggested Keywords Healthy, Wealthy, Smart, AAPT, Healthcare, Impact, Research, Opportunities, Mentorship, Equality, Connections, Education,   To learn more, follow Leon at: Website:          www.SportSpine.com                         https://www.aaptnet.org Twitter:            @LA3OSUCONN Instagram:       @osuconn   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:  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 today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found chosen and get those five star reviews. Right now if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic whim. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net health.com forward slash Li TZY to sign up for your complimentary marketing audit today. Now on to today's episode Dr. Jenna cantor. Cantor is back and being the host with the most for this episode. And we are happy to welcome Leon Anderson the third he is a native of Cleveland, Ohio. He graduated from The Ohio State University's Fisher School of Business with a Bachelor of Science degree in Management Information Systems. His first job was a systems analyst summer intern for his father's company centers for rehabilitation. There he discovered a passion for patient care. Subsequently, he pursued a degree in physical therapy at the University of Connecticut. After graduating, he was selected for a two year manual therapy residency program earning a master's degree in orthopedic manual therapy from the OLA Grimsby Institute. Leon is President and CEO of sports and spine physical therapy. The company operates three clinics in the Greater Cleveland area and one in Charlotte, North Carolina. He was inspired by his pioneering father, Leon Anderson Jr, who was considered a vanguard of the profession for over 40 years. SSP tees company, culture and core values of providing high quality rehabilitation services are a direct result of Leon's lifelong tutelage by his father. He is a charter member of the American Academy of physical therapy. He serves as a subject matter expert for the American Physical Therapy Association's orthopedic clinical specialists specialist exam. He also serves as an onsite reviewer of the Commission on Accreditation, physical therapy, education. So today, they talk about a PT so the history of AAPT networking opportunities and how that branch of our profession that organization within our profession profession came about so big thank you to Leon and Jenna and everyone enjoyed today's episode.   03:15 Hello, Jenna Cantor here with healthy, wealthy and smart I am super excited and honored to be here with the Leon Anderson, who is a major leader in the physical therapy community. He is the president and CEO of sports and spine physical therapy and is also a charter member of AAA, PT, the American Academy of physical therapy. Thank you so much for agreeing to come on Leon.   03:42 Welcome. It's good to be here. Thank you, Jennifer offering this opportunity.   03:46 Oh my gosh, I've just And it's funny, right people, we still we came on, I learned that you were just in Barbados, and you have a bunch of patients there and you were vacationing, that's incredible, you are living a life. There's so many opportunities and you're living that right now. I love it.   04:03 Absolutely. There are opportunities all across the world when it comes to physiotherapy. It's known as physiotherapy in most parts of the world, and physical therapy here in the United States. But just in the islands, you know, there's just a huge huge opportunity to bring the kinds of things that we do here to that particular population, because of the all the different technologies and nuances and things that we have, you know, that we have here. So, I was in addition to enjoying the beach in the sand, I was also enjoying given our advice on how to become a more functional individual, and whatever Island or whatever society or community that you live in.   04:42 I love that. Thank you. Thank you for your service series. That's incredible. I love that. I wanted to bring you on today to actually talk about a PT specifically talk about the history how it became to be in everything So I would love to just start with your perspective specifically, and how it came into your life.   05:09 Well, I grew up with, you can say occupational inheritance. My father was the 16th person in Ohio to be licensed as a physical therapist. He was a vanguard in our profession. He held many, many, I guess positions, if you would say, locally, nationally, even internationally, he was one of the first African Americans to be on the board of directors for the AAPT. In fact, there is a, a room at our headquarters in Alexandria. That is the Black Heritage Room, and it's named after my father and one of his protegees, who's also my mentor, the late Dr. Linda Woodruff, who was just an amazing, amazing mentor, and my father, Leon Anderson, Jr. and since I'm the third, but if you rewind back to when he got started, a PT that started mainly the the PTS of color that were involved in the APTA just didn't feel that their needs were being met, you know, as it relates to our communities. And so there are a couple of different little groups, like blacks interested in physical therapy or charm, I can't remember right now exactly what the term acronym is, maybe I'll think about that. But there are different groups that they would meet at the eight PTA annual conferences. And at some point, I think it was 1989. It was at 1989. In September, in Chicago, about 90 individuals met and I was actually a student, myself, and also donna, donna, it was not a fun doll, then. Now it was done in green Howard, that we were both students at the time. And now these individuals got together and they decided they wanted to do something that was going to be specific for the African American community and meet the needs of those communities that are disadvantaged and poor. And so that's where, you know, it was born out of and we have so many, I mean, just a plethora of talented African American PTS, in academia, in private practice, in the hospital setting, and, you know, in the military, just in all of the different different settings, and very accomplished, very accomplished ones also, I mean, it's just amazing. The BB Clemens, the, I mean, the mayor McLeod's, the Robert Babs, there's just so many that so many people who, who contributed so much to this organization early on, and we've done just many, many, many things to help students and then help our community. So that's, you know, in I hate the Babylon, but that is a kind of how we were born born out of a need, that needs weren't being met by the large the large organization, the APTA.   08:08 Oh, my gosh, this is a nerdy question. Okay. The meeting was in Chicago, was it over pizza? You know,   08:17 believe it or not see. So once again, we have such an accomplished set of founders. It was at like a, a Hilton, or a Sheraton, a Sheraton Hotel, where we all met. And, you know, they used Robert's Rules of orders, it was extremely, extremely organized. But remember, for years prior, there were these little interest groups that would meet over pizza and over coffee and over tea and you know, different things for many years, at the different organizational meetings, whether it be the annual meeting, or the combined section, or what have you. So at that meeting, we actually they actually established, you know, a skeleton of what our current bylaws are for the AAPT right now, so it was a very, very, very industrial meeting. And productive meeting over that weekend back in September 1989.   09:12 Wow, that is so cool. I love it. It really was from the ground up. It just organically. It happened so organically. And it was a major need and it just grew. I love that. That is so cool. And your legacy. Oh, you probably carry it. That was so much pride. I love that for you with getting involved. So your dad's involved. Did you feel pressure at the beginning? Like how did that happen? Because your dad is just so prestigious? And is it doing so many things for the profession? How was that for you?   09:47 Well, believe it or not, my first degree is actually in computer science at a computer science degree from The Ohio State University. And what I found was that by my junior year I was doing some statistics statistical analysis where my father during the summertime didn't do my summer off. And I was at a, a facility for the mentally and physically challenged. And while I was, you know, doing fixing the computers and trying to network computers and things, I also was a transportation aide. And I will transfer the patients from their cottages, to the main Physical Therapy Center. And I found that I fell in love with patient care. Although I'm the nerdy, mathematical computer guy and logical guy in my head, I found it to be extremely satisfaction, I found a lot of satisfaction, I should say, in interacting with these patients. And that's why I fell in love with this therapy, my junior year when I was at Ohio State. So I decided I wasn't going to just throw those three years away, I went ahead and finished out my, my, my career there ha state. And luckily, because my parents said they were not going to pay for a second education, I had to do it on my own. Luckily, I got a scholarship and academic and leadership scholarship because I went to our house State, I was on a board of this organization, students together against apartheid. And I was a peer counselor, I won the black leadership award my senior year. So with those along with my GPA, I was eligible for a scholarship. And I ended up at University of Connecticut, you know, on scholarship, so that worked out great, I wouldn't say that I felt pressure, it's my father just wanted to always want me to do whatever I was I was good at and, and to be happy, and to whatever I did wanted me to be the best at what I did, and to strive for excellence. But once again, I fell in love with patient care that that that summer 19, I think was 1985. And I really haven't looked back,   11:47 I want to get into the mission statement of a PT, I'm going to read them in sections because so that way it can be discussed each part in more depth, although I think it's quite, quite easy to interpret. So the mission statement is the American Academy of physical therapy is a non not for profit organization whose mission is to provide relief to poor and disadvantaged African Americans and other minorities by and let's talk about this first one, promoting a new innovative programs in health promotion, health delivery systems and disease prevention. Would you mind just talking more on the importance of that?   12:26 Well, we just have so many different talented individuals who are in all these different aspects, whether it be neuro, whether it be neurotherapy, whether it be sports and mettam, sports, med Med, whether it be dealing with childhood, obesity, bottom line is, I think it was back in 2010 with the Department of Human Services, Office of Minority Health and Health Disparities disparities came out with all of their initiatives, and we partnered with them. And I think it was probably 20 or $30,000. Grant, but I'm not sure right now. But But the bottom line is, is we partnered with them, because we wanted to really make an impact in our community, as relates to the health care disparities. So whether it's talking about diabetes are having different hypertension, and different organizational would you call them community health fairs, or programs, we even had a program with the Patterson cow foundation that they supported for childhood obesity. Our goal is for our individual members in their communities to make an impact and partner with the organization at large and use us, you know, to help them make the impact in our community using our resources. And our net network.   13:54 Yeah, yeah. It's funny as talking right now, everything you're saying is great. My husband's musical theater and he's singing full out right now. So I just want to acknowledge it is what it is love him. And you know what life is a musical? Isn't that great? Next, encouraging minority students to pursue careers in allied health professions. Oh, can you talk about the need there?   14:17 And on that note, we'll take a quick break to hear from our sponsor and be right back. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's digital marketing solutions have the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic win. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about his new integration. Head over to net help.com forward slash Li TZY to sign up for your complimentary marketing audit.   14:59 Also keeps me there, I think that we are still less than 3% of the profession. And the goal is to really expose the minority students to the profession as early as we can. So whether that means are different individuals, whether we're at one of our conferences, when we do some of the community outreach, or just someone in their own community, that's exposing individuals by going to health fairs going to speak at the local professional, and career career days, we've had so many opportunities. In fact, my wife and I, in conjunction with the American Academy of physical therapy, we ran a program called Let's Talk About program that did just that it really expose the kids to different professions until to improving their life skills and to becoming excellent and just empowering them to awaken the genius within them. And once again, that was one of those organizations that partnered with the APTA and use the 501 C three, until we got our own 501 C three, but then continue to partner with them. Because the goal is, if you can expose a child and broaden their horizons, it just gives them more options, on what they what they can do and what they can be when they get older. And it makes it makes perfect sense that if you can see yourself doing something, then or someone like you doing something, it increases the possibility that you have in your own mind that you can actually do it yourself. So when you look at Barack Obama, you have you have no idea how many, you know, kids right now can think to themselves that wow, Brock Obama was president I can be president or rob Tillman, or Leon Anderson, is, you know, high in an organization, doing things to help our community, I can do that same thing, I can make that particular impact. We've also had   16:51 visual affirmations, literally, yes,   16:54 we absolutely. We've also had many educational opportunities to help with our students. And just making sure that once you get into PT school, that you pass the exams, we used to hold many of the exam prep courts of the exam, prep organizations and courses around the country.   17:19 That's great. Yeah, it's all there's so much opportunity in this. It's a big one. It's a big one. And no, this speaks to any, any, anybody would like who is black, or in a minority, this speaks to you right away. Absolutely. And if you are wondering apps, yes, definitely reach out to AAPT. This is, this is part of their mission. Next, and finally is performing clinical research directly related to health conditions found within minority communities.   17:49 Same thing as as before, we encourage our, our members, and our constituents and our stakeholders, to engage with the professional organizations and do their poster research. And, you know, to really see, you know, what it is that our community needs, because most of the research that's done is just is or has been done historically, has been on the typical, you know, American, which may be a five, seven, you know, 40 year old white male. So the key is, we really want to make sure that we get data that lets us know, you know, what is the optimal amount of vitamin D, for a African American and living in the, you know, the Bible Belt, you know, that has this particular type of, of exercise level. There, this particular type of diet, you know, so, over the years, we've had many of those posters and the different organizations, annual conferences, and also in Chicago, Diane Adams, Saulsbury. And Vinod Rosebery, who's who's actually mayor now, they, in conjunction with the AAPT had a phenomenal he was a kid's fitness health club at an actual health club, and they were able to, to glean data on the health of our community, as relates to our kids and how they interact with an actual exercise routine. And a, a place to go that's safe, and also informative, and getting them to where they need to be. It was just it was just phenomenal. It was it was a phenomenal organization, and a phenomenal, healthy place to go.   19:47 I'm so grateful you have this research as part of your mission. I teach people how to treat dancers PTS PTAs. And we had a group discussion, one I, where we, we I pulled research and tried to find research on dancers, black dancers might be, where's that research black female dancers. And there was, there was one and it had clear bias. But it did show a little bit that there needed to be a lot more investigation. And, and then it just it was like crickets, it was crickets, when I was searching on PubMed, trying to find studies, specifically on minority bodies with that purpose for comparative data. And we didn't have in the little time I did to gather, we started talking about vitamin D, like you just mentioned, not from me knowing to bring it up. But from another black physical therapist in the room and other other black PCs in the room. Honestly, that became a topic. And it wasn't from research, it was was just from personal experience is and it's just, yeah, we need we need this information to do better for humans. so badly.   21:09 It's funny that you say that, Jenny, because one of my protegees it's interesting, because in when you talk about the academy, one of the one of the things that I think we're really, really famous for is it's an it's an N. It's been unofficial for many, many years. But we have a navigation program that helps not only students get into the profession, and get into school and stay in school, and then in addition to that, pass the exam, once you get into the to the profession, and how do you even navigate the profession. So when you mentioned the dancers, I immediately thought of one of my previous employer, employees and that one of my previous students, her name is Shane, I know I'm messing up her last name. And I think she's married now. So I'm really messing up her maiden name, but it's ojo, Fatima, I believe anyway, she is the she is definitely the TCS, the top physical therapist with the L Navy dance troupe. I think she might even be the medical director right now, I'm not going to be sure about about it. She's actually the medical director, I know that they really lean on her big, big time. But she's somebody who, you know, absolutely should be should be out front, not only giving you the information that you might need for your Google, you know, search. But once again, she's there to let that young girl or guy, you know, who's interested in dance, know that, you know, not only not only can you be involved in the performance arts as a dancer, but also as a medical or healthcare professional, or navigation program. So I think that she was a patient of I mean, a student of mine, at least 12 years ago, but our communication has never waned. We even talked as recently as last month, about her career, where careers going in and also getting other younger physical therapists and other parts of the country hooked up with her because as when they travel, they need to use local services, local physical therapy services, and whether that means, you know, a practice that they can come into while they're in that city or if there is a opportunity for an intern in a particular city where they are to come and spend some time with him. So our navigation program is so wide and it's so varied. When you look at just my career alone. I had my father I had Dr. Linda Woodruff. I had Rob Tillman. I had Robert Babs, I had at least 10 or 15, close mentors, role models, advisors, who could help me navigate where it is that I wanted to be, whether it's whether we're on Capitol Hill, doing some lobbying for physical therapy codes, whether I'm dealing with Ohio State University and their football team, or, or whether we're talking about trying to have a Howard University accredited exam. I remember I met with the president of Howard University because I was on the commission for accreditation for physical therapy, education. And I was there for an accredited accrediting visit. And now one of the people who's come in under our navigation, Vanessa LeBlanc, she is now a captive reviewer. So the reach is so wide and so long, that, you know, just being being associated with this network affords you such a wide array of opportunities and possibilities.   24:40 Absolutely. I'm just more than this navigation program. People might be perked up going, what is this? What is this? So I'm going to use some outsider terms on this. So yes, this is a mentorship program, but it's different. And it's really about when you connect with AAPT in court I'm where I'm mixing it up or saying it wrong. So when you connect with AAPT, anyone to a PT is they have a very large network of people with different expertise and you get forwarded to the right person. It's not just within the, the heads of the organization, because, I mean, everybody's doing this volunteer why so not? They can't, they can't, I'll take on everyone. But then from there, you go to this huge web, imagine like, Charlotte's beautimous beautiful web that's extremely expanded and connects you to all the multiple people that would advise you and take you through your journey to really accomplish a lot. It's very cool. And, and, and naturally expanding like you just said, with your your student, how you're now connecting her with students, you know, or people who could use her help. I think it's very, very cool thing that AAPT has going on. Did I explain that correctly?   26:00 I think so. I think he did a good a good summary job. Because it's not a instone program, what it is is right, right, exactly the way the way you the way you explained it was very, very, very good.   26:12 Yes, score. This AAPT has, has been around since 1989, as Leon was saying, and is an organization either, too, if you want to get involved, please reach out to them. Volunteers are always welcomed, there's plenty of opportunity, as you can hear from the mission statement. And, yeah, anything else you want to add on AAPT? A topic that I have potentially looked over because this is a big organ, this organization is a big deal. And I don't want to miss anything?   26:45 Well, no, I think you hit on the major things, I will say go to the website, if you have questions, then, you know, go ahead and submit them through the through the website. It's just a, an organization that I think is just very much relevant and needed to make sure that our community continues to be relevant, and get what get what it needs. That to keep us moving forward and moving in the right direction, because we're all connected. And we all need one another at some point, you never know when you're going to need need someone I remember, there was a member that was I would say he would come to the or to the meetings maybe every other year or something like that. I'll leave him nameless. But when he came, and he was actually being attacked by the State Board for a reason, that was not necessarily his fault. But because we had so many members that were involved in academia and also involved in the state boards that were able to help them out. But once again, you don't know what you need a lot of times until you need it. So just be involved, I would say it'd be involved in your, in all the associations that you can get that are professional associations, because you can glean information from from from everyone. Just because you're a member of AAPT doesn't mean you should not be a member of a PTA or any other healthcare or allied health organization that you think you're a possible stakeholder. And so yeah, I think that it just really makes sense to stay connected to the professional organizations because you won't know what hit you until it hits you. So what you want to do is stay ahead of the paddles, which is one of the terms that we use in our business, there's always a paddle coming after us at every every every point where there's legislation, or COVID It doesn't matter what it is. So the key is to be as prepared as you possibly can for each panels that come and if you can somehow anticipate what a panel you know might be booked for comps and by doing that you can be up on the current legislation you can be up on the current trends in the professor because we become about you know the current pitfalls you know, and then you're much more likely to be a successful individual and happy with your professor. I love it.   29:08 Thank you so much for coming on. I appreciate it and definitely to get connected with anyone AAPT like you said check go to that website. Thank you so much for coming on. We absolutely appreciate you Take care everyone.   29:23 And a big thank you to Jenna and Leon for a wonderful episode. And of course thank you to our sponsor Net Health. So again if you are looking to get your clinic found online, increase your reputation and your referrals then dead net house Digital Marketing Solutions has the tools you need to beat the competition get found get chosen get those five star reviews. If you sign up now for a free marketing audit digital marketing solutions from Net Health will buy lunch for your office head over to net health.com forward slash li T zy to sign up for you a complimentary marketing audit today.   30:03 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, Associate Professor and Associate Chair at the Department of Physical Therapy at the University of Delaware, Prof Karin Grävare Silbernagel, talks about her research into tendonopathy. Today, Karin talks about her historical perspective on tendonopathy, the future of tendonopathy research, and her presentation at the WCSPT. Is pain really worrisome? Hear about tendon loading, chasing the shiny new objects, creating expectations with patients, treating different kinds of tendons, and get her valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “If you just want zero pain, don’t do anything, but that’s really not what you want. You want to be able to move.” “Sometimes in our eagerness to do good, we get a little crazy.” “This is not a quick fix. This takes time.” “Just because it takes longer, does not mean a tendon has poor healing.” “Always have fun. If it’s not fun, it’s not worth doing.” “It’s a long life to work. Don’t hurry to get to the endpoint.”   More about Karin Grävare Silbernagel Karin Grävare Silbernagel PT, ATC, PhD is an Associate Professor and Associate Chair at the Department of Physical Therapy, University of Delaware, Newark, DE, USA. She is a clinical scientist with a strong record of mentoring clinical scientists (primary advisor for 10 PhD student – completed, and 8 current PhD students). Her expertise is in orthopaedics and musculoskeletal injury with a focus on tendon and ligament injury. She has been a physical therapist for over 30 years and performed research for over 20 years. At University of Delaware, she is the principal investigator of the Delaware Tendon Research Group and the Delaware ACL Research Group. Her work has been directly integrated into the clinical guidelines for treatment of patients with tendon injuries. She has presented her research at numerous conferences and published in peer-reviewed journals (100+ published articles to date). She has also been invited to speak about her research at conferences nationally and internationally. As the principal investigator of Tendon Research Group at the University of Delaware, she is working to advance understanding of tendon injuries and repair so that tailored treatments can be developed. The Delaware Tendon Research Group is an interdisciplinary team focused on improving treatment outcomes for tendon injuries. Her research approach is to evaluate tendon health and recovery by quantifying tendon composition, structure, and mechanical properties, as well as patients’ impairments and symptoms. Her research is funded by the NIH, Foundation for Physical Therapy, Swedish Research Council for Sport Science, and Swedish Research Council.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Research, Tendonopathy, Pain, Injuries, Treatment, WCSPT, Education,   World Congress of Sports Physical Therapy   To learn more, follow Karin at: Website:          https://sites.udel.edu/kgs                         https://www.udel.edu/academics/colleges/chs/departments/pt/faculty/karin-gravare-silbernagel Twitter:            @kgsilbernagel                         @udtendongroup Instagram:       @udtendongroup Facebook:       Delaware Tendon Research Group   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:  00:03 Hi, Karen, welcome to the podcast. I'm so happy to have you on and really excited to talk about tendinopathy research and treatment and clinical application. Super excited.   00:14 Thank you. I'm equally excited to be here to talk about my favorite topic.   00:18 Yeah. And later on, we will talk about, we'll give a little sneak peek to everyone about your topic. At the fourth World Congress is sport physical therapy in Denmark happening August 26, and 27th. So for those of you who want that fun sneak peek, you'll have to wait until the end of the interview for that. Because what we're going to start with is, I really want to know, the historical perspective of tendinopathy research and how it's been translated into the clinic. So us, as we spoke, before we went on 18 years ago, you wrote your thesis. And so you've got a really great vantage point to look back on, what what tendinopathy research was, where we're at. And then later on, maybe we'll talk about where you see it going. But I'll just hand the mic over to you. So you can kind of give us that historical perspective.   01:20 Thank you. And I think that, as we spoke about, too, I feel like I'm getting older because more and more my historical perspective kind of comes in. But I think it's important when I started as a physical therapist, so I started clinically in 1990. And when I started, we had in my courses and things you know, talked about muscle, you talked about ligament injuries, and all these things. And then the tendon was just this rope that went in between the muscle and the bone. And that was kind of it. And then when I started practicing, and I worked in Baltimore, and we worked a lot with with baseball players and things, and everybody had tendinitis was super undisciplined ages, tendinitis, Achilles tendinitis. So everybody had this inflammation in the tendon that we never really talked about. So okay, I felt like I was no dummy. I learned medical terminology. So I know itis was inflammation. So obviously, they had inflammation in this tendon, because that was the name was. So I thought our treatments then really, were treating the word. So we were really trying to rest because it was acute inflammation. We tried ice we did I onto freezes and fauna, for races, and they weren't allowed to load and all these kinds of things. And surprisingly, hopefully, some patients got better anyway. But that really sparked my interest into tendon in general, like, what is this? And then later on in the 1990s, that came up more and more research, Korean and Spanish started thinking about, you know, Achilles tendon would hurt more maybe when they were loaded, ie centrically and running, so maybe we need to train that and people are starting more thinking about how do we exercise and mostly maybe the lower extremity, tendon tendinitis. And then we had more research looking at if there was inflammatory components in the tendon. So if you took out cells and things too, there wasn't actually an acute inflammation. So this idea is maybe wasn't true. And that really opened the door for if it's not an acute inflammation, what do we do? So then in the late 1990s, beyond the curve is in Standish, it was another researcher knees and we're Tolman that looked at concentric versus eccentric loading. And then Hogan offense on in Sweden to started to have patients that were waiting to get surgery and he started like, okay, we're really going to load them, you know, we got a heavy load them, because maybe that's what they need, if not an acute inflammation, and started to see people get better if you actually load in them instead of resting them. At the same time we did our I started my PhD things, too, we started looking at, okay, should it be more overload, and we used our pain monitoring model versus the standard treatment that was, you know, circulation exercises, bilateral up and down, but not really trying to load it heavy. And what we started to see those exercise program that loaded more had better effect than the more like generic, protective things kind of things, too. So that's really when things started to change. Right. So I think the historical perspective is we didn't do anything. And we started to do things. And we had these huge jump in outcomes, which is brilliant. And our studies then was, you know, we were looking more at, you know, the Sylvan angle protocol, comprehensive, we use pain monitoring model to guide but also the loading and the exercises to kind of low beyond and not be worried about the pain because if the pain wasn't acute inflammation, maybe wasn't so worrisome, and loading the tendon was painful, but that was also the treatment. So we needed something to kind of understand how much could you really load. So we started with this exercises and being able to load and having kind of achieved this kind of change. I think that was really the the ultimate thing that happened in the late night. 90s, early 2000 And it was the combination of Korean and Spanish hooking out for some did we had programs and kind of moving that forward.   05:10 And there's something that you said in that? Well, a lot of what you said in there that I just want to pull out if we can. So, one thing that you just said is, is pain worrisome? And I think that's a really, really provocative question. Because if you ask the person living with the pain, yeah. And so how, as the therapist, if we're treating someone with a tendinopathy, let's say it's an Achilles tendinopathy, and the treatment induces pain, how do we communicate to the patient? That it's not as worrisome as you think it is?   05:53 Yeah, thank you for that question. And I think that's why the pain monitoring model that we've had, and really the pain monitoring model started with roll on to me who was my advisor, in patellofemoral. Pain, and that's when we applied it. And I think from the patellofemoral, pain, we kind of seen the same path, right? Just resting, it doesn't help you need to get strong. And then we will the tendons seems to be the same thing. And I think the pain monitoring model has been a lot of discussion is, you know, we go up to five is okay, and those things, to tell you the truth, I really don't care if it's five, or four, or whatever, I think it's that communication to the patient and communication that waiting for this pain to become zero, if that's the goal. And what I say to everybody was my lecture, and you might have heard that too, I'm like, Well, if that's the goal, I can tell the patient come in here, lie down on my nice little plants here in the office, you lie there, and I'm gonna go get a cup of coffee. And when I come back, you don't have any pain. So I've treated your pain, right. So I kind of start, I think, with the education. So the point is, if you just want zero pain, don't do anything. But that's really not what you want, you want to be able to move. So if you want to be able to move, you also need to get this tissue to tolerate more loading. And in order to do that, we actually need to load it. So we recover. So I spent a lot of time kind of explaining talking about this thing, so that there might be some pain when we're loading it, or without load, you're not getting anywhere. And what happened to a lot of people, they had some pain, the rest of it did last and they tried to do something a pain and they just D decline. And I talk a lot about hardening your tissues, right? This is loading, hardening of tissues. So the conversation is my goal with treatment is to increase the tolerance of your tissue over time, while keeping your pain level the same. So that's kind of the thing. So so your pain level, I'm fine with that you're not going to rupture, which is good thing to say for Achilles tendon rupture. That's like the big catastrophe. If that's not an issue, then we can follow it to and then we have the discussion. You know, above five, it's not good, or I don't know, you've seen Twitter, sometimes Twitter, that I use five, right? And I, I really don't care. I think the point is, there is a point of pain when pain goes from, it's uncomfortable to Ouch, I don't want it to be Ouch, I want it to be in five seems to be around in that round, right? And people can understand the difference in that. And it's, you know, you have the other conversation with the people that says, But I have really high pain tolerance. So this might not work for me. Well, you know, it's subjective. So I always tell them absolutely works even better for people like you. So, you know, sometimes maybe I'm a little silly, but that's. So I think that's kind of the point of really using it. So for me, the pain monitoring model is a way for discussing it and then using it. Some people feel like it's focusing too much on the pain, I actually think is does the opposite, right? Because it removes the worry. So I'm going to put a number on it. And it's just a number and everything else. And then we use training diary. So I use training diaries, you write down, you know, morning pain, worst, lowest everything else that you do. And then if I have three or four weeks, we can start comparing, and then people actually start seeing the numbers change with the activity, or the number stays the same. So I'm using it more of a of a descriptor, because if you just ask somebody you have pain, it's like they're gonna ask them what they did earlier. Right? And none of us remember, we don't remember how much pain was when we not painful. And so that's kind of how we using it in my description.   09:23 Yeah, I think thank you for that. I think that's great. And that also kind of answered my next question is how much load? How much can you load? How much load isn't? Is is enough? How much is too much? And I think you kind of answered that within that. But you want to expand on that a little bit or I feel Yeah, so I think   09:39 I think that's within the pain monitoring model too. Right? We're looking at that. But then you also have knowledge based on how the cells responds how the tendon response and I think that's where the next thing in the history perspective is now we're starting to see you know, which protocol is better. So now they're comparing Silvernail and offer zones or East centric loading, and it's all these. And really when you compare them, it's not that big of a difference. Right? The heavy slow resistance. I just say that you know who canal for some was in northern Sweden, he trained twice a day. I'm from Gothenburg and middle, we do once a day. And then you go down to Denmark, they did the three times a week for heavy slow, right? So Danish people are lazier than you know. But I think the point is, when you're looking at the data, actually, the outcomes are not that difference. You know, there might be some, you know, we can always argue that we're more satisfied with this. But when you're looking at the mechanical properties and things, you don't see that big of a difference anymore. And I think because I think you reached a saturation point, right? We've done no loading to loading now everybody does good. And I think for us as PTS now we're trying to manipulate more and more in that little realm, that for everybody, we might not see it when we do big studies comparing one group to the other, because I think we need to talk about individualized instead of precision rehabilitation and things too. So I think kind of that's where we're getting at. And they've been great studies coming on from unstuffy Agha Gordon Denmark from her thesis looking at moderate versus heavy and patellar tendon. And so I think that for the loading, you need to load them, you need to use the pain monitoring model, we need to do the progressive loading. But I as a PT would less worry about if I if you did two sets too little or five pounds to less, I think that's less of an issue.   11:29 Yeah. And when you said individual, I actually just wrote that down individualized care as you were speaking, because if all of the different protocols have basically the same outcome, then does it come down to what can the patient do, given the constraints of their life? Or their schedule? Or you know, their job? So do you have someone who can do something three times a day? Or do you have does this person might do better three times a week with heavy slow resistance, or, you know, it really depends on what the patient can do. Because the best protocol, I would assume is the one that patient is compliant with.   12:12 And I think you and I have been around way too long for this too, right? So because, you know, when you started, when you were at least when I started when I was young, right? You were so excited for every exercise. So I guess kept on adding to my poor patients like removing something No, no, that's a really good exercise. And you're adding. And what I'm getting to is that if I can get you to do something consistent with two or three exercises, I'm much better off giving you two or three exercises that you do consistently, than trying to think that I'm going to give you a ton of things. And I have patients now that are you know, they they come back, they come back every four or five weeks and see me or they send me an email and they do their exercise, because I told them to do for Achilles like bilateral three sets of 15. And then do unilateral three sets of 15. And do that for your rest of your life. Like you're brushing your teeth, and I'm like, you could probably go down to doing them less, or you can do heavier in the gym. And some people don't go to the gym, they don't want to do that. So you kind of modify it to kind of get some of the exercises there too. So I think that I think the biggest key is that you need to load you need to do things. And then instead of getting too hyped up for all the specifics, I think that's really where we're moving forward. And I had I had a lady that you know, recently with insertional tendinopathy that had been to the doctor been to all these other clinics, and there's thrown all these things on or didn't get better. And then it was massaging it. And it was like dry needling and the instrument assisted and those kinds of things to me, she was just getting worse. And I'm like, Well, I just think you should do these three exercises once a day. And she's doing and she's like, I'm walking. I'm not limping, you know. So sometimes in our eagerness to do good, I think we get a little crazy.   13:49 Yeah, and that brings me to the next thing I wanted to talk about. And it's sort of the shiny new object syndrome that a lot of people will get. And we spoke a little bit about this before going on the air. And I said a lot of it is sort of the theatrics around different kinds of shiny new objects. So how how would you address that to say younger clinicians? In you know, obviously talking about tendinopathy   14:14 Yeah, so I think that that one thing and it's still hard, I mean, I teach Doctor physical therapy students and then they go out and they completely forgot what I said. Right? So I think there's certain things everybody wants to go to clinical course and learn something more hands on and something more specific but I think that to me, the attitude is what we really try to teach them is like what tissue is that? How does that tissue respond right? To start understanding the underlying mechanisms because then you have then you have an understanding to build the other thing on instead of not having the understanding and just thinking that you doing things and then then you might be changing the shiny objects without thinking about the mechanism. So I'm very much a mechanism person in to try to think about why would we do it, but you all No need to realize that just putting the hand on somebody is very, very strong treatment effect. That's not, that's the same as listening to somebody and paying attention. And I have a colleague Now Greg Hicks has done finishing a trial looking at strengthening specifically for low back and an older in the control group who got hot, hot pack and massage as the placebo control. And they did really well too, right. So even we have mechanism, we should not be afraid of doing things that might help the patient in that sense. But we the explanations and things for what you're doing, you got to be really careful for right. And I think that I have a great effect on my patients, because I think I have a good program. We know what we're doing. I know it works. But I'm also not under estimating that if you can Google me, you're going to get better just by coming seeing me because he's going to assume that at least I know what I'm doing. So, you know, I utilize that effect too. So you just need to thinking about what we're doing. And I'm very scared of chasing the shiny objects for the wrong reason, because maybe that shiny object would be really good for a specific reason. And if we throw it on everything, we've lost, what is good for?   16:12 Yeah, if you beat me to it, I was just gonna say also people probably come to you knowing your background, and the work that you do. So they're coming in, like primed, like, this is she is the expert, I'm in the right hands. I know, this is gonna, you know, this is a person who's going to help me and that's a huge part of the rehab process is that trust that you have in the practitioner and that therapeutic relationship, but it also sounds like you're giving realistic expectations, and describing realistic expectations to your patients, which, again, takes time. And I know a lot of therapists like why only have a half an hour with them, how can I how can I spend 15 or 20 minutes talking to them? So what would you say to that kind of a comment?   17:02 Yeah, and I think that's another thing that happens over the years. Like, I feel like I do less and talk more, but that might be just my personality, too. But, but I think that that's without that understanding, when you start that therapeutic alliance or understanding why you're, as you're doing, you're not going to get anywhere. And patients and especially patients with tendon injuries and tendinopathies. I mean, it takes six months to a year, I tell them that right away, it takes six months a year, you can do what I say, I'm pretty sure you're gonna get really well, you might not be 100%, I'm gonna get you definitely to 80 or 90%. If you don't do what I say, we can meet here in a year again, it doesn't bother me. Right? So it's handy because I think when I was younger, I tried to take on the problem and I I'm handing it back right away. I'm like, doesn't bother me if he doesn't do don't do it, you know, you can just come back to understanding and I think the other part from from the young clinicians were tendon injuries is the biggest thing is, this is not a quick fix. This takes time. And what you see a lot with the younger clinicians or maybe younger, my younger self, too, is like your to do treatment for two, three weeks, and they're not there yet. And then you get worried. And when you get worried the patient get worried. And then you start changing things. And then then they get more worried because you don't seem like you know what you're doing right, you know, it's setting the expectations. This is what you're going to do. It's not any cool exercises, this is going to take time, and having the training diaries that I follow over time and they say, You know what, I don't think much of happening. I'm like, Well, you weren't here three months ago, you could only walk one mile, but the pain of five. And now you're jogging for miles. I'm like, I think that's a pretty good improvement. Right? So having those to kind of working on and I think that's really, really important.   18:45 Yeah, and my next question is, is are all tendons created equal? So we sort of alluded to an Achilles tendon and a patellar tendon or we can talk about, you know, a golfer's elbow or tennis elbow. So when we're talking about all these different tendons, are they all created equal? And can we kind of throw the same treatments at each one, regardless of the part of the body?   19:10 Yeah, so again, it's kind of the same thing that attendance is a tendon in certain tendons structures, right? But all tendons are meant to connect muscle to bone and allow for mobility and that help us however, the design of those tendons are also meant for what they're good for. Right? So the Achilles tendon is the biggest tendon in the body because it's generates a lot of force and helps us move it move. patellar tendon is a little bit different isn't big, but it also tries to help change the angle of force around the knees. So then we put a patella and so all of a sudden we have compression and tendons are not very good for compression. The rotator cuff is more of a flatter tendon, that has a lot of curvature and the compression there is a problem right? So the flatter tendon combines more. Spread the force versus around tendon they kill As tenderness and then you're thinking about tendons in the hand, right, they are really long and thin, to be able to manipulate the fingers really gently build up the force gently. So they have different functions. And soon as you have different function, the tendon has to be slightly designed differently, which makes if it's designed differently, the treatment or the loading might be needed to be very differently. So I think one of the biggest thing is a tendon is really good for tensile forces, but not a good for compression forces. So for example, the rotator cuff, when you're talking about these overload tears is usually an inferior kind of compression that slowly degenerates, a tear. And the Achilles tendon is nothing like that at all. It's a high load, that kind of happen because you pull it apart just like Play Doh, you pull it apart from two different ends, and it kind of can rupture. So I think those are really, really important. What we also see as the lower extremity tendons seem to respond fairly similar. They're not as high in central sensitization indexes and don't have those things versus differently when you're looking at upper extremity tended to So there are definitely differences. So you need to kind of thinking about the basics, that it's not probably an acute inflammation that we need to treat it and then you need to start thinking about what does this tendon do? Is it being compressed as a flat? What are the other structures? Right? So Achilles tendon, you know, that is Achilles tendon. The real problem is, it's right there. There's not much else. That's why I study it, because it's easy to study versus the rotator cuff. We talk less about rotator cuff tendinopathy. And we talk more about shoulder pain, right? More because we not so sure. Is it purely the tendon? That's the problem and other things   21:40 add a lot more structures around it than just the Achilles tendon. That can adjust the Achilles. Sorry, but yeah, yeah. Yeah. So the little, a little more complicated area of the body will say, yes, yeah. So, you know, I think it's great to sort of look at that historical perspective. And I love that you kind of talked about where we are now, where do you see research moving towards, in the tendinopathy? field?   22:12 So now we're getting little bit into what I'm going to talk about in Denmark, too. But I think, yes, so one of the big things that we're really working on, is that, okay, I felt like we kind of reached this point, we're doing really well with everybody. But again, you know, if you look at average, with a big group, we're still not 100% On average, right? Some people aren't 100% recovered, versus some people are not. And why is that and we can't manipulate the treatment anymore. I need to figure out who do I treat how right we've been there in other areas, too. So really, what we're doing in our in our research now is really trying to use various statistical models and larger group data to really first evaluate, we'll be starting to call a tendon health, I'm really proposing that tendinopathy might be more of a biological disease, more like you're talking about knee osteoarthritis, there used to be just wear and tear, and now it's a biological disease, I think tendinopathy need to be considered the same way. And the reason I say that is because it's not just that the tendons structure had changed, or that you have pain, there's so many other variables related to it, like you have personal factors too, like BMI or diabetes affects them in differently cholesterol do so you have the metabolic factors, you have the personal factors, right. And you have, you know, the fear factors, and all these kinds of things play a role. So we call that our tendon health model. We really started with function, structure, pain and symptom, psychosocial factors. And then I realized it was a person too. So we actually have personal factors. And based on that we're trying to figure out are there different? Because you can't, we can in clinic, you can treat every person in singular, right? But, but we need to also to have more of the precision health understand what we do in the health system understanding are the various groupings. So who should we treat how to be very efficient. And that's some of the research that we're working on now. It'd be looked at my PhD students try and handle and found like, we have different groups, we have what we call activity dominant, which might be the one so we see a lot of them, the runner's active, they don't have a lot of symptoms, they don't have a lot of deficits, tenant is not that bad. versus group that we've called structure dominant, that are heavier, they have really horrible looking tendon, that poor function. And then we have a group that we call psychosocial dominant, that maybe the worst are not the best, but they're people with higher fear, decreasing function, but the tendon might not be so bad. And when we started thinking about that, well, now you can understand maybe how you can treat them a little differently. And then we can start looking at how should we treat them based on looking at randomized controlled trials because from a researcher perspective, if I threw all of those in, and I do the same treatment, some of them might benefit a lot and some of them don't and then the treatment is seared out right. There is no difference. But then I lost Ask the benefit for the ones that might benefit and I lost learning from the ones that didn't benefit the needed something else.   25:07 Fascinating. And you're going to be talking about this in Denmark.   25:12 Absolutely. And we have new data, how it changes over time and all those kinds of things. Yeah, well   25:18 don't give it all away. Now. Will we want people to go to Denmark to see you present this live? Demo? Yeah. Yeah. I mean, it sounds fascinating. I love the idea of a tendon health structure. And I love how it's it is, seems to be evolving to be more about the whole person, not just someone with a tendon injury. Yeah. Right. Because like you said, it could be like, two people can have the same injury. It could be one could be a postmenopausal woman who has the same injury as a young 30 Something male runner, maybe they both have an Achilles tendinopathy. But are you going to treat them exactly the same?   26:01 Yeah. And I think that's when we need to start thinking about this, some of the programs are maybe the same, but how do you modify them? And what are the expectations? And then what are the other things that you can add on to that, to really make sure that we get more people up to 100%, and really try to focus on them. And as a researcher, sometimes those things get lost. And that makes that's concerning to me.   26:26 But I for one cannot wait to hear that talk in Denmark. Now. Before we start wrapping things up here, what advice maybe give three tips, if you want to give more or less whatever you want. But what would you give to what tips would you give to clinicians who are treating patients with tendinopathy? Injuries? I don't know if I want to say injuries, if that's quite the word, but diagnoses let's say, so what are your top tips?   26:59 So my top tip is to kind of think about what that it is the structure and that structure responds differently than muscle structure and bone structure to thinking about it from that from the tissue level when you're designing the treatment program. And I think the number one is tendon takes longer to recover than other tissues. So setting that expectations right away. I mean, it's a clear indication when you're looking at hamstring injuries, is it purely muscle or is it more proximal with a tendon is clearly evidence to show that it takes longer. So if you have that expectation and sitting down to explain, but just because it takes longer does not mean a tendon has poor healing, it has very adequate healing is just healing that takes a little longer. And sometimes I even explain that that is a good thing. Because a tendon can last you for a very long time. Like for marathon runners, the Achilles tendon rebounds you so you can run a whole marathon, if your muscle was doing that, you'd be fatigued way earlier, and you wouldn't be able to do it. So the low metabolism is beneficial. But this is the rehab, it's going to take your time. So that's one of my biggest thing and taking time to kind of thinking through that. The other piece of advice is do not panic. And my clinician in our clinic, they tell me back to others what I say because I always tell the patient right away, you're going to get better. This is going to take time, and you're going to have setbacks. And I want to tell clinicians that to the patients are going to have setbacks, they're going to come but don't panic when they have setbacks. You know, it just is what it is. And if you set the expectations right away, the patient's going to come in and have a setback. Now they're like, Yeah, I have my setback. But you told me I would eventually have it right? Instead of not expecting them because then we react on a dime, oh, they're worse today. What am I going to do? And what am I to change? Like, no, this is part of life that goes up, it goes down and moving. So I think those two things, and along with really using the pain monitoring model, and training diaries are my key things.   29:04 Great advice. And I love that do not panic, because they know when you're panicking, yes, right? The eye you know, they see it in your face. And like you said, you start throwing everything in the kitchen sink on there. And they're like, Well, wait a second, what just happened here? I thought you said I could just do this. But I always tell patients like this is not a linear journey. It's not like you're going up a roller coaster and it's going to be linear and perfect. Like it's going to go up, it's going to dip down, it's going to come up maybe dip down but not as much and then you're gonna go up again and you know, it's a little bit more of a squiggly line and that's okay. And people really do appreciate that because setting expectations is paramount. I always feel like if I do nothing else, if they hear nothing else, at least they have an idea of what to expect. So that it's not crazy. Just   29:59 And I think the training diary to me, I use it for any patient for anything, I think that was really key too, because that calms all of us down. Let's see, let's go back here five weeks, wherever we're at what you were doing. And then we can see the pattern. And I even had one person that gave me like an Excel spreadsheet, and a color coded the pain. And if you looked over like a year, you can see that red and orange decrease and the green was increased, you know what I mean? Those are the patterns that you want to see. And it's hard to see those in your daily life. So that's why I think that's really important.   30:32 Yeah, that is a dedicated patient. Yes,   30:35 I do. But yeah,   30:38 yes, well, right. Right. But well, this was great. Where can people find you? If they have questions? Maybe you're on social media? Where can people find you?   30:51 I am on social media at kg silver Nagel, I think I'm on Twitter, is the main one is that but I also run the Delaware tendon research group, and attend them on a ligament research group. So on Twitter, we also have the UD tendon group. We're also on Facebook, and we're also on Instagram. And I'm easily found the University of Delaware and Department of Physical Therapy to please feel free to reach out and connect with us, you know, on the social media and those kinds of things that we're doing. And I'm very excited to discuss these clinical things.   31:26 And if you don't mind, can we talk a little bit about the Delaware attending group because you guys have some projects that you're working on to do you want to tell the listeners about those projects? In case you know, you need recruiting or you need volunteers? So go ahead.   31:42 Yes, we always need volunteers. So we actually have we have a lot of ongoing studies, but one of the big ones that NIH funded right now is we're looking at comparing men and women with Achilles tendinopathy. So we're up to 145 recruited patients out of 200, we had a little dip around COVID. So we're actually providing treatment for anybody that is around the Delaware Philadelphia area, please feel free to reach out or send your patients. We're also have ACL studies ongoing. One of the big ones also been relating to tendon is looking at the recovery from patellar tendon grafts to see how they change over time, how does that tend to actually recover? And could that if the doesn't recover fully, can that explain some of the deficits that we do see their ACLs injuries to we're also hoping to soon start more of looking at insertional, Achilles tendinopathy, with treatments we have. And one study with shockwave treatment, we have studies that we're hoping to start now looking more at metabolic factors, and getting a little blood draws and those things. So we have on our website with all of those things going on. So if anybody's interested, please feel free to reach out or look at our website.   32:53 Perfect. And we'll have a link to that at podcast at healthy, wealthy smart.com under this episode, so one click and we'll take you right there. So before we end, I have one question. Question 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 you can pick which ever age of your younger self you   33:14 would like. So I'm going to pick myself before I even went to PT school, because one of my mantras is to always have fun, and I will stick to that now. And I'll stick to that younger because if it's not fun, it's not worth doing, even if it's research and those things. So do anything that's fun. But I was did not want to go to school in Sweden, I wanted to do sports medicine wanted to go to the US. But I was very worried that if I didn't get in, when I was 20 that I wasn't going to go to PT school because it took four years and then I would be too old when I graduated before I was ready. So I wasn't going to go luckily I got in and I stayed on. So I think to to my younger self. It's a really long working life. So just keep on having fun and plugging along and learning more things. And I have taken the really long path to academia with the clinician for many years and doing those kinds of things. So that I'm happy for so I'm glad I got in and didn't say I wasn't going to do it. Because who cares if I was 2425?   34:14 Yeah, and that's so young. Yes, but isn't it funny when you're 1819 20? You're like, Oh, forget it. I'll be an old person by then 25 behind the eight ball when of course, now that were a little older, we can look back on that and be like, Oh my God. Yes. And   34:34 I mean, it's like it's, it's a long life to work. Don't hurry to get to the endpoint, right? Enjoy it get experienced during that time, because as I tell our students, I've had a lot of fun during my years and worked with sports workers, clinician travel, research, academia, you know, you got to have fun.   34:53 Absolutely. Well, and on that note, I want to thank you for coming on the podcast and having such a fun conversations. Well, thank you so much. And everyone, if you want to get a chance to see current speak live, then join us at the fourth World Congress, a sports physical therapy, it is in Denmark and August 26 and 27th of this year. And not only will you get to see speakers like yourself, but there's also going to be great networking, activity breaks, things like yoga, or running or walking tours, paddle paddleboarding, all sorts of fun stuff. So it's again, not going to be quite your average conference, and a lot of it is going to be clinically focused and clinically based. So I think that's really important. I think a lot of times people think, Oh, we go to these conferences, it's going to be researchers just talking about their research and how's that going to affect me clinically? Well, this conference is all about that. So I think, right? Absolutely agree. Yeah. So come join us in Denmark. Again, thank you so much for coming on. And everyone. Thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, Aalborg University Professor, Prof Michael Rathleff, talks about his role at the upcoming WCSPT. Today, Michael talks about how he organized the congress, creating tools for clinicians to educate their patients, and his research on overuse injuries in adolescents. What are the barriers between the research and implementation in practice? Hear about the mobile health industry, exciting events at the congress, and get his advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “The clinicians out there have a hard time both finding the evidence, appraising the evidence, and understanding [if it’s] good or bad science.” “There’s a lot a clinician can do outside of a one-on-one interaction with a patient.” “It’s our role to understand the needs of the individual patient, then make up something that really meets those needs.” “It’s okay to say no. You have to make sure to say yes to the right things.”   More about Michael Rathleff Prof Michael Rathleff coordinates the musculoskeletal research program at the Research Unit for General Practice in Aalborg. The research programme is cross-disciplinary and includes researchers with a background in general practice, rheumatology, orthopaedic surgery, physiotherapy, sports science, health economics and human‐centered informatics. He is the head of the research group OptiYouth at the Research Unit for General Practice. Their aim is to improve the health and function of adolescents through research.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injuries, WCSPT, Education,   IFSPT Fourth World Congress of Sports Physical Therapy   To learn more, follow Michael at: Website:          https://vbn.aau.dk/en/persons/130816 Research:       https://www.researchgate.net/profile/Michael-Rathleff Twitter:            @michaelrathleff   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 Hello, Professor Ratliff, thank you so much for coming on the podcast today to talk a little bit more about your role at the fourth World Congress is sports, physical therapy in Denmark, August 26, to the 27th. So, as we were talking, before we went on the air, we were saying, man, you're wearing a bunch of hats during this Congress, one of which is part of the organizing committee. So my first question to you is, as a member of the Organising Committee, what were your goals? And what are you hoping to achieve with this Congress?   00:35 I think my role is primarily within the scientific committee. And one of the things we discussed very, very early on was this, like, you know, when you go for a conference, you go up to a conference, you hear a bunch of interesting talks, and you feel like, I'm motivated, I'm listening, I'm taking in new things. But then Monday morning, when you see the next patient, it's not always that all the interesting stuff that you saw, is actually applicable to my patient Monday morning. So we wanted to try and emphasize more. How can we use this conference as a way to translate science into practice? So the whole program and the like, the presentations will be more about clinical applicability, and less about more p values and research methodology. So not that the research is not sound, but there'll be more focused on how can we actually apply it in the context that were working. That's why also, we had the main title of translating research into practice, which I think will be hopefully a cornerstone that people will see, well, if there's really interesting talk about, it could be overuse injuries in kids, which will be a lecture that I'm having, then they'll also be a practical workshop afterwards to kind of use that what's been presented, and then really drill down on how we can use it in in clinical practice. So the goal is to, to get people to reflect in your network, but also take a lot of the things and think, Wow, this is something that I can use next Monday for clinical practice.   02:09 And aside from a lot of lectures and talks, you've also got in informatics competition. And so could you explain that a little bit and why you decided to bring that into the Congress?   02:23 Yeah, so this was a major, not a debate, but an interesting discussion on how we can even in the early phases of the conference, when people submit an abstract, make sure that the abstract can actually also reach more end users target audiences for that case. So we decided that people actually had to submit an infographic together with their the abstract. So normally, you send in like, 250 words, for a conference, but for this conference, we wanted them to submit the abstract, but also the visual infographic to go along with Olympic Well, am I making an infographic that is tailored to patient? Is that a patient aid that I'm trying to make? Is it something that's aimed but other researchers? Or is it clinicians, so they have to tick off? Which box Am I infographic actually intended for? So when the audience or the participants come and join the conference, they can actually take these infographics for those that want to print them they can use in the clinic afterwards, just another layer of trying to make some of this research more easily communicated to the audience, but also, the things that can be used in clinical practice, like some of the people have submitted abstract, have some really, really nice infographics that I expect will be printed and hang on, on a few clinic doors around the world afterwards, I hope.   03:48 And when it comes to dissemination of research and information from the clinician, to the patient, or even to the wider public, where do you think clinicians and researchers get stuck? Like where is the disconnect between that dissemination of information as we the information as we see, and by the time it gets to the consumer or to let's say, a mass media outlet? It's like, what happened?   04:15 Yeah, that's a big a big question. Because it's almost like why are we not better at implementing new research into our clinical practice? And I think there's heaps of different barriers. We've we've done a couple of studies, something new was also in the pipeline where we look specific, get the official context, and we can see that this barriers in terms of understanding the research, that's actually one of the major barriers that the clinicians out there have a really hard time both finding the evidence, appraising the evidence, and also actually understanding is this good or bad science. And then you have the whole time constraints on a clinical practice because who's going to pay you to sit and use two hours On reading this paper, and remember, this is just one paper on ACL injuries. But in my clinical practice, I see a gazillion different different things. So how am I going to keep up with the with the evidence? Is it intended that I'm reading original literature? Or how am I going to keep up with it? So I think there's a lot of different barriers. But at least one of the ways I think we can overcome some of these barriers is that researchers climb out of the ivory tower and think of other ways that we can communicate, research, evidence synthesis, it could be infographics, it could be sort of like decision age for clinical practice, at least that's one of the routes we're taking in terms of also the talk I'm giving at the conference that we're trying to think of, Can we somehow develop AIDS that will support clinical practice something that scene but the physiotherapist something that's aimed at the patient, that will sort of make it easier to deliver evidence based practice? So we've done one, one tool that's being developed at the moment is called the Makhni, which is something that can assist clinicians in the diagnosis, the communication of how do you communicate to kids about chronic knee pain? How do I make sure that they have the right expectation for what my management can be? And how can we engage in a shared decision making process. And we have a few other things in the pipeline as well, where we want to, to build something, build something practical that you can take in use in clinical practice to to support you in delivering good quality care, because just publishing papers is not going to change clinical practice, I think,   06:45 yeah, and publishing papers, which are sometimes wonderful papers. But if they're not getting out to the clinicians, they're certainly not going to get out to the patients and to people, sort of the mass population.   07:02 I completely agree. It's a bigger discussion, I'm really focused on how to reach clinicians, because I see the clinicians as the entry point to delivering care to patients and parents and, and the surrounding surrounding community. But if you think of, like wider public health interventions, we have the same problem as well. And also we create this sort of like, No, this inequality in healthcare, but that's another   07:30 line, although there can of worms. Yeah, we could do a whole series of podcasts on that. Yeah, yeah. And I agree with you that it needs to come from the clinician. So creating these tools to help clinicians better educate their patients, which in turn really becomes their community. Because there's a lot a clinician can do outside of just a one on one interaction with the patient. And so having the right tools can make a big difference.   07:58 Like in, if you look at a patient that comes to you for an ACL injury, or long standing musculoskeletal complaint, they're going to spend maybe 0.1% of their time together with you and 99.9%, they're out on their own. And I think it's important that we when we're one on one with them, sort of like make them develop the competencies so they can do the right decisions for their health in the 99.9% of the time that they're out there alone, when they're not with with us, I completely agree with you that there's a lot of things we can do to make them more competent in thriving despite of knee pain, or shoulder pain or whatever it might, it might be. And I think that's one of the most important tasks, I think, for us as clinicians is to think about the everyday lives they have to live when they leave us and say see you next time.   08:51 Yeah, and to be able to clearly communicate whatever their diagnosis by might be, or exercise program or, or any number of, of 10s of 1000s of bio psychosocial impacts that are happening with this person. Because oftentimes, and I know I've been guilty of this in the past, I'm sure other therapists would agree that they've this has happened to them as well as you explain everything to the patient, and then they come back and it's, they got nothing zero. And it might be because you're not disseminating the information to them in a way that's helpful for them or in a way that's conducive with their learning style. So having different tools, like you said, maybe it's an infographic that the patient can look at and be like, Oh, I get it now. So having a lot of variety makes a huge difference.   09:48 And I think you touched on a super important point there that patients are very different, that they have different learning styles, they have different needs. And I think it's our role to enlist Send the needs of the individual patient and make up something that really meets those needs. So more about listening, asking questions and less about thinking that we have the solution to it, because I think within musculoskeletal health or care, whatever we call it, some clinicians would use their words to communicate a message that might be good for some other patients would prefer to have a folder or leaflet. Others would say, I want a phone, I want an app on my phone, something that's like learning on demand, because at least that's something we see regularly. Now that we have the older population that wants a piece of paper, we have the younger population that wants to have something that they can sort of like, rely on when they're out there on their own one advice on how do I manage this challenging situation to get some good advice when you're not there? When I'm all on my own? So, so different?   10:57 Yeah, and I love those examples. I use apps quite frequently. And I had a patient just the other day say, Oh, my husband put this, the app that that you use, because I was giving her PDFs, and she's like, Oh, my husband put the app on my phone. Now it's so much easier. So now I know exactly what to do if I have five minutes in my day. So it just depends.   11:21 And I think the whole like mobile health industry, there's a lot of potential there. But I also see, at least from a Danish context, that there's a lot of apps that is very limited. It's not not developed on a sound evidence base, or it's just sort of like a container of videos with exercises. And I think there's a huge potential in like thinking of how can we do more with this? How can we make sure that it's not just the delivery vehicle for a new exercise, but it's actually the delivery vehicle for improving the competencies for self management for individuals? I think there's, yeah, I'm looking forward to the next few years to see how this whole field develops. Because I think there's really big potential in this.   12:12 Yeah, not like you're not doing enough already. But you know, maybe you've just got your next project now. Like, you're not busy enough already. So as we, as you alluded to a few minutes ago, you've got a couple of different talks you're chairing, so you've got a lot going on at the World Congress. So do you want to break down, give maybe a little sneak peek, you don't have to give it all away, we want people to go to the conference to listen to your talks. But if you want to break down, maybe take a one or two of your topics that you'll be speaking on, and I give us a sneak peek.   12:48 I think the talk that will be most interesting for me to deliver and hopefully also to listen to is is the talk that I'm giving on overuse injuries in adolescence, because I think it's we haven't had a lot of like conferences in the past couple of years. So it will be one of these talks will be meaty in terms of of new date, and some of the things I'm most interested go out and present is all the qualitative research we've done on understanding adolescents and their parents, in terms of what are the challenges they experience? How can we help them and also, we've done a lot of qualitative works on what are the challenges that face us experience when dealing with kids with long standing pain complaints, we've developed some new tools that can sort of like, help this process to improve care for these young people. And I really look forward trying to Yeah, to hear what people think of, of our ideas and, and the practical tools that we've that we've developed. So that's at least one of the talks, that's going to be quite interesting, hopefully, also, we're going to actually have the data from our 10 year follow up of so I have a cohort that I started during my PhD. They were like 504 kids with with knee pain. And now I follow them prospectively for 10 years. And this time period, I've gotten a bit more gray hair and gray beard. But this wealth of data that comes from following more than 500 kids for 10 years with chronic knee pain is going to be really, really interesting. And we're going to be finished with that. So I'm also giving a sneak peek on unpublished data on the long term prognosis of adolescent knee pain and at the conference. So that's going to be the world premiere for for that big data set as well.   14:36 Amazing. And as you're talking about going through some of the qualitative research that you've done, and you had mentioned, there were some challenges from the physio side and from the child side in the patient and the child's parents side. Can you give us maybe one challenge that kind of stuck out to you that was like, boy, this is really a challenge that is maybe one of the biggest impediments in working with this population.   15:06 I think I think there's multiple one thing that I'm really interested in these in this moment is the whole level of like diagnostic uncertainty and kids, because one of the things we've understood is that if the kids and the parents don't really understand why they have knee pain, what's the name of the knee pain, it becomes this cause of them seeking care around the healthcare system on who can actually help me who can explain my pain. So so at the moment, we're trying to do a lot of things on how we can reduce this, what would you call diagnostic uncertainty and provide credible explanations to the kids and then trying to develop credible explanation for both kids and parents? That's actually not an easy task, because what is a credible explanation of what Patellofemoral Pain is when we don't have a good understanding of the underlying pathophysiology? So there, we're doing a lot of work on combining both clinical expertise, what the patient needs, what we know from the literature, and then we're trying to solve, iterate and test these credible explanations with the kids. And yeah, at the conference, we'll have the first draft of these, what we call credible explanation. So that's going to be at least one barrier one challenge, I hope that some of the practical tools we've developed can actually help   16:25 i for 1am, looking forward to that, because there is it is so challenging when you're working with children, adolescents, and their parents who are sort of call it doctor shopping, you know, where you're, like you said, you're going around to multiple different practitioners, just with their fingers crossed, hoping that someone can explain why their child is in pain or not performing are not able to, you know, be a part of their peer group or, or or engage in what normal kids would would generally do. Exactly. Yeah. Oh, I'm definitely looking forward to that. So what give us one other sneak peek? Because I know you've got the, you're also chairing a talk on the first day. But what else I shouldn't say I don't want to put words in your mouth. What else? Are you looking forward to even maybe if it's not your talk, are you looking forward to maybe some other presentations,   17:26 I'm actually looking forward to to the competitions we have as well, because I've had a sneak peek of some of the research that's been submitted as abstracts, and the quality is super high. So both the oral presentations but also the presentation that the best infographics because they'll also get time to actually rip on the big screen and present their infographic. And I look forward to see how people can communicate the messages from these amazing infographics. And I think these two competitions are going to be to be a blast and going to be really, really fun to, to look at. And amazing research as well. So I really look forward to the two events as well. And then of course, oh no, go ahead. No, I was just talking about look forward to meeting with friends and new friends and be out talking to people once again in beautiful new ball in Denmark in the middle of summer. It's hard to be Denmark in the summer. We don't have a lot of good weather, but Denmark in August is just brilliant.   18:31 Yes, I've only been there in February. So I am definitely looking forward to to Denmark and August as well. Because I've only been there for sports Congress when it's a little chilly and a little damp. So summer sounds just perfect. And I've one more question. Just kind of piggybacking off of your comments on the amazing research within these competitions. And since you know you have been in the research field, let's say for a decade plus right getting your PhD a decade ago. How have you seen physio research change and morph over the past decade? Have you seen just it better research coming from specifically from the physio world?   19:20 I think it's the first time someone said it's actually more than a decade. So, but that gives me a time perspective. But yeah, I've actually seen that. My perception is that physiotherapy research in general but also sports physiotherapy research went from being published in smaller journals we published in our own journals to now there's multiple example of sport fishers performing really, really nice trials that have reached the best medical journals that have informed clinical practice. So I think we see this both there's more good research Basically out there. And I also see that we've moved from, like a biomechanical paradigm to being more user a patient center, we see more qualitative research, we see that physiotherapist, sport physiotherapist, they sort of have a larger breadth of different research designs, they used to tackle the research. I think, like looking even at the ACL injuries, if you go back 10 years in time, looking at the very biomechanically oriented research that was primarily also joined by orthopedic surgeons to a large extent. Now, today where fishers have done amazing research, they understand all the the fear of reentry, they're trying to do very broad rehabilitation programs, ensuring that people don't return to sport too rapidly. And and also understanding why they shouldn't return back to his board now developing tools that you can use when you sit with a patient to try and and educate them on what are the phases, we need to go through the next nine to 12 months before you can return to sport and so on. So I think I'm just impressed by, by the research. And when I see the even the younger people in my group now, they start at a completely different level when they start their PhD compared to what we did. So I can only imagine that the quality is going to improve over the years as well, because they're much more talented, they're still hard working. And they have a larger evidence base to sort of like stand on. And they already from the beginning, see the benefit of these interdisciplinary collaborations with the whole medical field and who else is is relevant to include in these collaborations? So yeah, the future is bright. I see. Yeah,   21:50 I would agree with that. And now as we kind of start to wrap things up here, where can people find you? So websites, social media, tell the people where you're at.   22:04 So I think if you just type in my name on Google, there'll be a university profile at the very top where you can see all my contact information. Otherwise, just feel free to reach out on LinkedIn or Twitter, search for my name. And you'll find me, I try to be quite rapid and respond to the direct messages when, when possible, at least   22:25 perfect. And we'll have all the links to that in the show notes at podcast at healthy, wealthy smart.com. So you can just go there, click on it'll take you right to all of your links. So is there anything that you want to kind of leave the listeners with when it comes to the world congresses, sports physiotherapy or physical therapy, sorry.   22:52 Be careful not to miss it, it's going to be one of these conferences with a magical blend of practical application of signs, it's going to be a terrific program in terms of possibilities to to network and engage in physical activity, whatever it's running, or mountain biking, and with an amazing conference dinner as well. So I think it's, so this would come to be one of one of the highlights for me this year. So and I think the whole atmosphere around this conference is also that if you come there, as a clinician, you don't know anybody, that people will be open and welcoming and happy to engage in conversation. There's no speakers, that wouldn't be super happy to grab a beer or walk to discuss some of the ideas that's been presented at the conference. So I think it's going to be quite, quite good.   23:45 Yeah. So come with an open mind come with a lot of questions and come with your workout clothes. Is is what I'm hearing?   23:56 Yes, definitely. Definitely.   23:59 And final question, and it's one that I asked everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self, and you can pick whatever time period your younger self is.   24:13 So I think in if I had to give myself one advice when I was in my sort of like, MIT Ph. D, time coming towards the end, I would say to myself, that it's okay to say no, you have to make sure to say yes to the right things because it's very easy to say yes to everything. And then you create these peak stress periods for yourself that would prohibit you from from doing things that is value being with friends or family and so on. You don't have to say yes to everything because there will be multiple opportunities afterwards. So practice in saying no and do it in a in a polite way. People actually have a lot of respect for people that say, No, I don't have a time or I'm I'm going to invest my time on this because this is what I really think is going to change the field. And this is my vision. So So young Michael, please please practice in saying no.   25:11 I love that advice. Thank you so much. So Michael, thank you so much for coming on the podcast. And again, just a reminder, I know we've said this before, but the World Congress is sports, physical therapy, we'll be in Denmark, August 26 and 27th of this year 2022. So thank you so much for coming on the podcast and thank you for all of your hard work and getting making this conference the best it can be.   25:36 Thank you, Karen, thank you for the invitation to the podcast.   25:39 Absolutely. And everyone. Thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, Owner of Access Physical Therapy, Clarence Holmes, Jr, talks about generational differences in physical therapy. Today, Clarence talks about burnout, the idea of value, and the different ideas of pay structure. Why is the measurement of productivity problematic? Hear about the promise of mentorship for lower pay, the problem of toxic positivity, and finding the better way in each new generation, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “The reason why things are fluid and changing with every generation is because there’s always a better way.” “We have to be open to that better way.” “No one loves PTs as much as PTs love PTs.” “It is so heathy to have a full well-rounded conversation that points out the bad and the good, and you don’t have to finish with a positive statement in a conversation.” “Get comfortable with being uncomfortable.” “It’s become an expectation in this country to overwork.”   More about Clarence Holmes, Jr Dr Clarence Holmes, Jr is a native of Cleveland MS. He attended Mississippi State University for his undergraduate studies and received his Doctor of Physical Therapy degree from the University of Mississippi Medical Center in 2014. Dr Holmes then completed an orthopedic residency with Mercer university in Atlanta GA in 2015. He has worked in various settings to include sports/outpatient orthopedics, acute care, and the state jail system. Now, he owns and operates Access Physical Therapy, a concierge cash based physical therapy practice in the Atlanta metropolitan area. He also works as a staff physical therapist with Kindred At Home. Dr Holmes has been involved with APTA at various levels to include 2 terms on the Student Assembly Board of Directors, delegate for the state of Georgia to the House of Delegates, and currently serves as a board member for the Georgia Foundation for Physical Therapy. In his free time, he also owns and operates The Travel Doctor, a full service travel agency as well as tackling small woodworking projects. He also scuba dives and enjoys traveling the world with his beautiful wife, Turquoise and their golden retriever and chihuahua/terrier mix puppies.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Burnout, Generational Differences, Productivity, Mentorship, Improvement,   To learn more, follow Clarence at: Website:          https://www.accessptatl.com Twitter:            @matterundrmined Instagram:       @caholmes6 Facebook:       @clarenceh3   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:  Hello, this is Jenna Cantor with healthy, wealthy and smart. I'm really excited. I am interviewing Dr. Clarence a Holmes Jr. Just wrote on Zoom, or we're doing the interview. And Dr. Clarence who said, just call me clearance. I'm like, Okay, hi, Clarence, said that he works with home health and is the owner of a concierge cash based practice, which everybody who listens knows I'm cash based. I'm like, Yeah, hello, Conrad. I love that so much. Let's serve our people, our patients. We are coming on because we met at a conference. And there was a discussion on generational differences in physical therapy. And Clarence had some real interesting thoughts on this. And I was like, this is a podcast in the making. So I approached him right away. And I said, Can we do this topic and a podcast? And fortunately enough, he said, Yes. Like a proposal. It was beautiful. So here we are talking about generational differences in physical therapy. I think this is a really, really important topic. Now. I just let's just start diving in to one we're saying general racial differences, everyone, please don't refrain from getting offended with how we, how we try to describe this, because this is one we're differentiating between ages. And I saw I saw individuals struggling with that trying to be appropriate. So if we do say anything in our descriptions, inappropriate, feel free, please absolutely correct us. But be nice, because we're doing the best we can. But this is a very important conversation. So we'd rather take the risk in in really diving into the topic. So yeah, just let's all be nice. Okay. So regarding generational differences, I'm assuming that we're talking about the more seasoned crowd, people who have been around for a long period of time, compared to newer people in the physical therapy. Oh, right. Correct. Am I missing anything? Or is there any other way we need to define it?   02:39 No, I mean, and honestly, you're talking about me when you said if you recognize people being uncomfortable, trying to differentiate between these these generations, in conversation without trying to fin that was me at our conference. I didn't want to say the boomer generation, I didn't want to say the millennials simply because a lot of people tie a lot of negative connotations to those. And we're   03:03 also missing Gen X, because Gen X is actually the y'all are the youngest practitioners right now. Not millennials. Yeah.   03:09 Yeah. And I think there's a lot of similar Z   03:12 is Z. Oh, my God, ie, Z. Oh, my gosh, I missed the letter in the alphabet. Yeah. It might   03:17 be x. I don't don't hold me to it. But But, but yeah, so that was one. But But no, you captured it perfectly. I do think there is a a riff between the older generation and the younger generation to just put it put it lightly. Yeah. Just simply because and I mentioned it in the conferences that the older generation are the ones who are owning these practices, traditional practices. And the younger generation, our generation are the ones who tend to be more of the employees. And that's natural. But what's what's unnatural? Well, this is also natural to have some generational difference was unnatural is the riff, the, the battle that kind of comes along with it, and how we respond to it. So   04:03 yeah, so let's, yeah, I love that. Let's do what we're aware. I was very interested. Let's go back and and just do one general generational difference at a time and then if we okay, I feel like that's what pops in our head for now. And that's it. That's great. So one, just named one at the top of your head one Gen. Gen. Oh, my gosh, why is this? So? General? generational difference, let's start with one.   04:29 So I mean, there's two big ones that stick out to me. One is just this idea of pay structure. And specifically in the PT realm of, of how long has someone been here? versus what is this person doing for my company? And the best example I can give is me personally, of working in a job my first job post residency. I'm an ortho I'm a lover, or I will consider myself an ortho PT, even though I work in the home health arena, and the concierge cash base, I will consider myself an orthopedic physical therapist. My first job post residency was at a private practice in Atlanta, and I was paid the least amount of all the therapists across the entire company, which was four practices in Atlanta. But I was the second highest producing therapists in the company. And so, you know, generational differences comes down to the old way of doing things was, who has the most experience, they get paid the most? My personal opinion is, that's not logical, we're, I'm a logical being and a lot of my generation are, if it doesn't make sense to us, we're going to be vocal about it. And it didn't make sense to me that I was producing one paper, more money, better outcomes than the majority of the therapists and I was paid the least, that's one major win. And it kind of feeds into the second you asked for one, but this kind of feeds into it. Younger generations, older generations value loyalty. You know, they expect somebody to come in and work for them for 10 to 1520, almost 30 their entire careers. And my generation just, we're not happy, we're going to move on. And so that puts a lot of responsibility on the employer to find out what makes us happy. And sometimes that just doesn't, that doesn't translate well.   06:39 Yeah, I see where these connect, let's focus on the first one, because that is a really good, interesting point, I have definitely mentored some dance PTS who are burnt out, and they are in a situation where, Oh, Gosh, darn it, what is it productivity, productivity is measured. And that has been very problematic for them, because they'll come in, and they see that they are, they know, they're getting paid less. But they're not more because in your case, you actually saw the data, but they're seeing the, they are seeing the exact number of patients as a seasoned professional, there, and they're just they don't understand why they're getting paid less, if they're seeing the same amount, then they were there, they would imagine, I would be seeing less patients, then that would make more sense, you know, but no, that's not the case. And therefore, that income would still be it is assumed that income would still be made. So it's almost like they're being profit, they're more of a profit is being made off of them. They're exhausted, you know, but they're not getting a lighter load to feed that exhaustion, that adjustment, they're getting treated just the same. And so they don't understand that pay difference when they come in. And I'm going to bounce off this a little bit more because of what the reasoning so it's going to get a slightly off topic, but I'm always okay with that is the promise of mentorship as a reason for why they are paying less that can be a reasoning behind it, which still, there are some clinics that actually provide mentorship, but the majority of them do not actually provide that mentorship, so it's more verbage. Or they have some sort of automated system, that's there maybe videos or something. So there, it's not really an extra effort. It's something that's already there that can help streamline what's going on. Especially if you're in a place that measures the productivity. You can promise it as a as a somebody owns a clinic, however, who's the physical therapist, and how much time do they actually have to really mentor? So if there really, it doesn't make sense, right? This reasoning of oh, why, you know, and these are generational, different thoughts, but for I think that's what you're hitting is that the younger generation will speak their minds and say, hey, you know, they're not getting that mentorship, they're not getting that value for them to go. Oh, that's why then because they get oh, you know what, I'm getting great mentorship, kind of like where people think residencies, getting great mentorship that get one in paying less I get it. I totally get it. That's not the case. No, no, in a lot of circumstances.   09:33 Seven years, I think I've been out seven and a half years for a PT school. And I've never been in an environment outside of residency that that had any type of formal mentorship. But you're correct in that I've have had several interviews with several companies that have promised mentorship because that was important to me. I kind of did less the reason I worked at the job that I did that I'm mentioning in this in this interview. This conversation. The reason I took that job, and I knew I was getting paid less than I was worth. Um, the reason I took it was because my clinical manager and the only person who was more productive than I was a personal mentor, who was my was one of my direct mentors in residency. And so I saw it as an opportunity to continue getting mentored. And so I'm getting an exchange of additional mentorship. I will take less pay.   10:32 Okay, yes. And your, your through your apps, you're like, Oh, yes, yes.   10:36 Correct. But there was no formal mentorship. Now, I did continue work with this guy. I did learn a lot from him. But there was no formal.   10:45 That's a big, that's a big deal. It's not exactly,   10:48 exactly. And there's no when is the end point? I mean, when is the point where I say, Okay, I've received enough mentorship now I'm ready to get paid. Okay. Right. There has to be some kind of trade off there. So. But you're absolutely correct that that is there is a common promise of these employers to employees, younger, generational PTS, of mentorship, in exchange for, you know, lower, less than ideal pay, but is delivered upon.   11:20 Right, right. And I think that's the thing, because there's different ways to work around depending on the clinic, and everything that can happen in these rooms for negotiation. So when these different mindsets come into the room, for it to work out, but you got to follow through on both sides. One is providing the mentorship and the other side is accepting, that's what you accepted, and knowing that owning that. So, but it can be I mean, you know, what I was about to go into different things you can negotiate, but this is not a lesson on negotiation. So I'm going to skip over that. So yeah, when you when you are going into a clinic, I feel like that is a way to potentially solve the problem, but it's just not being solved right now. It's it's still, these gentlemen are the we have people who own these businesses who are getting annoyed about the the younger generation talking about money, but then they're not looking at, they're not really listening and taking in what is being said, because it's it's a block that we can get our own bias on how we lived our lives. And, and we need to get out of ourselves. I say that, as a practice owner, myself, we have to always work to get out of ourselves all the time, in order to better listen, to be with the changes of the world. And the reason why there are changes, but the reason why things are fluid, and it's always changing with every generation and so on, is because there's always a better way. Right? And we may not answer to it. But But there's always a better way. And and you got to figure out, you know, what's what's going to if you really care so much about keeping them around for a long time. And that's, that's a big deal for you. And absolutely, totally get that it's great to have somebody there for a long time, then what is it that they care about? What is it that they care about? You know, and how do you and then if you want to do something that is not financial? Because your your clinic can only afford so much? What are those intangibles that you can bring to the table? Or even the physical therapist coming into work for them? What are those intangibles, and that's where you can really come to the table for a better exchange with those generational differences. I think, you know, and,   13:36 you know, and one of the things that you kind of touched on is that we have to be, there's always a better way, and we have to be open to that better way. And I think that's where we run into an issue of when a younger generational PT says, well, this doesn't make sense to me, I want this amount of money. That's not us complaining. And I think that can be perceived as, as as, as a complaint, US whining, because we were known as the whiny generation. We you know, we complain a lot and what compared to what we're told is that we complain a lot, we're whining, we're never satisfied. And it's not that we're whining. It's not that we're sad. It's just that we grew up in the information age, we know what the PT next was making. Well, we know what the average PT makes. And so we come to the table and ask for this. It's not as whining and it shouldn't be perceived that way and we shouldn't be promoted as the whining generation is annoying. Having the information available to us and trying to benefit on or not even benefit just just be pay. We're given what we're worth. You know, we're rainbows and clouds profession. I mean, we we are a just a happy, just beautiful people and we just love people love everybody. And we're so happy go lucky and lovey dovey and I love that about us. But one thing that we do tend to forget is that the word can mean that we are healthcare practitioners first, but this is also a business. We have to be sustainable, to be able to provide the jobs for our employees, we have to be fulfilled in our careers to be able to provide the care the level of care that our patients deserve. And some of the ways that we do that is to ensure that our employees are happy. Somebody brought up at the conference, the idea of valuing your employees. And value in itself. I think, for us as this lovey dovey profession means so many different things, but value in itself as a word is a financial word. What is the value of me as a a physical therapist? I know my financial value, if you cannot meet that, as you've already touched on, if you can't meet what I'm asking for what else can you meet me, meet me halfway meet me with increase vacation days, maybe with an increase a formal mentorship program. We're supposed to meet and you're supposed to meet me where I am as an employee. And so I think that's where there's a big barrier as well. And that sometimes we're a little bit too focused on intangible things where a lot of or several of us are looking for tangible benefits in my generation. So I think that's a big riff. And it's a it's got to do with our identity crisis in our profession that I said this at the conference. Nobody loves pts. As much as PTS love BTS. And that's our issue as as a profession that we have to address. And I think that kind of that kind of flows over into this this generational difference. Oh, my God, it does. It does. Absolutely. Absolutely. And so that's, you know, I don't want to get too deep here, but I want I actually   16:55 want to bounce off you because, yes, because they popped in my head earlier. And I was like, I just let the idea, you know, because I just want to listen to you. But yes, it's the Pete, the best thing to T PTS, you know, and there's nothing wrong with us, the more seasoned professional that I mean, yes, ever. When I say this, I know they're seasoned. Like, I know, they're sick, we're not perfect. But the C's, they they live on this rainbows and clouds. I'm just saying, I know, it's a harsh way to say it. I hear I hear what I'm saying. But whatever I'm gonna say it. And then we have where the younger generation, I think it's Gen Z, because Gen X is before. So okay, so we have the Gen Z, and the millennials are newer in the profession. And they're not afraid to point out things that they think are wrong. But I think then with that in mind, I think from higher up there is toxic positivity. And I think that's where that comes in. Where it's pushed upon, you cannot say anything bad. But then we lose this honesty and transparency in what's going on in the communication. And, and God forbid, something bad is said, you know, boy, and guess who's on social media, everyone? So if you're talking about, you know, like, oh, there's younger people are complaining. Facebook is older people, man, Twitter is older people. Like there's some younger on there too. Yeah. But like the hotspots to be at are tick tock and mostly ticked in my opinion. Tick tock. Yes. And then I think I never looked at the data. So yeah, but I think Instagram is secondary, but that also has to do with like, how I like to watch the videos personally, I can I can scroll through the Tick Tock thing and then I can go to Instagram Instagrams a little bit not as smooth I go back to tick tock okay. So um, but but that's you know, that's where it's so far talking about all the younger they all they do is complain that's, that's all ages baby. That's all ages, we all we we all like don't I think it is so healthy, to have a full well rounded conversation that points out the bad and the good and you don't have to finish with a positive statement in a conversation about it's okay to end in a gray area. It's okay to end in a dark area and both see it you know, yeah, that is I don't have a solution. Like that's actually that's not a good thing. It's okay. But we but this toxic positivity puts anybody going through anything on the spot if you're anybody who might be oh gosh, dealing with somebody who is has poor health in your family and you can't talk about it or mention it at all and you're yet to put on this face. I get it. That's you know, I'm putting in air quotes professionalism, but professional professional only means literally other profession. Everything else is defined by you. Or defined by me. So literally, that's all perfect. Like everything else is like up in the air up for grabs. however you interpret it. So the you know, took like, place these these random rules on what professionalism, professionalism is from that point on is is purely subjective. And that's where that toxic positivity comes in. Yeah. And then in then we get these risks these butting heads, because everybody has different core values, which is great. And I think that is a huge generational difference and where we lose and miss out on opportunities to listen and hear more.   20:29 Correct, correct. And that's where the issue becomes. I spoke on generational differences, as in the context of what is leading to burnout in early career professionals are the career pts. And I spoke on generational differences as one of the things that I thought was a key key difference. And one thing to note to note is that this isn't specific to pt. It's not burnout is not specific to PT, these generational differences is not are not just specific to physical therapy. This is a doula globally, this is definitely an issue in our country. There are, you know, I'm gonna make this a political conversation. But you know, there are, you know,   21:16 whatever all's fair game when you're with me,   21:20 you see, there's a group of people that believe that, you know, there's no, this is the greatest country on Earth. And that this is there, they would, they would know, they would not live anywhere else. And to say anything bad about our country is anti American. And then there's another generation that says, this is a good country to live in. This is, hey, I'm happy to live here. But there's a crap ton of issues that we need to address to make this country as great as it could be. And so that is, I say all that to say that there is no, I don't think we solve this issue. I don't know if there is a solid solution to the issue. But as I stated before, I do believe there are pptx, specific generational difference issues that we can address. And we should address. And as long as everybody is willing to hear each other out. Yeah, compromise, which is kind of where my conversation was with with the gentleman at the conference that we spoke about earlier. I had an opinion, but I heard him out. And I still don't agree with him. 100%. But I can identify a little bit more with where he's coming from. And I think that's key, I think it's important to have these conversations get uncomfortable with being, you know, get comfortable with being uncomfortable. And have these uncomfortable conversations to say, yes, these are the issues we have with your generation. These are the issues y'all have with mine. Where is that common ground? You know, is they always is, like you said better than we are? And so So, you know, I don't know, I don't know, I'm not the visionary, I see that you I can't give you the solution. I   23:08 don't know where I know, it's just to have a conversation. So that's all we're just having a conversation about this, which I think is great. You know, to get your minds and everyone's minds to start to think you know, are there you know, generational differences and everything. And be careful as you listen, it can be very hard because we there are a lot of people we're going to people help, we're a service business. And with that we get these people pleasing mindsets, where we can lose ourselves. And I would actually say definitely big time in the younger, newer generation. And in order to please the generation that has been around longer, we don't listen to ourselves and just agree it's okay to disagree. It doesn't mean you have to disagree. But really keep challenging yourself to get more and more in tune with what you believe in. And greater conversations can happen, greater solutions, greater growth and progress between all of us can happen, which is so cool. And it may not happen overnight, where you feel comfortable to talk about it. But keep I definitely agree with what you're saying. It's just if you can just keep even if it's a little bit challenge yourself a little bit more every time to just, you know, get there, you know, not easy, not easy. No. I love it. Any any other generational differences that you think oh, Jenna this or have we reached kind of your like, those are kind of the main ones where we   24:41 Yeah, no, I I do think those are my, you know, very inter intertwine those two that I talked about. I don't think that as as a this is sort of like a final word if you Yes, yes. I do think that specifically to this country, we value overwork For example, I, you know, I think that we value the the clinician or the co worker, not just in PT, but in general, we value the person who does the things that they're not required to do as a part of their job. That's what we use to determine who is who's that shining employee, who's the one that that goes above and beyond. Right. And it shouldn't be that I mean, for example, I remember, at this same job, we hit a low point, we hit a low point, always in January, it's an outpatient clinic, deductibles reset, so we're January, it was a low period, had a lot of openings on my schedule, so that everyone else and I was sitting in and getting caught up on documentation, going over some things with my mentor, learning new skills, in walks the owner, are asked, What are we doing? I tell him, you know, I'm trying to learn some things. And he says, Well, why don't we are marketing? I say, What do you mean? He said, you know, your patients, your schedule is low, why aren't you are out, you know, getting us new clients. And I'm like, that's not my job. Is that is you are the employer, you hired me to see the patients that frequent your establishment. Okay, I'm not the one to go out and beg these physicians to send us, okay, how much begging you do, the deductibles reset, that's going to be a phenomenon that happens every single year. So, but that's what the expectation from some employers have. Yes, I hired you to see patients and turning the documentation on time. But in also, I expect you to do these things, these these things that I didn't tell you about in your interview, but we expect you to do these things is become an expectation in this country, to overwork to do things that are not required to view and that is how we measure our employees and not on the job that they do. If you see all the patients on your schedule, go home on time, get your documentation in on time, and it's all you did for the rest of your life as a PT you'd never be promoted and you know in traditional practices so I say that's that's another generational thing is that I think we older generations value overwork working you all you need to be busy all the time. And we value we being the younger generations, a healthy balance of work and home life. I think that is another riff all of these are intertwined, but I think that's a another riff that's that's that's causing an issue, not just in our not just in our profession, but but across this whole country.   27:42 Now, yeah, definitely. I love it. Thank you so much for coming on to talk about this. If you are listening to this podcast, and you have some other ideas and stuff, feel free to write in the comments, just keep the conversation going. I think it's always good to just talk about it. And then And then if you're somebody who's about to go in for job interviews, write these things down for you to consider what you're going to bring to the table for your negotiations track on both sides, what was discussed in that interview? So it's very clear. If things come up that are that we're not included, it's so you can have a better chance of being on the same page. Yes, you're correct. We didn't bring that up, or you know what we need to make sure we bring that up, because that does come up, the more we can be on top of that transparency in the communication can better help address generational differences right off the bat, do keep in mind seasoned professionals owning your own practice when these students are graduating, they have a very low sense in general sense of self worth. So for the overwhelming majority, they usually jump at a job faster than they should. Because they are so excited. Anyone wants them. And that is a big thing that happens often at clinics. So just be aware of that them saying yes doesn't necessarily mean they were listening to what they wanted in the first place. Because they feel so grateful that they were not rejected, they were accepted. And that takes over everything. It helps it feeds into them eliminating what their core wants are because they struggle with self value. Alright, that's it. Where can people find you on the social or email, whatever you feel comfortable with sharing.   29:40 So I laugh when you say the old people are on Facebook and Twitter because that's really what I use is   29:48 and I'm in that category. So I feel comfortable saying   29:51 I'm not a Snapchatter I do have an Instagram. My Facebook name is just mine. That's what I'm primarily on. That's where I'm most entertaining. Book   30:00 is it clearance a home's nobody's claiming homes, clients homes,   30:05 parents homes as well. I'm the one that's scuba diving in my photo.   30:11 If it changes to hiking, everyone's gonna get confused.   30:14 I know why it's not going to just all my photos are nice. And then my instagram name is CA Homes six ca h o l mes the number six. Oh, I   30:27 love it California. You're not from there. But it's fun to say. Wonderful. Thank you so much for coming on. Everyone. If you're listening, please be nice. Be nice. Yeah, you can communicate but be kind. If there is any possibility that what you wrote might be in a way interpreted in a mean tone. Don't write it. I just don't I don't see. Like, honestly, it's just why and I'm not being toxic positive. I'm just being real. Like it's only going to just why why? Like go speak to your legislative representative about it, you know that you can actually make changes. Alright, that's it. Thank you for coming on.

In this episode, President of IFSPT, Luciana de Michelis Mendonça, talks about her research and the upcoming World Congress of Sports Physical Therapy. Today, Luciana talks about the importance of the WCSPT and the results from her research. Why are organisations like IFSPT important? Hear about why sports PTs are important in injury prevention and reduction programs, pre-season assessments, implementing prevention programs, and get Luciana’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “We should assess our athletes to make the most amazing tailored prevention program.” “Injuries happen, but if you can decrease the time that the athlete is spent outside the game, then that is a win for the team.” “Warm-up sessions with the physical therapist were the methods used to prevent injuries.” “Be lighter, less stress, [put] less pressure on yourself.” “I am where I am because I’m good at what I do.”   More about Luciana de Michelis Mendonça Luciana is a professor in a federal university in Belo Horizonte (Brazil) and develops research in the field of sports physical therapy. She has participated in the last four IOC world conferences on injury and illness in sport with poster and workshop presentations. She was involved in organisation of physical therapy services for the Rio 2016 Olympics and Paralympics Games. She was the first female president of the Brazilian Society of Sports Physical Therapy (SONAFE), in a country with many restrictions to women's participation in sport and politics. Since 2017, she has been an executive director of the World Physiotherapy subgroup International Federation of Sports Physical Therapy (IFSPT) and is now IFSPT's president. She is committed to enhancing the dissemination of sports physiotherapy good practice and knowledge globally and to increase equity in sports physiotherapy.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injury Prevention, Prevention Programs, Exercise,   Recommended Reading How injury registration and preseason assessment are being delivered: An international survey of sports physical therapists How injury prevention programs are being structured and implemented worldwide: An international survey of sports physical therapists Sign up for the Fourth World Congress of Sports Physical Therapy To learn more, follow Luciana at: Website:          https://ifspt.org Twitter:            @luludemichelis Instagram:       @lucianademichelis   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 today I'm very honored and excited to have on the program Dr. Luciana de mckaela Mendoza. She is a professor in a Federal University in Belo Horizonte in Brazil and develops research in the field of sports physical therapy. She has participated in the last four IOC world conferences on injury and illness in sport with poster and workshop presentations. She was involved in organization of physical therapy services for the Rio 2016 Olympics and Paralympic Games. She was the first female president of the Brazilian society of Sports Physical Therapy in a country with many restrictions to women's participation in sports and politics. Since 2017, she has been the executive director of the world physiotherapy subgroup, International Federation of sports, physical therapy or ifs PT, and is now IFSP T's president. She is committed to enhancing the dissemination of sports physiotherapy, good practice and knowledge globally, and to increase equity in sports physiotherapy. And in today's podcast, we will talk about some of her research into injury prevention and the role of sports physiotherapist in those programs. And of course, we will also talk a lot more about the fourth World Congress is Sports Physical Therapy, which is happening in Denmark this August 26, and 27th. That's 2022. So if you want to find more information about that, you can click on the link at podcast at healthy, wealthy smart.com. To find out more about the fourth World Congress is sports physiotherapy, again, taking place in Denmark. So we will talk a lot about that. And we will also get a sneak peek of some of Luciana has talks there. She's speaking and she is moderating. So she's got her hands full for sure. So I want to thank her for coming on the podcast and everyone enjoyed today's episode. Hi, Luciana. Welcome to the podcast. I'm excited to have a conversation with you today. Hi, Carrie. Thank you very much for having me. Yeah, it is my pleasure. And now before we get into the meat of our interview, can you tell the listeners a little bit more about you about your history in sports, physical therapy. And as I mentioned, you are the current president of ifs pts. You can talk a little bit about that as well. So I will hand the mic over to you.   03:06 Okay, Karen, so I'm from Brazil. I'm a sports physiotherapist and I graduated in 2003. So I'm 20 years as a physiotherapist. And I'm also a professor in diversity here in Brazil. I'm based in Belo Horizonte. And   03:28 I started to work. Since the as a students and sports team, I wanted to do physical therapy because of sports. I am passionate about it. And I, I started in this political scenario in the Brazilian society of sports, physical therapy. And I started it was in 2016, it was the year of real to tastic significant part Paralympic Games. So it was a really big challenge. I also work in the physical therapy services during the Olympics and Paralympic game here. And I started being part of the Executive Board of the IFSP CI in 2017. So I learned a lot during the presidency of Anthony Schneider's in Christian torborg. And now I have this big challenge to be IFSEC. President so I'm balancing this actions related to if activity and also with teaching and also research about sports, physical therapy. And my research is mainly directed to injury prevention, and also injury risk profile. So I think that's perfect. And can you talk a little bit more about IFSP T and kind of the importance of having these organizations and what they what they do, what are they there for   05:00 Yes, so the International Federation of Sports Physical Therapy is a subgroup of the word physiotherapy. That's our main our mother organization. So as a subgroup, we have to engage countries all around the world that have specific group related to sports, physical therapy to join the IFSP team. So nowadays, we have 34 member organizations in the SSP T. And our main mission is related to disseminate good practices, support research on sports, physical therapy, of course, and also promote actions to support our members, the whole community. So improve the practices around the world. And also it's a good it's an important way to connect with people. So I think the most amazing gifts that I had, being in IFSP T board is to network with people around the world. So it's a really   06:18 important way to have our professional, our profession, organize it. And so I probably will be in the presidency for the next four years. That's the plan. Yeah, that's, that's amazing. And one of the things that, like you said, as part of the organization is networking, and we'll say this will probably repeat this a couple of times, but the Fourth World Congress is sports, physical therapy is coming up August 26 27th, of 2022 in Denmark, and obviously, you will be there and you are a part of several presentations.   06:57 But like you said, your research is around injury prevention and assessment in sports, in sports. So can you talk about why the sports physical therapist is an important component of these injury prevention programs or injury reduction programs?   07:19 Yes, I just want to stress that, yes, the Congress of sports, physical therapy, it's important action that IFSP t also have, we are one of the main organizations, the main sub groups of world physiotherapy that deliver International Congress. So we have the first one in Bern, the second one Belfast, the third in Vancouver, and now illegal in Denmark. So I, I went to Belfast to Vancouver, and now I will be enabled for sure. So   07:55 I'm sorry, Carrie, I forgot your question. Oh, yeah. No, so my, my question, like I said, you're doing you're doing a ton. You'll be doing a ton in Nyberg. But one of the things that I know you are talking about is about your research that centers around injury prevention, and something that you're passionate about as if the sports physical therapist should really be involved. So why is that?   08:19 Yes. So I always thought that the main action as a sports physical therapy in a sports team, of course, I should be aware that, for me, I need support all athletes available to the coach to the head coach to train. So for me, it's, it was always a good time to have like the physical therapy department, empty without athletes there, because all athletes should be on the fields playing and training.   08:56 So for me, prevention was always important action that we as therapists should be aware of. So I, when I finished my PhD and start to be a teacher in university in Brazil, I started to wander, especially after I started to work in the IFSP. Board, I started to wonder if the prevention, the role that the Sports Physical Therapy had in prevention, and I know that how this works in Brazil because I was sports physical therapist and the volleyball team and soccer team. I was wondering if it was like the same, or I was wondering if it should be the same. Or if we are here in Brazil, we're doing like similar things that other professionals data around the world. So I have a sabbatical year in 2020 and I went to Belgium to work with Eric FitPro.   10:00 I was there in Uganda, the University of Ghana, as a visiting professor. And we started to develop a surveying to understand what role the sports physical therapists had in injury prevention. So I will talk about some of our results, we have two papers about this survey that were that are published in physical therapy in sports. And this helped me to have   10:33 sort of idea about the role. And we have really interesting information about this, that, of course, I will share here in this podcast, and also in the World Congress of sports, physical therapy. And also we develop a Delphi design to establish a consensus on sports injury prevention programs. So this is also an interesting   11:01 study that we could deliver an IFSP participated to, with this Delphi study linking   11:09 people from different countries. So I'm really excited to talk to you about this caring and say something that should make people a little bit curious and participate in the Congress. In Denmark. Yes. So when can can you give us a little bit of info, you don't have to give it all away? Of course, people can go and read the the   11:36 published papers, but in this   11:40 in this study, you had, how many people? What did you find? How did you do it?   11:50 So yes, for sure, I can share some of the data that we had the papers are published. And also you can indicate for your audience, I can send you the links. It's important, I totally understand caring that sports injury prevention area, we need to move forward related to research, we need to understand a lot of things. But I think it's interesting to understand what the professionals what the sports physical therapists are doing, because this can bring up some questions for future research. So   12:29 on the survey, we   12:32 we had 414, sports, physical therapists participating around the world. So I think we had like, people from 32 countries. So I know that the amount is not so high, we could have more people participating, but it was delivered in 2020, during the pandemic. So this is one thing that I should stress because, yes, we had 32 countries participating, but I, for sure, I expected to have more people there. But we had questions in this online survey that was related, link it to the synchronous sequence of prevention that were Matalan delivered, and maybe it's the the most use it, model or to make decisions about prevention. So we ask it if this sports physical therapists participated on injury prevention, sorry, injury registration. It's common here, Brazil, but I didn't know if my colleagues in other countries participating in the injury registration. We also asked if they assess it, the athletes to build the prevention program. So if they did, for example, preseason assessment, that's the more common way at least in Brazil. So I was curious about that. And also, I we asked about their prevention program. So if the pieces participated in this action or not. So about equal registration, the first thing this I think this is an amazing result, because we had more than then 80% of the sports physical therapists that participate in this study, were responsible for me to reverse the situation. So we can now say that maybe the sports physio are the are the person like more important more responsible to properly register injury in their sports team? So this brings brings up a lot of other questions. So for example, maybe we should IFSP T should deliver some actions to maybe   15:00 increase the knowledge and maybe the competence on this matter on our community. Because of course, if we are responsible for this, we want to do an amazing job. So it's, it's interesting. And it's good also to exchange some experience and learn from good examples. So this is really good. And we also ask about the main barriers.   15:29 So for sure now register the injuries. So more than a half of this physios said that lack of time in their routine was the main factor to not properly register injuries. So maybe we need to discuss also about the sports physio routine, inside the sports team. I think we talk we should talk more about this, especially in conferences that we can get together a lot of professionals from different countries, and we can learn from their experience.   16:08 So can I move forward? You have a comment about registration? Nope, I think I think that's good. And I do like that. You said, Hey, maybe this is a chance for us to get together learn from each other. Because perhaps there are ways to streamline this that people just haven't thought of that other people are doing. So you're right. It's a great opportunity for sports organizations, like if SPT to bring sports physical therapist together and say, Well, wait a second, some of you are doing this with some of you aren't. And if it's a lack of time, what can we do to give you a structure that can streamline your process? Yes, exactly. And it's one thing that here needs to be done. We just We can't like, Okay, I'm not going to register injuries, because how can I be sure if I'm going to prevent the injuries if I'm not registering? So if you're not registering, is it like they didn't happen?   17:09 Yes. And another another thing that is really interesting, what is the injury definition? That is sports, physical therapists are using my understanding, we can select different definitions, because this maybe rely on the sports modality.   17:32 But we need to talk more about this, I think we should   17:37 exchange and learned and maybe from this, maybe if aspartate can deliver some guidelines, I don't know, because it's one of our missions. Also to make the FSB T is the main resource for the Sports Physical Therapy community. So I think we will maybe in the future, we are going to have more actions based on the findings of so I'm really excited about this. Okay, so let's move on to preseason assessment. So how many are performing? And what are the barriers? I know that this is this, topics of little bit controversial, I know that we have a group that thinks that we should assess, and another group of sports physio, or research thinks that we, we don't need to. But our survey shows that 77% of the participants perform preseason assessments in their athletes.   18:45 So 222 sports fields, said that they do. This is amazing information. And I didn't expect for this high percentage.   18:59 And I was happy because I believe that we should assess our athletes to make the most tailored, most amazing tailored prevention program for our athletes. I know that this is a challenge. I totally understand this. But if I think about myself as a sports, physical therapy, if I'm working in a sports team, I will like I will do my best to assess the athletes and try to deliver   19:30 into an individualized prevention programs. So but we have like, opposite side here because only 30% of these sports physical therapists that do preseason assessment, customize the provincial program bases in the results of the assessment.   19:54 So this is a point that we need to understand better. We need to understand what is happening. Why   20:00 They sports fees you give energy to assess the athletes, but they don't apply the results to build the prevention program.   20:11 So we didn't   20:14 ask it like specific questions about this. To understand this, we only asked about the barrier. So the main barrier   20:23 that was indicated to not before assessment, it was lack of structure and organization of the sports team.   20:33 So about half of the participants indicated this barrier.   20:38 I understand makes sense, but I'm not sure if this barrier explain 100% of the reasons to not perform the precision assessment. And I think maybe this is also relied on the evidence that we have related to these. We have big discussions about injury prediction probability. So maybe we need to make some advance in research about this topic. And maybe we need to talk more about this to make more like have this issue more clear to everyone, specially the clinician.   21:22 Because I think so now, it's my opinion. Okay. I think we need to assess our athletes, and maybe maybe even the process of assessment should be discussed. Because if we, if we are here in a roundtable with sports, physical therapists, and we ask how you assess your athletes, which tests do you select, probably carrying, we are going to have different answers. So I don't I'm not sure what this means. It means that we don't have standards. We don't have like a protocol. Should we have a protocol? I don't know. But what I know is that we need to talk more about this. Yeah, I mean, oh, go ahead. Sorry. No, no, I just like, I just want to say that I was really happy with the the results that sports fields with a majority is performing a preseason assessment. But on contrary, I was I get a little sad to see that not like 1/3 of them are really applying the Results to Build provincial programs. And yeah, and so I brings up a couple of questions for me, and that is, have you seen preseason assessments? Decrease injury, are they and again, this goes on? I think what you just said that sort of prediction and probability. So if you do a preseason assessment, does that predict less injuries? I don't know. Have you seen? What are your thoughts on that?   23:06 Thank you for asking this caring, I think   23:10 preseason assessment. The main propose is not to predict injury, they may propose is to identify those athletes with more susceptibility or probability to get the injury and then we can act before this happened. I'm not saying that if we perform a preseason assessment and beta prevention program on the results, our athletes not going to get into I'm not saying that injury, always going to happen sports, but we can, for example, decrease the severity.   23:52 So if I have one athlete that I can, for example, I apply the stars question balance test, and I see that this athlete have a really low stability, functional stability in the lower league. So I can include in their provincial program, exercise to improve the stability, and maybe he will, he will, like have the ankle sprain, but I can decrease the severity.   24:26 So I will decrease the time loss. I will make this athlete more available to the head coach at the end. That's my reasoning on preseason assessment. And I think there is a misconception about this issue also. Right? Because I think, you know, if we're playing devil's advocate, some people may say, well, the preseason assessment isn't going to eliminate injuries. Why am I why am I doing it? Right? But like you said, injuries happen. But if you can decrease the severity if you can decrease the time that the athlete is spent out of the game   25:00 Yeah, then that's a win for the team. And it's a win for the coach in the organization. But if only 30% If if you have all of these sport physiotherapist doing a preseason assessment, then only 30% customize the program. Now we have to come up with some incentives for that physiotherapist to customize   25:19 the program for the athlete. And again, that may be like you said resources available to them, if it's one person and 50 players,   25:30 that it's difficult, you know that that's that that's quite difficult. But   25:37 I can understand how this can be a very frustrating part of research, because there's a lot of moving parts. And it's not just the sport physiotherapist, who has all best intentions and at at the heart of, of of their work. But there's a lot of external factors that need to come into play. But   26:03 I do I also like your that idea of being on a round table with sport physiotherapist and saying, Well, what do you do? What do you do? And maybe like you said, I don't know if a protocol is right, but maybe some sort of a roadmap where you have some basic assessments, and then you have the freedom and the ability to get creative, but to have certain certain things in there that makes sense for that sport?   26:31 Yes, I totally agree with you. Here in Brazil, I have a lot of colleagues and friends that came from the Brazilian society of sports, physical therapy. So we talked a lot in exchange a lot. So I, I myself, I have my challenges related to really delivering the prevention program that I i understand that would be like the best thing to do. But of course, this also relies on the relationship with the head coach, district parenting coach. So it's a lot of factors variables that we need to understand. And that's, that's really individual. It depends on the context of each sports team. So that's what I when I say that maybe we don't, we will not have like a protocol, because it depends on the sports team reality. But I agree with you that we can give maybe some roadmap to help everyone to organize better, considering the context, right? Yeah, exactly. Exactly. Oh, that's yeah, that's that really opens up a can of worms for people. That being said, let's move on to prevention programs. So what did you find with that?   27:53 Yes, so about the prevention program, we see that warm up.   27:59 sessions with the physical therapists were the methods more use it to prevent injury. And I think about warm up this was already expected because it was one roadmap that FIFA 11 Plus gave to everyone, not only for soccer, we have evidence on basketball, handball players. So FIFA 11 Plus really helped in this maybe this   28:31 basic organization, and how to deliver some preventive action in a more easy and accessible way. So I think it's really interesting that this survey, like confirm that one map, it's a really good strategy to include the provincial probe on athletes routine, because the athlete will need to warm up. So we have this moment, and why not. So instead of make the athlete do like,   29:06 whatever exercise or just running on the field, why not to be more specific and includes exercise that the athletes really need to do based on the sport modality.   29:20 Epidemiology. So for example, we know that in soccer, we have a lot of famous hamstring strain, we have a lot of ankle sprain, knee sprain. So why not to include some melodic at the size it some balance exercise? I think this is a really   29:38 important action that every old sports physical therapist needs, so be engaged and participate and about the individual sessions with the sports physical therapists. It's important to us and then I really expected some information around this   30:00 because we know that we have some time zone athletes that need a specific exercise that needs to be delivered by the physical therapist. So I was happy to say this because this was the methods more use it more indicated by our participants. And above the barrier, we saw that lack of time in athletes routine was the main barrier to perform the provision. This was indicated by 66% of the participants.   30:34 Of course, I expected results. And that's why warm up, it's important action because this is already in adults routine, we don't need to change the routine to include one more time and period to do   30:51 the exercise related related to prevention. So again, carry I don't know if this only this area only about athletes routine, we can understand why we can't perform major prevention. And as I said, Before, I understand the challenges. I think it's not easy. But I think it's a wonderful, it's a wonderful action that sports physical therapists participate. And it's really, of course, important for our athletes health, not only performance, because we have evidence that provincial programs also increased performance. But also I'm concerned about athlete's health, we need to, of course, help the athlete because no one wants to get into it. So this is really, it was really important.   31:49 For information that is the also indicated and these information helped us. So sort of build the questions related to the consensus, that was our second step during my experience in Ghent University with Eric.   32:11 Right. And so at W CSPG. You're going to show some data about the Delphi consensus, so you don't have to give all that away, people can go to the conference to hear more about that. But if you want to give a little preview, now's your time. So you what are the main topics investigated?   32:31 So about our Delphi, we organized the consensus in three parts. So the first part was related to how the thesis should plan the provincial programs. So this planning was about the information or the reasoning to develop the injury prevention program. So this is interesting, because we have information that, for example, sports, physio, use the reasoning related to biomechanics, or the base decision only on evidence and injury, Epidemiology, or athletes, injury history. So we have this kind of information and result and this is really brings up some discussions. So I hope that on the conference, I can, we can have this moment to discuss about our information, our data. The second part was about the organization. So how work environments before the implementation, how this affects the delivering the injury prevention programs. And the third one is about the implementation phase that I know that there is a lot of discussion and research, we have a specific we have specific groups of research that really go deep in this matter of implementation. So in this third phase, we identify barriers and facilitators to implement the injury prevention programs, and also related to compliance, if visibility. So this is how we organize the Delphi. It was a huge amount of work from all the core authors that participated in this study, and really happy that we can now say that this is accepted in physical therapy in sports generally, we can now really disseminate   34:39 this information, and I'm really happy to be part of this. Yeah, well, congratulations because that is a ton of work. And again, if people want to learn more about this, then you can come to Nyberg August 26 27th The Fourth World Congress is Sports Physical Therapy in Denmark.   35:00 And I mean, who doesn't want to be in Denmark in the summer? Right? I mean, amazing. Yeah, this will be my first time in Denmark. So my I am excited. So of course, no Denmark, but also to meet my friends from Sports Physical Therapy community, specifically before this, sorry, after this pandemic. Yeah. So I really miss my friends. And I really excited to talk more about injury prevention. And so our consensus results, and exchange and networking with everyone there. Yeah. And where can people find you? If they have questions? If they you know, we'll have the links to the studies that you mentioned in the show notes. So if people read that, and they have questions, where can they find you?   35:53 Yes, Carrie, so I am on social media. So I have my Facebook profile, Instagram, it's with my name, no change at all. And also in Twitter, is Lulu the chalice so you can find me there. And we can keep talking about information. IFSEC. I invite everyone for be like in the World Congress of sports, physical therapy, it's in August. So I'm really excited to be there. And I hope to see you there all for caring. Yeah, I will be there. I'm looking forward to it. And now final question that I asked everyone knowing where you are now in your life and in your career, what advice would you give to your younger self? Good question. Okay. So maybe, first, I would say to my own self, congratulations, you are an amazing woman in you accomplished a lot.   36:52 For sure, I never thought that I would be where I am now. As IFSP President working in federal, probably the most important federal university here in Brazil. So I'm really happy. If I could give her some advice should be be more lighter, less stress, less pressure on yourself, Luciana.   37:23 But at the end, we don't don't care if this increased pressure or stress, help in a way.   37:31 me to be here where I am. Or if I could go through this path. Be more.   37:41 I don't know light. I think the word is like, Yeah, I think so. And, and I love the fact that you said you know, you would congratulate yourself. And I think celebrating wins and celebrating what we do are things that women don't often do. Right? We're always sort of congratulating others and putting others up, but we never sort of congratulate ourselves and celebrate our wins. And, and I think if I were to go back and tell my younger self, something that would be it, like stop making yourself smaller so that other people can be bigger. It's a constant exercise. I didn't accomplished my winnings, my victories so often, but now I can see clearly that I am where I am, because I'm good in what I do. So perfect. What a way to end the podcast. I think that's great. So again, people can see you live in Nyberg, August 26 and 27th. At the fourth world, Congress is sports, physical therapy, you again will have the link on the conference and how to sign up. And we certainly encourage everyone to do that. Like you said, What a great way to meet up with colleagues to get some really great information and be in a beautiful place while you do it. Yeah, exactly. And on August 25, five, we are going to have a network session delivered by FFTT. So we are going to have also this moment to get together and exchange. Perfect. Is there anything else? You know, you're the president? So is there anything else that we missed? Talking about the conference that you want to let people know is is also happening? We are going to have an interesting conference because it's going to be I think the first World Congress of sports, physical therapy that we're going to have specific moments to do sports in the program. So we are going to have this more serious moments to talk more about our practices and research but also light moments to practice sports and be more friendly there. Yeah, so basically bring your workout clothes is what you're saying. Yeah,   40:00 Oh, yeah, that's exactly perfect. Perfect. And I don't think I mentioned that when I spoke to Katie so I'll be mentioning that moving forward that bring your sneakers bring your workout clothes, that traditional   40:13 well here in the US for whatever reason, people like always wear suits to these things.   40:20 So don't don't worry about the suits, but definitely bring your workout gear. Yes. Perfect. Perfect. Well, Luciana, thank you so much for taking the time out today and coming on to the podcast to talk about all the great stuff you're doing. Thank you so much. My pleasure, Kara. Thank you so much, and everyone thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.   40:43 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, Nigerian Sports Physiotherapy Association Founding Member, Ummukulthoum Bakare, talks about her important research and advocacy of sports physiotherapy. Today, Ummukulthoum talks about her research on women’s football, the issue of compliance and adherence, and the next steps in her research. What are the challenges for women football players, and how are they mitigated? Hear about her experience advocating for sports physiotherapy, her presentation on The Unbreakable Young World Athlete, and get her advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Passion will drive you.” “The increase in projections of the numbers of registered football players has skyrocketed by the participation of women in football.” “Coaches need to understand that they can be empowered to take charge.” “You don’t have to think of injury prevention as this thing that is separate. It needs to be integrated.” “Nothing is impossible. If you can dream it, you can do it.” “The sky isn’t the limit anymore.”   More about Ummukulthoum Bakare Ummukulthoum Bakare is a Doctorate Candidate in Sports Physical Therapy at the University of Witwatersrand in South Africa. Her research is focused on women’s football and injury prevention. She is a founding member of the Nigerian Sports Physiotherapy Association and is active in disseminating the FIFA11+ injury prevention programme in her native country and across Africa. Her passion has centred around the sports of football, basketball, and para-athletes and injury prevention. She received her Bachelor of Physical Therapy and her Master of Physical Therapy from the College of Medicine, University of Ibadan, Nigeria. Ummukulthoum has worked as a physical therapist since 2001 and has won several awards for her service locally, regionally, and internationally. She is a member of the Medical and Scientific Commission of the Nigeria Olympic Committee and an Associate Editor for the British Journal of Sports Medicine.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injury Prevention, Women’s Football, Empowerment, Advocacy,   Third World Congress of Sports Physical Therapy   To learn more, follow Ummukulthoum at: Website:          https://www.facebook.com/nspa.org.ng/ Twitter:            @koolboulevard Instagram:       @koolboulevard   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 everyone, welcome back to the podcast. I am your host Karen Litzy. And in today's episode, I'm really honored to welcome UMO cooltone Bukhari she has a doctorate candidate in Sports Physical Therapy at the University of Witwatersrand in African South Africa. Her research is focused on women's football and injury prevention. She is a founding member of the Nigerian sports physiotherapy Association, and is active in disseminating the FIFA 11 Plus injury prevention program in her native country and across Africa. Her passion has centered around the sports of football, basketball and para athletes and injury prevention. She received her Bachelor of physical therapy and her Master of physical therapy from the College of Medicine University of Ibadan in Nigeria UMO kooltherm has worked as a physical therapist since 2001, and has won several awards for her service locally, regionally and internationally. She is a member of the medical and scientific commission of the Nigeria Olympic Committee, and an associate editor for the British Journal of Sports Medicine. So in this episode, we give you all a sneak peek of what she is going to be speaking on as one of the guest speakers at the fourth World Congress of Sports Physical Therapy, which is taking place August 26, to the 22nd 2022 and Nyborg Denmark. If you want more information on the WC SPT conference, head over to podcast at healthy wealthy smart.com. Click on the link in the show notes under this episode. If you can, I highly suggest signing up and joining us in August in Denmark. So Lumo coutume is just one of many speakers that we're going to be highlighting over the next couple of months. We have a great conversation today about the unbreakable Young World athlete which she will be speaking about Nyberg. So everyone enjoyed today's episode and be on the lookout for more speakers coming up in the next couple of months. Hey, Katie, welcome to the podcast. I'm really happy to have you on.   02:43 It's lovely to be here, Karen. Thanks for having me. Yes. And like I said in the intro, gosh, you are a real rock star in the physiotherapy world. So you are a founding member of the Nigerian sports physiotherapy Association. You are a member of the medical and scientific commission of the Nigerian Olympic Committee and an assistant editor for the British Journal of Sports Medicine. And so that leads me to my first question is How important do you feel these associations are for the profession?   03:20 Thank you, Karen. It's is really very important, especially from my side of the   03:27 of the continent where we have very limited resources. And it's always a good opportunity to connect with other colleagues from around the world. When we first started the the Nigerian sports physiotherapy Association, were just a handful of people who, you know, came together to say, look, if we did start an association like this, it would help us be able to connect with other colleagues and associated other associations from around the world. And then we connected with IFSP T, which also given us a lot of opportunity to connect with the rest of the sports PT world globally. And that has kind of enriched us over the years. And I'm happy to say that Nigeria was also the first African country to be affiliated with IFSP T. And we still have a great relationship till today. And I'm also actually, I think, the first African and the IFSP T board. The executive board. I was elected in 2019 in the last Congress in Canada, for the Nigeria Olympic Committee. That took a lot of work because it's actually by appointment. And over time, it had only just been physicians. There hasn't been any room for physios to get on board, but I think for somehow I just kept well with the National Society. I'd be the Nigel site of physiotherapy, I just kept pushing to get on visit   05:00 ability for physios get us to get, I mean, get the Olympic Committee to also organize specialized training for physios and all of that, and I was doing all this work, making sure that where they were conferences happening, I wanted them to, you know, support people to attend and all that, and a former vice president of the Olympic Committee, and as I look, I think you'll bring your loved one on board. And I'd like to nominate you to be on the on the medical commission. And I was like, Okay. And   05:34 when I got in, I was the only female and I was the only physio. But I am glad that we time a lot of things have changed. Because one of the key things I'm passionate about is to give room to allow upcoming and early career sports medicine stakeholders, be it physio psychologists, you know, doctors, physicians, but give room for the younger ones to be supported and, you know, have access to all the IOC courses and things like that. So I it's been, it's not been an easy journey, but I think you can change a lot more from the inside than the outside. And that's, that's why I took on the assignment. And so far, so good. It's, it's worked out. Yeah, it's slow. But it has worked out a bit. Yeah, amazing. And I was going to my next question was going to be what, what has it been like for you to kind of be the first to have a seat at the table? Right, the first woman which I'm not surprised, and the first physio to kind of have that seat at the table, what has that been like for you? And what lessons have you learned?   06:43 Um, to be honest, it was not a really easy thing to do, especially when you are in the middle of about, you know, 12 other people who, and you probably also are the youngest. Let me add that, even though I don't consider myself young, per se, but in that tool,   07:06 I was the youngest. So but I think luckily, I What sort of helped me was that I spoke with the chairman. And I told him Look, this is   07:18 this is the ideas that I have. And I feel like I know there's a lot of work that needs to go on behind the scenes, I'm happy to do all the heavy lifting, or writing and all that, but we need to push for more things to achieve our mandate. And he was very happy with that. And later, a lot of a lot of the other board members just felt like Okay, it looks like we have somebody who's willing to do all this heavy lifting with you know, writing proposals and stuff. And we just kind of make things work. And somehow they just realized that I wasn't really doing it for any self. For myself, as it were, I was trying to get us to have a better a wider ecosystem for sports medicine resource, be it physios, doctors, you know psychologists, pharmacists, nutritionists and stuff like that. And so far, so good. We've we have quite a sizable number of young, early career people coming on board, a lot more people are not interested in sports, physio and all that. And which is because before now, nobody really wanted to do sports physio, they felt like,   08:26 you know, you're, you're never going to be rich. Like you're always just   08:31 the government is always owing you money. And so why are you a physio per se but then I tell them that look, passion will drive you it is just a calling and you really need to understand that.   08:44 What can in any another prefer in any other specialty or physio? It's quite rewarding as a sports physio as well, if you if you're driven by the right   08:55 circumstances. So yeah, it's not going to be easy, because half the time you'll find yourself like a fish out of water, especially being a female   09:05 where you're working multisport settings and you have to work with male team and all of that you have to hold your own. But it's it is rewarding. And yeah, so yeah. And it sounds to me like some of my students. Yeah, some big lessons. There are one, being willing to put in the work and to opening the door so you can help bring other people in. It's not opening the door for yourself and closing it on everyone behind you. No, no, because there definitely has to be a transitional plan. What is the sustainability of whatever you're doing? Because at the end of the day, your time is going to come and go. So who are the people that you're empowered to continue that journey, the vision and to be able to achieve   09:51 you know, the end goal of making sure that there is that continuity, and that you have, you know, so they pay forward and they can   10:00 didn't pay forward until, you know, for as long as as needed. And we would have a big pool of sports physios because I can tell you that Nigeria is over 200 million people, and maybe about 10 million active Lee involved in sports at a competitive level. And we still don't have enough physios to cater for that number.   10:27 So there's still a lot of work to be done. I can't do it alone. It's a collective team effort. Yeah, I mean, you have to increase the capacity. Exactly. Right. So that that all of these 10 million people, which is a huge number of people cannot be seen by estimating. It could be more, right. Definitely. Yeah. So obviously, you don't have the capacity for all of that. So if you can open that door and bring in a lot of like enthusiastic, like you said, physios, physicians, psychologists, nutritionists to help you continue to build up the capacity of a sports medicine program across the country, you'll be able to reach more people. Exactly. And that's what it's all about. And now, let's talk about your research. So you've got this passion of building up the capacity for sports medicine in Nigeria, let's talk about your research, which I know you're also passionate about. So I'll hand it over to you.   11:31 Okay, so I'm currently working in women's football. I mean, it is what it is because women really don't get much attention for anything, even in football, and for research specifically, as well. But as we all know that the   11:49 increase in projections of the numbers of registered football players has skyrocketed by the participation of women in football. And we know that for women's for women, we are more or less we have certain   12:08 certain factors, that puts us at higher risk of injuries. We know football has burden of you know, contact injuries and all that but can reduce the injury rates of non contact injuries. Now, because women I hire, that when population were what areas due to biomechanical factors, biological factors as a result of hormones and stuff, biological become biomechanical because of, you know, pelvic hip ratio, you know, being at higher risk of ACLs. So you want to be able to minimize that risk. And how to do that is to actively engage in injury prevention. So trying to bridge the gaps, especially in a low resource setting where we don't really have much human resources, infrastructure and all of that, and people still want to play football. So my research is trying to bridge the gap with the population of women playing football, and the use of an evidence based, comprehensive warmup program, which is the FIFA 11. Plus, it is a basic injury prevention program, but it works. But it's not going to work if people don't know about it and compliant with using it. So it's trying to find out what are the challenges in the setting? And how can we mitigate these challenges to be able to improve compliance and adherence, and be able to achieve injury prevention goals, because even on a global scale, compliance, and adherence is a big issue with anything. So, um, since we also know that we have to always tailor things to the broader ecological context, or whatever we're doing. It's not one size fits all, because you have to figure out what are the things that can work in this setting? How can we adapt that can we adjust certain things and whose responsibility is going to take the leadership of the injury prevention philosophy, how this behavioral change is gonna affecting? So this is this is a research that I was working on, or I'm concluding at the moment. And I'm really excited because now I think FIFA also is doing trying to do a lot of stuff for women's football. So hopefully, that can help. You know, in the next five years, we'll see women's football going to a different level than we are right now. Yeah. And you know, as you're talking about that and talking about the resources or lack thereof, it really makes me think I'm in New York City. I'm in the United States where we have an abundance of resources, and people still don't comply with injury prevention programs, right. And so I can't imagine being in   15:00 In a part of the world where you don't have the the manpower, the end all of the things that we have here, yeah, yeah, in order to make these programs stick.   15:13 Exactly. So this is one of the things that I found out is, along the course of my research, is that coaches need to understand that they can be empowered to take charge, rather than coach to see me as a medical person, like trying to take over their job, I'm not trying to take over your job, I'm only trying to help the team so that he can have more players available for selection and team can do better because at the end of the day, it's inversely proportional, the less injuries in the team, the more the team, you know, can can can progress and be successful. So at the end of the day, I think the messaging also matters, the messaging about, Okay, Coach, if you do this, you're going to have more players available for selection. And when you do have more players available for selection, then your team has a better potential to fight for the title to get to win a trophy. And when that happens, you get a bonus or something in your pocket. And it all everybody sort of it's a win win situation when your players do or injury free. They have longer carrier carrier longevity and so many other things. So the reason begins to change, you know, begins to change and at the end of the day. And then another thing I say to them that look, you don't have to think of injury prevention as this thing that is separate. It needs to be integrated. And there is no flexibility to adapt   16:45 and just integrate, it will still work. The most important thing is that you are committing at least twice a week for these exercises to be done. And you will see the difference that it brings to your team. Yeah, it's all about incentives. Right? How can you how can you meet the people where they're at with the incentives they need? And like you said, it's all about the messaging? Yes. Okay, wait, mindset changes, right. And that kind of takes us into I think what you're going to be speaking about at the fourth World Congress is sports physiotherapy, which takes place August 26 and 27th of this year in Nyborg, Denmark, and that is the unbreakable Young World athlete. So talk to us a little bit about that, and a little bit about your presentation. We don't give it all away, of course, you know, we want people to come and see you live, so we're not giving it all away.   17:46 We can dangle some highlights out there.   17:50 Okay, so the first thing is, I think that right now, everybody knows the potential of sports. So   17:58 everybody wants to start young. Now the pressure there on the young athlete is to begin to perform at a professional level at a young age. And that impacts a lot of things in terms of because you know, the type of dedication that you need to, to perfect, whatever sport that you're doing. And, you know, many parents and guidance, everybody wants, oh, I want my child to be Cristiano Ronaldo, I want my child to be messy. Now the pressure is much on these kids. And one of the biggest challenges that then these the burden of having to deal with that kind of pressure, whether physically, psychologically, and every other thing that makes up these young athletes would really be a huge load for young athletes out there. How can we balance that? Now, I will be talking from the perspective of law resource where I'm coming from a lot of many people.   18:57 In the developed countries, they have a lot of support for young athletes. And be it nutrition wise psychology, and so many other things that you we don't have the luxury of that. And many times, the kids who just want to play like they don't want to do anything serious or anything like that. But there's still the pressure and demand on them to excel. Because people see that if you if you're a good sports person, or you're able to make a break in either football or basketball, which is one of the top spots in Nigeria, then we can change our economic situation. And that helps us out of poverty, and all this kind of and all this type of thing. So I'm just going to be talking from that perspective of low resource and how the young athletes   19:50 as much as you want to encourage sports participation, but there has to be that striking balance to enable them to succeed   20:00 That's a lot of pressure on a young kid.   20:03 Yes, yeah. Yeah. Well, I mean, I know I'm definitely looking forward to that talk in Nyborg. Is there anything else that you're working on projects moving forward? Anything you're looking forward to in the future, whether it's future research, speaking gigs, getting more involved in in the profession as a whole? What do you have coming up?   20:30 Okay, so I'm trying, I'm rounding up my doctorate right now. So hopefully, I can get a postdoc position as well to continue to work in women's football.   20:44 That is what I'm hoping for the next maybe six months there about, but other projects that I'm passionate about involves power athletes, I'm very, very passionate about walking with our athletes, because also they too, were like a minority   21:01 group. But I see that they are really the super humans, you know, with everything. And with the limited resources and everything you can think of the still strive very hard I want to get on on the world stage. They are the ones who put Nigeria on the on the on the map for medals, because I was with the team in 2016, in Rio, and   21:27 we won eight gold medals, set new eight world records.   21:33 So I feel like yeah, there's a lot more that I want to learn. And   21:39 I'm also trying to do some technical courses. And   21:44 there's something called classification for power athletes, where it's like, you're trying to make sure that all the athletes are classed,   21:53 in in the desired classes that they can compete on a level playing ground. So apart from the technical officials, they also need the medical people to come and do all the assessments of you know, movement, muscle power, and all these things, just to be sure that, okay, we have classes athletes properly, and they can compete without having undue advantage over the other colleagues in a similar category. So yeah, so I think that's really the next thing that I want to do. It sounds amazing.   22:27 Some of my students trying to move on to postgrads. I've just provide them some of my own shares, some run experience, support them along the way as well. And so that's, that's what I think I'll do. Amazing. Well, it sounds like you have a busy time coming up and doing really, really great work. So congratulations on all of that. And now where can people find you? If they want to reach out to you? They have questions. They have thoughts, where can they find you?   22:56 Okay, so you couldn't find me on social media? You'll see on Twitter, it's at cool Boulevard.   23:04 And it's also the same handle on Instagram at cool Boulevard. So and that's cool with a K, correct? Yes. K with the K Yeah, yeah. And we'll have all of that information and links directly to all of your social media in the show notes for this podcast, so people won't have to search too far. And now as we wrap things up, one last question that I asked everyone, it's knowing where you are now in your life and career, what advice would you give to your younger self?   23:35 Um, nothing is impossible. If you dream it, you can do it. So just surround surround yourself with people who will always find your flames. People will always ginger you to keep going. And I think, you know, the sky isn't the limit anymore.   23:55 You can keep going so that I'll give to my younger self. Excellent advice. And just if people want to see Katie speak in person, like I said a little bit earlier, she will be speaking at the fourth World Congress is sports, physical therapy, August 26, to the 27th of this year, 2022 and Nyborg, Denmark. So again, we'll have a link for that as well. So you can go on and take a look at the whole program and sign up and come to Denmark in the summer, which I'm assuming is going to be great. I've never I've only been there in February when it's pretty chilly and snowy and rainy. So I'm excited for I'm excited to go. And I'm excited to listen. I have never been to Denmark. This will be my first time. So yes, I am looking forward to meeting you. And the rest of the delegates from around the world. Yeah, it's gonna be great. So Katie, thank you so much for taking the time out and coming on today and talking about all the great work you're doing. We are all inspired. So thank you so much. Thank you for having me.   25:00 and looking forward to see you soon. Yeah and everyone thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.   25:08 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, Physiotherapist and Sports Injury Researcher, Kerry Peek, talks about sports injury research and the neck. Today, Kerry talks about her research into sports injuries, developing training programs, and evaluating feasibility and adherence to programs. How can greater neck strength assist in reducing head and neck injuries? Hear about measuring neck strength, defining “normal” neck strength, and get Kerry’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “You wouldn’t send an athlete out without doing knee exercises, and yet we do it quite regularly with the neck.” “We need to do some isometric exercise but with ballistic intent.” “I don’t think isolated neck exercises is going to give you the best bang for your buck.” “The best exercise is the one they’re going to do.” “We need to make sure that the research in this space is high-quality research.” “We need to be more critical in the way that we apply research in neck strengthening.” “If you’re really good at designing exercise programs, get creative.”   More about Kerry Peek Dr Kerry Peek (PhD) is a physiotherapist, behavioural scientist, strength-and-conditioning coach, and sports injury researcher with the University of Sydney. She has over 20 years of clinical experience in both Australia and the UK working with many athletes across a range of sports, age groups, and playing levels, including elite athletes in football (soccer), rugby, motor racing, American football, and athletics. Her current research is focussed on mitigating sports related head and neck injuries and has just completed a project on neck strengthening and heading funded by a FIFA Research Scholarship. Kerry has presented to the UEFA medical committee and assisted in drafting UEFA's heading guidelines. Kerry is the Chair of the New South Wales State Council for Sports Medicine Australia.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Research, Injury Prevention, Neck Strength, Exercise, Training,   Recommended Reading The Effect of the FIFA 11 + with Added Neck Exercises on Maximal Isometric Neck Strength and Peak Head Impact Magnitude During Heading: A Pilot Study Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review Purposeful Heading in Youth Soccer: Time to Use Our Heads Higher neck strength is associated with lower head acceleration during purposeful heading in soccer: A systematic review The effect of ball characteristics on head acceleration during purposeful heading in male and female Heading incidence in boys’ football over three seasons The incidence and characteristics of purposeful heading in male and female youth football (soccer) within Australia Neck strength and concussion prevalence in football and rugby athletes    To learn more, follow Kerry at: Website:          Kerry Peek Twitter:            @peek_kerry ResearchGate: Kerry Peek   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:  Hey, Carrie, welcome to the podcast. I'm so happy to have you on.   00:06 Thank you so much for inviting me.   00:09 And just so people get our connection, I was in Monaco for the IOC conference, and I went to one of the platform presentations, and you were discussing your research, and I found it to be fascinating. So you do a lot of work with the neck and head and I just absolutely loved it. I loved your presentation. I learned so much about it. And then as I dug deeper into you, I realized that you and my friend Evangelos Pappas, there was a connection there. So I texted Evangelos. And I said, you know, Carrie peak? He said, Yeah, I'm like, Oh, cool. Could you like, tell her that? You know, I really liked her presentation, because I was like, and, and I'm, I'm sitting right behind her. I don't know if he texted you that you're like that. It was like a psycho or something. I'm like, I'm sitting behind her.   01:01 He did text me that and it was just really funny to have this funny conversation between Australia and we're in Monaco, and you're American. And yeah, saying, oh, Karen sitting behind you make sure that you introduce yourself. Yeah. After the presentations are finished.   01:15 Yeah, that was funny. But I loved your presentation. So now I can't wait to talk about your research on this episode. So I'll just kind of throw it over to you to talk about kind of the body of your research and why you chose the topic that you did.   01:30 Yes, I am. I'm a physiotherapist. And now a sports injury researcher and I started in the early 2000s, working with Don gatherer, who is the former England rugby physio, and was the Chief Medical Officer The is the Chief Medical Officer. Sorry, I'll start that again. So yeah, so I started as a physiotherapist, I graduated in the late 90s. I graduated in the UK and I worked with Don Gajraj, who was a real mentor to me, and he was the former England rugby physio and also went to two Olympic Games. And he'd really developed a practice which specialized in neck rehabilitation. And this was an area that I don't really remember studying an awful lot at university, like we did manual therapy. And really, as soon as you got patients pain free, they were free to go like I don't remember really doing a lot of neck exercises. And so we had lots of players that played rugby, we had OpSite athletes, and we had Formula One drivers coming into the clinic, who had had a history of head or neck injuries. So concussion, which wasn't really talked about much in the 90s. But looking back, a lot of them work and cast. And we started doing a lot of rehabilitation, and I really am an exercise based physiotherapist. I really like doing manual therapy. And so it was just fascinating to to really come from that perspective to see, okay, what's the mechanism of injury? And how can we replicate this, you know, doing various exercises are really sports specific. I then moved to Australia and had children and got distracted bit by doing other things for a few years. And it wasn't until my son as an eight year old was heading a football, that I thought, actually, we should probably be looking at neck exercises in this cohort, considering they're using their head to you know, deliberately redirect the ball. And that really sort of got me down this, I suppose research rabbit hole, because at that time I was doing my PhD. And since then I've moved to the University of Sydney. And so really what my research is focused on now is how we can mitigate sports related head and neck injuries.   03:39 And so of course, you know, my next question is, what is the rationale for why training the muscles around the neck can play a role in reducing sports related head and neck injuries? Because, boy, it seems like some low hanging fruit right doesn't cost a lot of money, easy to implement. So what's the rationale there?   04:02 So I mean, first of all, I want to say that I don't think that next month is going to solve every head and neck injury. You know, I think it's part of a multifactorial approach where we will look at more changes and look at, you know, whether that's body checking or collision. But it when we're talking specifically about neck exercises, I mean, the notion that greater neck strength can reduce head acceleration, particularly during heading or during collision sports is that stronger, stiffer, next, increase the coupling of the head to the body, and then help to stabilize the head on contact. So whether that's body contact or head contact, and so really, we're looking at the stiffness, which is the ability to resist defamation, and then the strength which is then you know, being able to increase neck stiffness. And so it is really that coupling between the head, neck and torso.   04:54 And how do you explain this to a patient that you're giving these exercises As to increase neck stiffness, because I know a lot of people might think well wait a second, I don't want my neck to be stiff. So how do you can? And I love that you define that? Would you mind repeating it? Because I think it's really important. And how do you explain that to a patient.   05:14 So I tend to explain to my patient by using sort of the picture of a bubble head, so I do call them bobble heads. So you've got this figure, and then this head that moves really freely. And you think if you, if you nudge the, the head, it wobbles, you know, quite a lot. And so that's a lot of head acceleration, even if you touch the body, the head will also move. And so if you think if you are being tackled in sport, or you're heading the ball, then there's a lot of head acceleration there. And we use sort of head acceleration, we measure it, you know, with inertial measurement units, thinking that you know, this, if the head is moving a lot, the brain is moving a lot. And so if you can reduce the amount of head acceleration by increasing the strength and the stiffness between that bubble head and that fixed body, then that's a way to hopefully reduce some of the movement of the brain within the skull.   06:08 And that makes a lot of sense. And I think that is a great way to say that your patient, because they'll better understand what you mean by neck stiffness. Because I can just see, like, eyes getting wide, like, I don't want a stiff neck. But you're like, Well, when I wait a second, that's not what we're saying, We want you to be able to the neck is still mobile, but we want you to be able to accept those forces when they're placed upon you. Right?   06:35 Exactly right. And, you know, we know that head injuries and things are getting more prevalent in, in sport, and whether that's because of increased reporting, or whether it's just because the athletes are getting fitter, faster, stronger. And so some of the hits that you see in American football, and in rugby league and rugby union, I mean, they're horrendous. And, you know, if you've got this head that is really not well connected to the body, and you're being hit by a, you know, 100 kilo athlete, then that's such a vulnerable component. And I think that the neck, really working in this space, it's the last area of the body that we routinely exercise, you know, you would never send an athlete out, whether they're that's a prevention or whether they're post injury, without doing the exercises, you know, you wouldn't have an ACL and say, right, there's no pain there, off you go. And yet we do it quite regularly with the neck.   07:29 Yes, very much. So. And now when we're talking about strengthening the neck, how do you measure this, the strength of the neck.   07:40 So there are lots of ways that you can measure the strength of the neck. And a lot of these different methods have been shown to have good reliability. My issue is whether they're valid, and they're valid within particular sports cohorts. So when you're looking at assessing neck strength, I mean, generally, when you're looking at any assessment of muscle strength, there's reasons why you do this, you might be using it as an outcome measure. But generally, you're doing it to inform the load that you will input you you will apply when you're then exercising. So when you measure neck strength, it has to have some carryover to the position that the athlete is going to be in for their sport. And it also has to have some carryover to what you're trying to resist. So in with the neck, for example, you're trying to resist lots of head accelerations. So generally, you need to assess the neck using isometric or maximal isometric contractions, because you want to resist movements. Most sports are upright, you know, they're running, jumping, walking, running, and, and so you need to be upright when you test them. If that's how you're also going to exercise them. Now there may be differences. So if you're a rugby forward, you're going to be in a scrum position. So there may be reasons why you want to replicate a scrum position to test an athlete. But some measurements of neck strength are done in a supine and prone position. And these can often give you very different neck strength profiles, to when you actually assess somebody's upright. And there's problems if you are assessing someone in supine or prone, but you want to exercise them upright, because because you just don't know what the actual maximal strength score is in that sport specific position. So the way that I mentioned extreme is that I get them fixed in a seated position because I can standardize that position much better. And I use a break technique. So this is really looking at eccentric loading in an isometric position until you can break the contraction, I guess, of the neck. And this is shown in lots of different areas of the body that a brake technique will yield much higher scores than a mate technique. And so again, if you're using the brake technique, particularly because you're generally trying to keep the head and neck still when there's contact placed on the head or body, and then that is sort of like an eccentric load. So this will give us our maximal score, for which Has the flexes extensors left or right side flexes. And then this gives us a much better maximal result that we can use for percentage of one rep max when we're thinking about load.   10:14 And are you using a handheld? dynamometer? for that?   10:18 Yes, I probably should have said that first. Yeah, but I am using a handheld dynamometer with a load cell in series that's placed on the head with a with a head harness. And so yes, you do incrementally load that.   10:31 Yeah. Nice. And now, how, how do we know what normal is? Like? What's a normal strength profile for NEC? And and then how do we know what's normal for a position within a sport?   10:43 And that's a great question. Because when you when you look at the literature that's out there, the first thing I always do is I look at what was the method to assess neck strength. And if it is in a lying position, then I take the results slightly with a pinch of salt, because they too tend to give you a different neck strength profile. So there are a lot of studies particularly in rugby that have been tested using the same method that I that I use. And this was first developed by by Don gatherer. So it's not any great surprise that I use that because we used in clinic for a very long time and tested hundreds of athletes. But now having moved into that research base and had a look at all the different ways that you can test neck strap, it's still my preferred method. And so we've tested rugby athletes, we've tested football players. And what we're generally finding, and this is sort of consistent with the literature. And what we expect a neck strength profile to look like is that the extensors should be the strongest. So if you look at a result, and the extensors are not the strongest, is it related to the testing technique or the position that they're tested in? Or is there a problem there, so it isn't an injured population, that might give you something that's a bit different. So extensors should be strongest flexors are generally the weakest. And side flexors will sit somewhere in the middle there, depending on the population. So in rugby and American football, you often do want to have the side flexes to be stronger, and a lot stronger than the flexes. So they tend to have a very wide sort of neck radar if you were to plot this on a graph. Whereas if you have football players, for example, because of the conditioning from hitting a ball, they may actually have quite strong flexes. So I always have a look and plot the results on a radar. And then I also calculate the flexure to extensor ratio to see what that looks like. And so in the literature, normal is often considered around point six of a flexor extensor ratio, but I have seen it as low as point five as high as point seven. But I always think if in a sporting population, if it's below point six to me, that's that's honestly a red flag, but it's certainly a yellow flag.   12:47 It's problematic, or can lead to can lead to more problems. Yes. And where can people if they're wondering like, hey, where can they find the method that you use to strengthen? Is there a paper? Is there something you can point to because we can sort of put it in the show notes?   13:04 Yeah, so I do detail the the method for assessing neck strength and a paper that we published earlier this year in sports medicine. So we looked at the neck strength of football players, adolescent football players from 12 to 17. And then we implemented an X strengthening exercise program and to see whether by strengthening the neck this actually had an impact on reducing head acceleration during heading, and we found that it did so that the neck strengthening method is is detailed in that paper.   13:34 Perfect. So we'll have that paper, we'll put it in the show notes a link to it so that people can read it at their leisure. Now, we talked about why you're looking at it, how you're evaluating it, what does a training program look like?   13:50 So that's, that's really interesting as well, because I think, because there's not a lot of published literature on neck strengthening, I think you tend to find that you have different camps of people, some that are very pro neck strengthening, and that that certainly is myself. And, you know, a bit like you were saying earlier is that it's low hanging fruit, you know, why wouldn't we try and strengthen it because the potential gain is huge, and it wouldn't not strengthen any other area of the body. So I kind of think what, you know, why wouldn't you do it? But on the back of that, we also have to think what's the best way to strengthen the neck and I think some people are quite negative towards neck strengthening, because some of the papers that have been published, the exercises that they use are sort of self resisted exercises where they're pushing against their forehead and holding that and doing isometric holds. And a number of studies have shown that this doesn't really have an impact, it may not even impact in which increasing strength and it may not have an impact in reducing injury risk as well. And that makes sense. You know, I don't implement those exercises because When you're talking about reducing something like concussion or heading in football, those hits happen in fractions of seconds. So we don't need to have high insurance of the neck or just isometric control over a long hold, what we need to be able to do is fire those muscles really, really quickly. And so we've been playing with some neuromuscular exercises. So it isn't our paper that was published in sports medicine, but I'll try and describe it, but you're kind of in a setup position, but you're rolling backwards and forwards, and you're trying to stop your head from hitting the ground. And so the idea from that is really to try and contract the neck flexors really quickly if the heads in neutral, and then we turn the head to the side and the other side, and we do the same exercises. But the idea is that you've got that anti gravity strengthening, but you've also got, you know, you're trying to stress the muscles to fire really quickly. And that's what they have to do. So most of the the literature that is talking about neck strengthening is sort of indicating that we need to do some sort of isometric exercise, but with ballistic intent, and that's the bit that is often missing, for most of the neck exercises in the literature.   16:10 Yeah, and that's the exercise you described in Monaco, sort of, for people, if you've ever taken Pilates, it's rolling, kind of like rolling like a ball is kind of what that's kind of, you know, that's, that's at least what I got from it. And I remember I got back to my room, and I was like, we're gonna try and see what happens here. And it is it not as easy as it sounds.   16:32 No, and, and it does, it does work the net quite hard. And you can see it, you can see the net contractions in somebody else that's doing it. But the way that we sort of played with this exercise, and I will just credit to bursting, but also, we meet on a regular basis. And we talk about neck exercises. And he's also widely published in the neck strengthening arena, and was part of this paper as well. But what we were trying to do was come up with an exercise that use no equipment that didn't take long. So these exercises take 90 seconds. And that could be added to an existing neuromuscular program. So in this case, we added it to the part two of the FIFA 11 plus. And this is really important because I actually don't think isolated neck exercises is probably going to give you the best bang for buck either. I think we need to integrate it into, you know, other strength and conditioning programs. And again, this is sometimes where you see in the literature that they're just adding neck neck exercises without thinking about, or what is that neuromuscular control to the trunk as well. And how are we stimulating that?   17:31 Yeah, that makes so much sense to not just do things in isolation. I mean, gosh, especially when you're talking about athletes who rare? There's not many athletes that do things in isolation?   17:45 No, no. And and I think that that's just really important to get that adherence as well. Because if they think it's an add on program, and it's going to take ages and 10 minutes to an athlete is actually quite a long time when they're doing so many other areas of the body, that if we could integrate it into existing programs, or integrating into multi joint movements, then it makes sense to them. And it and it's, it's it's integrated. It's not an add on.   18:09 Right? Because of course, as we all know, as physio therapist, one of the hardest things through a rehab process is the patient that doing the rehab. Right, so the best exercise is the one they're going to do. So if you explain it well. And you integrate it, you're more likely to have that patient do the exercise. Have you found that? Have you found difficulty patients adhering to the program?   18:38 So, so we didn't, we did, we did look at the evaluation of feasibility. So my PhD is actually on adherence to exercise. So it was something that was really at the forefront of my mind when setting any exercise intervention, that we need to have some sort of process to evaluate it and see whether the, you know, the players and the coaches found it feasible, and did it take too long could they see the benefits of it, and it's generally scored really, really highly. And I think that is the fact that we tried to just minimize the time that it took that it was complex. So you know, the youngest athletes were sort of 12 years of age, and you know, they all understood what they needed to do, but also to make it you know, applicable to their sport. I think that's really important.   19:21 And what are your thoughts on different kinds of strengthening you know, we see things on YouTube people will see things on YouTube and I don't mean to go down a rabbit hole on that, but you know, tying weights around their head bands around their head doing things with bands and weights with movement of the neck. What are your thoughts on that?   19:44 So there's certainly some crazy stuff on on YouTube or Tik Tok and I think that's not necessarily specific to the neck. I just think that again, what you've got to try and do and, you know, I think exercise therapists, whether that's physios or exercise physiologist that do exercise really well, they understand the sport and they understand the mechanism of injury. And so if you're going to add a weight to your neck, you've got to think, Okay, well, how am I adding the weight? And how is it replicating, you know, the risk of injury, or what I need to do within my sport. And so if you're in a crouch position, which I've seen in lots of videos, where they've got a head harness, touch the neck, and then there's really, really heavy weight at the end. And I kind of think, why you're doing that, what's that for? And maybe in the scram, maybe that's applicable, but you know, I can think of very few reasons why you would need to do that. And when they hang weights off the top of their heads, you know, you think of that, you know, that axial loading that they're doing. Again, why would you want to do that?   20:51 Yeah, I don't know. That's why I asked, and so we got an answer. I don't know, I really do not know why you'd want to do that. But now now listening to you talk about your research, it just makes so much more sense to integrate it in a neuromuscular based exercise, you know, integrating it with other muscles within the body and making sure that it makes sense for the position and the sport of the person. Yeah, absolutely.   21:21 And I think this is about knowing, knowing your patients, knowing your athletes, and, and if you apply that sort of methodology for any exercise, you know, whenever you see someone, so I've been invited to do some work with the RW F here, so the Air Force, and I don't know a lot about PILOTs, but you just go in here, talk to the pilots, and you say, okay, so what do you do? And you know, when does your neck hurt? And? And how long are you in that sustained position? And how much G force are you being exposed to when you're in a fighter jet? And you just kind of start to understand, you know, what, what's happening to this person? And how is that potentially, you know, making them at risk of injury? And then how do we need to train those muscles in a way that stimulates, you know, what they're exposed to as part of their job or part of their sport? I mean, you do that with every other joint of the body? You know, I think we routinely do that. But we just need to do it at the neck as well.   22:19 Yeah, and great advice. And now is there anything as you know, throughout our conversation today that we didn't touch upon, about your research, maybe about your PhD work that you think would be audience would really love to hear more about?   22:37 Um, I think that it's important. I think it's important than I think I sort of said this a bit earlier on that, we really need to make sure that the research in this space is really high quality research, and that we understand, you know, the mechanism of injury, particularly things like concussion, that we don't think that neck strength is going to solve everything. But you know, when we're reading papers, it's understanding, you know, what method did they use, you know, are the results actually believable, or didn't the way that they measured neck strength have given you such an unusual profile that actually shouldn't read any further in the paper, or it's just not applicable to your athletes, for example. And so I think that we need to be much more critical in the way that we apply research in neck strengthening. And I think that, although I'm very passionate about next trend thing as an intervention, you know, I don't think we should overplay what we can potentially do in this space, either. It's just part of our toolbox, but it's not going to be everything.   23:38 Yeah, there. It's not the panacea for all ills having to do with head and neck injuries.   23:44 That's right. And I think that if you don't understand about how to integrate a neck strengthening program, I mean, I'm very happy for people to reach out to me, but, you know, talk to people and, you know, as I say, critically appraise what's going on. And I think, you know, if you're really good at designing exercise programs, get creative, you know, have a little bit of a play of what you're trying to do. And I think that's often how we get really innovative in the way that we approach exercise programming as well.   24:11 Yeah, and it also sounds to me like there's not a one size fits all. Approach, exercise or program. No,   24:21 I mean, I think there's things you don't do. And then everything else is kind of open to Yeah, depending on your athlete. So yeah, don't hang away off your head.   24:29 Yes, that is fabulous advice. And now as we start to wrap things up, I'm going to ask you the question that I asked everyone, and that's knowing where you are now in your life and career. What advice would you give to yourself as a new grad right out of physio school, your younger self?   24:50 I think that's a great question. And I don't regret anything that I've done in my career, but I would say that I've probably come to really specializing in neck strength is a bit too late. So we started in the early 2000s. So my first paper was published in 2005. And as I say, I got distracted doing other things. And I wish I'd continued with it. And I didn't partly because I was having children, and I'd moved to Australia and just life got in the way. And when I came back to it in the probably about 2015 16. So 10 years later, and nothing had moved forward, really. And I just thought that was a really missed opportunity. And so I if I could go back in time, I would probably, yeah, I would probably want to squash those 10 years into maybe 18 months.   25:40 Well, that would be pretty amazing time traveling. So where can people find you? If they have questions, they want to follow you on social media, where can they go.   25:51 So the best place to find me is on Twitter. So I'm at peak underscore Carey, I don't tweet about anything other than my research. So that's the best place to find me. And then you can always drop me a message through there. Otherwise, you can probably find me via Google, at my email address at the University of Sydney.   26:09 Perfect. And just so everyone knows, we will have a link to the papers that we've mentioned today. So if you want to read up on those that don't worry, they will be in the show notes at podcast at healthy, wealthy, smart, calm. And Carrie, I want to thank you for coming on. Like I said, I really loved your presentation in Monaco, which was just a short snippet of kind of the amount of things that we talked about in the podcast today. So thank you so much for taking the time out and coming on.   26:36 No, thank you actually went to your presentation in Monaco as well. And you've informed a lot of what I do as well about, you know, I think that most research is quite ego driven. And I'm not an exception to that. And we think that if we publish a paper that somebody is going to read it and we're going to change the world. And that rarely happens because players and coaches don't read research. And so your presentation was about you know, engaging with the media and doing a lot more in the social media space. And that really hit home to me that we have to try and bridge that gap if we can to translate research to practice. So no, thank you.   27:10 Oh, well, that's nice. I'm glad to hear that I will pass that along to my partner Osman, as well. So thank you for that. And again, thank you for coming on. I really appreciate it. And all of you listening. Thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, Owner amd Founder of Goldsmith Therapy Solutions, Dr. Philip Goldsmith, talks about value based purchasing in home health. Today, Dr. Phil talks about the pros and cons of value based purchasing, and prioritising results over productivity. How will value based purchasing in home health turn out? Hear about OASIS assessments, the difficulties of working with insurances, and get Dr. Phil’s valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “It looks like value based purchasing in home health is going to be a good thing.” “Home health therapists are probably, unfortunately, some of the worst offenders at underdosing strength training.” “Professional communication is where the good are going to be separated from the bad.” “Most of the private insurances base their policies on payment on what Medicare does.” “You’ve got to be involved with advocacy if you want to see change.”   More about Dr. Philip Goldsmith Philip Goldsmith, PT, MSPT, EMT, DScPT, COS-C, is the owner and founder of Goldsmith Therapy Solutions, a provider of high-quality management, consulting, and clinical solutions for home health providers. Dr. Goldsmith has been a practicing physical therapist for more than twenty years, with experience in home health, skilled nursing, and outpatient orthopedic environments. Dr. Goldsmith received his BS in Health Studies from Boston University in 1996, his MSPT from Boston University in 1998, and his DScPT from University of Maryland School of Medicine in 2011. Additionally, Dr. Goldsmith has extensive experience in leadership and financial management of small and mid-sized not-for-profit corporations and has won more than $200,000 in grants for public safety organizations with which he is affiliated. Dr. Goldsmith lives in Hanover, PA, with his wife and son.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Results, APTA, Home Health, Value Based Purchasing, Insurances, Advocacy,   To learn more, follow Dr. Phil at: Email:              pgoldpt@gmail.com LinkedIn:         https://www.linkedin.com/in/philip-goldsmith-a81a692 Twitter:            @pgoldpt APTA Home Health: https://www.homehealthsection.org/leadership   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:  Alright, let's go. Hello, healthy, wealthy and smart. I am Jenna canter here with the Dr. Philip Goldsmith, who we're going to refer to as Dr. Phil, don't you love it? I'm so grateful to have Phil here, because he has a small business owner who runs a business in which he provides Oh, I'm gonna mess this up. And I'm so excited to where he brings stuff to the home health people and they're happy and they smile and say thank you. Without it and I get it.   04:05 That's pretty close.   04:08 Would you mind summarizing in that perfect sentence you just said a second ago of what it is you're more details on your business, like   04:14 elevator speech. It's called Goldsmith Therapy Solutions. And I provide high quality clinical consulting and management services to the home health industry.   04:26 I love it. And that's an elevator speech we all need to have you know for each of our own individual businesses, anybody who interviews with me knows I don't spend too much time going into the bio stuff because that will just be in the people can read it and then Wounaan go oh my gosh, I love Dr. Phil, you know, look at this. Wow, incredible. We are going to dive right into the topic which I know nothing about. I'm a cash pay cash based out of network PT working with performers. So I'm going to ask all the base questions to fully understanding the situation so everyone can better get on the on the same page with this apparently, and I I'm, I'm not saying it's not but just for me, it's new, apparently topic that's like a hot topic, and that is value based purchasing in home health. I know nothing about it. So let's talk about what is that? What is the value? What is that   05:21 value based purchasing is Medicare's new payment model for certified home health services provided to Medicare party beneficiaries.   05:33 Why is that important right now,   05:36 because it's different, how Medicare is moving away from the you go do a visit or provide a service and we pay you for a service to a model where they pay you based more on your outcomes, and how good a job you do at taking care of those Medicare beneficiaries that have chosen to avail themselves of your services.   06:05 That sounds great to me from a physical therapy standpoint, because that's what we care about. So how was this? Let's start with how this is good. And then we can go how this is potentially something that could get in the way of providing care to people fully. So how is this good?   06:20 This is good, because it removes a lot of the artificial drivers that were skewing utilization. Meaning, excuse me until about three years ago. The more visits you the more therapy visits you made, the more money you got. And that was unfortunately driving practice patterns and everybody Medicare, not Medicare kind of agreed. This isn't working. Yeah, yeah. And   06:55 because that's about productivity, not about results. Yeah.   06:59 Right. And it was it was too much widget counting, and a lot of home health agencies were making a lot of money on providing therapy visits that weren't necessarily necessary. Hmm, Mm hmm. So, you know, the the interim step on the way was this thing called pdgm that we're in now where it's all based on functional states and diagnoses? And that's about it.   07:28 Yeah, it's not nothing to push getting them to where we need to get them or to protect them from getting worse. If we're talking about home health. Yes, yes. Okay. Okay. So then let's talk about where this could potentially be problematic.   07:45 So the, the concern is, are you comparing apples to apples, meaning they're dividing the agencies up by state by geography and buy large versus small volume, to try to make apples to apples. But the big issue is, this system works literally by robbing Peter to pay Paul, somebody is going to make money. And somebody is going to lose money. So the other people at the other end of the scale can make money.   08:25 Where could you go and give some details on this? Because I'm not really following on on how this could be? Yeah,   08:31 Medicare is gonna say, Okay, we're gonna take all of the large volume agencies in the state of Pennsylvania. And we're gonna line them up by the outcomes we've chosen, they haven't told us the outcomes yet.   08:46 Deciding what the outcome what outcomes matter,   08:49 they are in the process of that now, who are the consulting   08:52 with doctors?   08:57 So there is what's called a technical expert panel, and we could do that alone. The concept of technical expert panels could be its own podcast, where basically they bring in people in the industry and ask them, What do you think is important? Um, do they pay them? They cover their expenses, do they? Do   09:25 they start to get a financial interest to sway certain ways and their responses? Okay, okay.   09:32 They're representing their industries. So, you know, they can, I could volunteer to be on a technical expert panel. And my job is to bring the perspective of the physical therapy industry. Hmm. They also do us, you know, these big beltway consulting firms that you hear so much about, and they have policy wonks that work at CMS that do this stuff. A lot of its actuaries accountants and lawyers? Because one of the big rules is this is supposed to be budget neutral, meaning the pot of money doesn't change. It's who gets how much of that pot changes, specifically, the agencies that are the bottom performers, they're going to lose it as much as 5% of their reimbursement, so that the top performing agencies gain 5%. See,   10:25 there we go. That's where I think a financial interest could sway what people say, because this could be less money towards their industry. Well, it's problematic,   10:37 home health in general. I mean, this is, it's already, you know, you're already getting paid a lump sum for the care of each individual. And that varies based on those clinical and diagnostic factors that that I talked about before. Right. The scuttlebutt is,   10:55 I don't, but I just need to highlight that. I know I love that you said scandal, but this is great. That means rumors, love it scuttlebutt, I'm going to start using that every day.   11:06 One of the big outcomes they're going to look at is readmission to the hospital, did you keep your patient out of the hospital? Because that costs Medicare more money. And they're gonna look at functional outcomes, like transfers and ambulation. And there may even be a patient satisfaction component because did you know that Medicare mandates patient satisfaction surveys in most settings, you get those annoying Press Ganey surveys? Because Medicare says Thou shalt, and they track those, and those are actually publicly reported data.   11:41 That's actually great. I think the patient what their happiness is everything. Yeah, I think that's great. That's, yeah. Okay. Okay.   11:52 So it's your secrets here.   11:54 So it's it sounds though, like it's a bit of a gamble on where things are going to lie. And what's going to be decided on what these outcome measures are? That sounds like the biggest concern, what are these outcome measures that we're going to be using? Because if we're talking about movement stuff, you   12:15 aren't talking about movement stuff. But, you know, they've already established that all of the measures, the outcomes that are going to be looked at are either Oasis based Oasis being the clinical assessment that's done in homecare at a minimum every 60 days. Okay, Mission recertification discharge, hospitalization, return from hospitalization. That standardized assessment gets done. I have   12:47 a question about that, actually. And this is just from my own experience, it's a completely different audience that I work with. So when I'm working with my performers, I'm reassessing every single time I work with them. I'm a niche practice, though. I'm, I'm small and keeping it small. And so therefore, they get like real top, you know, I know them inside out what's going on in their lives and stuff, so I can best help them. So that is very, very specific. And and I'm lucky to be in that position. So when you're saying 90 days, that sounds like a long time for like a formal reassessment. I believe in oh, gosh, PT, school, it was it was a matter of like two months. So is it because of the the age where things may take longer to see results? Why it's a 90 day spot? Like, why is that? I'm honestly asking, it's not for judgment, I'm trying to be very transparent on my own bias. So I can learn   13:37 that every 60 days, well, every 60 days, that OASIS assessment gets done. However, that doesn't change, that your state Practice Act still applies that you may have to reassess every 30 days or every 10 visits or every 14 days, whatever your state Practice Act says, and Medicare still has the every 10th Visit reassessment requirement in home health, where they expect you to be using objective functional measures, and looking at your plan of care and your goals and saying, Are we getting where we need to be,   14:16 which is what we do in physical therapy. That is we're always asking ourselves that question.   14:19 Okay. This is more of a you know, it's more of a big picture thing. Yeah. Okay. For example, the emulation question. There's independent, there's independent but needs a one handed device independent but uses a two handed device can walk but need supervision at all times. And then there's a couple of answers for wheelchair bound, or bed bound.   14:46 Yeah, I'm not familiar with this, but I'm learning as you're talking about, is there anything about risk of falls because that's like the big a big one.   14:53 They look at that from a process measure standpoint, meaning they ask you, did you assess for fall risk, and there's criteria given a multifactorial objective. So really, it's got to be a two pronged thing. They're not looking at the results. They're looking at. Did you do it? Yeah.   15:17 Yeah. Is there room for? And this may be you don't know, because this is a bit of mind reading. As far as you know, right now, is there room for measurements for neurological disorders where we know that things may they're going to decline over time? You know, are immune immune? Am I saying the wrong thing? I think he's doing the wrong thing. But is there room for that where they have a health situation where things are going to decline? We know that but we're trying to keep them functioning their best as they're going through their process?   15:50 The answer is yes and no. Okay, the questions and answers don't change. What changes is, they can tease out by diagnostic grouping and by what they call risk adjustment, where if your agency has a high population of clients with progressive neurologic disorders, that's the the term in favor now. Okay, thank you, they're going to risk adjust your statistics to reflect that, meaning, we see that you have a larger population of people who probably aren't going to get better. And we're going to do some statistical mumbo jumbo in the background to adjust for that. But that doesn't change the answers that the clinician is using. Okay. There's no, I have to pull a different document because I have a different diagnostic group. There's no, I answer these questions for this diagnosis. And that questions for that diagnosis? Yeah. Yeah, the people who very much a big picture of   17:03 the people behind the scenes, I think I know the answer this question, but I'm still going to ask it, the people behind the scenes who will be assessing the the progress progress, and, you know, if it's fitting, looking at the outcome measures and what we need for that patients, are they medical professionals? Are these just people who are trained to work for this company? Who are the Who are these people?   17:28 So field clinicians who work with clients answer the oasis for each client, the agency, then submits it electronically to CMS. And the risk adjustment is baked in to the computers at CMS that process all this information.   17:50 Also, it's a computer thing. It's all very,   17:53 and that's part of the reason the assessment is somewhat limited in big picture. Yes, it's a it's a computer thing. Ah, it's a i. i, maybe maybe not. But it's a lot of higher level statistics. That's way above my head.   18:11 Right, right. Yeah. Oh, wow. That's what this is so negative for me to say, but what an easy way as a person in CMS to point away and go, Oh, no, it's the system's. That's what they computed. Like, I can't. I'm like, Who created it? Who designed the code? Fine. We'll look at the code person I need to understand. Okay. Okay. So, I mean, it just sounds a little bit like a trip to Las Vegas, where you studied a little bit. So you know, a bit about gambling, you say, let's say you're very educated about that, and you but it's still gambling? You don't really know. I don't know, I just I,   18:53 you know, it's, it's pretty well known how they do the risk adjustment. You know, it's just the statistics of how it's done is pretty high level, but we have a good feel for what they're risk adjusting for and what questions they used to do the risk adjusting.   19:15 I mean, do you think the physical and physical therapy industry home health for this, because that's what we're focusing on? Do you think what the way we have things set up now, the way I mean, that's the whole point is to be measuring their outcomes? That is literally what we're doing all the time. Do you think we're pretty safe with this adjustment? If anything, it'll probably be for the better if you're just overall? I mean, because we did the good versus the bad. Where do you think it's, it's gonna turn out for us?   19:46 It looks like value based purchasing a home health is going to be a good thing. It is going to reward you for doing your job well, and being aware of your outcomes and delivering good health. Quality physical therapy that drives the outcomes? Yeah, there's going to be, it's going to challenge the physical therapist and the PTA to work at the top of their license and to collaborate with the other professionals. Because some of these measures don't happen in a vacuum for lack of a better term, they don't happen unless you're working as a team, and everybody's on the same page. Yeah. And that's really that interprofessional communication is where the good are gonna be separated from the bad.   20:40 Yeah. This isn't my world. Oh, continue,   20:44 there's, you know, definitely the agency is going to have to be very aware of their outcomes and their data. And the understanding of that data is going to be huge. Yeah. And I can tell you, that there are consulting firms and companies, and that can look at those outcomes at a clinician level. And they're going to tease out high performing clinicians and low performing clinicians.   21:16 Yeah, yeah. Yeah. And I'm assuming that's where the concern is, what is, oh, I'm gonna backtrack to actually what I was originally thinking of asking. What is the hot talk on the streets regarding this? What are the big things that other physical therapists and people in the industry are going like, hey, about it? Or do we already cover those things?   21:41 We've covered a lot of it. I think there's a lot of optimism around this. Because the more recent changes over the past couple of years, starting in October 2019 really pulled back on the number of visits. We were seeing clients. And some of that is real. And some of that is artificial. Yeah. And it's gotten me up on my soapbox a number of times, because home health therapists are probably, unfortunately, some of the worst offenders at underdosing strength training. Oh, yeah, you want to get me started? Don't get me started.   22:34 Yeah, yeah. So it's, it would force that that push, I would love. It   22:39 forces us to understand how to deliver strength training, how to deliver the most the best outcomes we can in in fewer treatments.   22:52 Yeah, how to get trust, motivation.   22:55 really gotta understand you've got to be a high performing clinician, yeah. To survive in this market. Yeah, because a home health agency literally cannot afford to have lower performing clinicians that can't deliver the outcomes. Yeah. And a lower number of visits.   23:16 Yeah. Yeah. Absolutely. Absolutely. I definitely get that. So I I mean, I'm all about the outcomes. I've had people a different dance physical therapists asked me about how I do my outcomes and it really does depend on my patient and everything but I have a very I have a special circumstance you know, like I'm very lucky to have this niche that I have. i There are from an outpatient not out push out. Yeah. Out not outpatient. Wait, I'm getting so confused. Ortho. From an ortho standpoint, I'm calling because I'm not, I'm not home health. So I'm just like trying to get back to my my world. There are definitely I'm gonna choose my words specifically. So if you are a person who does own a clinic, that sees a lot of patience, you are a mill, there is no way to paint that there is a reason why there is a name for that. That's like saying, I, you know, I was you know, born from two Jewish parents and I grew up I have my Bar Mitzvah and then and like, I still observe Passover, and then be saying, I don't I'm not Jewish. Like what? Like, no, I'm Jewish, you know. It's very weird comparison. But whatever. That's what I chose. And I'll go with it. We   24:41 get to the point of mills.   24:44 I've always thought that the it was because of the problem with insurance and reimbursement and it's one of those like chicken or the egg kind of thing. What happened first, which I use in defense for any clinic. I'm like, hey, they're trying to figure out how to get reimbursed but at the same time, does in this horrible circle of terrible reimbursement trying to communicate what you did and everything, and people are trying to make money, which is fine, it's okay to want to make money Hello. Is   25:15 we as a profession do wrong to allow an industry to devalue our services like that?   25:24 It's because when trying to guess this is me, because I'm not a network. So, but from what I've seen, it's it's clinics trying, they're doing their best to report what they're doing. They outcomes with the patients, while at the same time speaking the language that the insurances say, they will reimburse. And then also these insurances saying they're going to reimburse, but they're not actually reimbursing, then there are administrative staff calling over and over again, fighting to get those reimbursements, you know, getting better at that. So that's why you have certain people working on the at the front desk, and then and so then they increase the number of patients during that time, because while they're gambling per patient on honestly, this is how I look at it for a patient on getting that reimbursement. Through, you know, the paperwork we've we've been trained to do to report outcome measures and everything. They're not they're not getting paid for it. They're fighting to get paid even on the basic level. So I think, but I don't know what happened first if insurance happened first, or, and, or the, you know, provision of the services, and they decided for it to be a lot of people that's the chicken or the egg thing. I mean, I'm sure somebody could look up the history, but I think that's where people just say, Oh, the healthcare system is messed up needs to be fixed. I, that's where I kind of lean back on to kind of be fair to everyone. Not that there has to be a middle ground. But I mean, that is kind of the truth. If I owned a big business, you're constantly you're like, Okay, I've hired this, these EMR systems, you know, we're we're gonna track and write down things. I hope this is the right system. Okay, this one's not working. Let's do a new one. And then you have your clinicians going, Ah, dang it, we have a new one, I have to readjust. But it's because we're trying to do it. Honestly, we're trying to do it legally. And then insurances just go, now, we're just not gonna reimburse you, we're not gonna explain why. And we're gonna be difficult to get in contact with to discuss and figure things out. So I don't know it's a random tangent, I'm sure people will go be like, Jenna said something wrong. I'm not the person to attack here. I'm just speaking. If you have problems, go talk to the insurance companies and figure it out if you already know how it works. But that's kind of how I look at it being problematic in the Ortho world specifically, because there is a lot of measuring of my brain out there. There's a lot of measuring of what was the word that we use, the more patients you see.   27:56 Counting widgets, counting widgets.   27:58 It happens, it does happen at the larger clinics. But yeah, can you I mean, I'm not saying I'm not saying I'm not saying I agree with it. But also, can you blame on? You know, like,   28:12 you started this to make money. I get that, you   28:17 know, but, but I mean, what I am in the business to hear, I mean, that's what I'm doing my own thing, is it easy to do what I'm doing, is it easy to get the patient Oh, my God. But that's I that's where I put my energy where I put my energy. But I feel like what is happening in the home house, like, Oh, my God, this is hilarious, full circle, but I'm going to connect it, it's going to be amazing. Feel like the Home Health what you're doing with pushing that pushing forth. The outcomes, I would love that I would, but I would love to actually be that not than just saying that. We love their beat. Let's make it all about the outcomes. And honestly, I feel like that's what we've been trying to do the whole time. It's just people aren't. insurances aren't saying there aren't following through with it, what they say they're going to reimburse, they say, We can reimburse up to this amount. It doesn't mean anything. It's horrible. So I would love there to be fixing in that way.   29:13 And I think someday Medicare will come around to a value driven system for outpatient therapies. And until Medicare does, nobody else will mean, Medicare very much still drives that bus.   29:31 Yeah. Wow. I never realized that. That's yeah. How do you know how do you I mean, honestly, asking, How do you know that they're the ones driving the bus?   29:43 Because most of the private insurance is based their policies on payment on what Medicare does,   29:53 because they're so huge. Yes. Mm hmm. Oh, gosh. Not saying it. It's easy to say there's no easy road.   30:02 That's where all the that's the root of all the CPT codes and everything else. Medicare needed a common terminology to wash claims through a computer to pay people. Let's boil everything down to a five character code.   30:21 Right, right, right. Wow. Huh? She's What a hot mess. It just gives me a headache thinking about all of it. I don't like it. It makes I need cake. Or pizza. Oh, not chocolate though. My dad loves chocolate cake. Are you a chocolate cake person?   30:43 I am a chocolate person head on.   30:46 We only put like chocolate cake is so different from chocolate bars come on.   30:51 Yes. But they both have their merits   30:54 F No. Disagree? Absolutely not. All right, if you are a person that if you would handle your stress from chocolate cake, just as much as chocolate bars. Okay, your team Dr. Phil. If you're like No, chocolate, just chocolate actual chocolate, your team? Jenna. I'm interested to see if there's going to be any written debate on this or discussions I'm sure there already has, which is why you were meeting Dr. Phil was like, let's do this topic. And like, I don't know anything about this, which is good. I think it's good because then I get to learn everybody else who listens gets to learn. And oh, I'm going to just say this just because I am not a fan of meanness. Don't attack either of us in this discussion. If that's in your if that's in, if that's in your intention in in hearing this and your response, oh, just at this as a message just for you get out of here. Well, we got to be better together, we need to be able to have these discussions, talk about it, totally fine to speak on your concerns about it or all that stuff. But we're just attacking each other that is not helping out the patients at large. This is about the people we serve. So we're discussing this to see what's going on to better understand what's going on. If you are in an estate, you are close to somebody who is in legislature, the then do talk to them, or see if there's a pre written letter from a PTA right now regarding this through their app, if you're in a PTA member or see if you can get a hold of that letter through a friend or something or I'm sure it's honestly on their webpage for you to easily access to advocate sending a letter to fight this or fight for it, whatever it is, because there's there's positives and negatives and everything. I mean, sometimes there's you know, it's leaning one way, obviously, but we got to just take action. If you want to see something you got it don't just reply on here take action. Well, I just gave so many different messages and one thing at the end, but that's okay, I'm fine with it. Any last words you want to say on this matter that you that we haven't covered? Dr. Phil?   33:15 I think the take homes are twofold. You just said the first one. You've got to be involved in advocacy if you want to see change. Second, value based purchasing, like we're talking about it today is just in the home health arena right now. It is what Medicare wants to bring across the board across all settings. And, you know, they don't they want to get away from fee for service. They want to get away from ID to units. If they're x and a unit. If they're X, a unit of East M and A unit of manual therapy and you need to pay me for it. They want to know a client walked in your clinic with this problem. They had these issues that we're able to quantify. And at the end of it, the client left our clinic and the issues were gone and here's how we've quantified it. That's what they want to be able to pay you for. And if you can't be excellent with that. You're not going to have a successful practice 510 years from now.   34:34 Thank you. Thank you so much. Where can people they wanted to get in contact with you Where can they connect with you on either social media or email?   34:44 I am P gold PT on Twitter. I do have a personal Facebook. I am not fancy or cool enough to have Instagram or Tik Tok or any of those. I have LinkedIn. My email is Easy it's P gold pt@gmail.com. The other place that's really easy to find me is if you go to a PTA home health.org on the leadership page, you'll find my name. Currently the treasurer of APGA Home Health formerly known as the Home Health section. And in two weeks in two days I become the President   35:29 didn't say that at the beginning. I was like, I wonder if you want me to and you didn't say bring it and bring it out? So yes, this is a person. This is a person who's very involved with fighting and spin keeping on top of what's going on for home health. So thank you so much, Dr. Phil, for coming on for your name. I love just saying Dr. Phil over and over again. And just sending you the biggest hug from afar. We got a meet at a conference recently and you are a gem. Thank you so much, and everyone send love to Dr. Phil for for his time.