Healthy Wealthy & Smart

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

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

In this episode, Co-Founders of Trailhead Learning Collective, Jenn Bell, PT, ScD, COMT, and Audrey Elias, PT, PhD, OCS, talk about their work doing Continuing Education different. Today, they talk about the current state of Continuing Education, integration of information, and addressing Continuing Education courses. How is Trailhead Learning Collective different? Hear about active learning techniques, some upcoming retreats, and get Audrey and Jenn’s advice to their younger selves, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Our patients are human, but we, as clinicians, are human, and it’s important to respect that.” “There is a time and place for everything.” “There is an alternative way to get your continuing education done that also takes care of yourself.” “Remain flexible and keep watching for those opportunities.” “All of it is worth it. All those experiences are things that you can draw on.” “It’s alright to go do different things that aren’t exactly on your path.”   More about Audrey Elias and Jenn Bell Jenn Bell, PT, ScD, COMT, and Audrey Elias, PT, PhD, OCS, are co-founders of Trailhead Learning Collective. Audrey is clinical faculty in the University of Montana School of Physical Therapy and Rehabilitation Sciences. She completed her DPT in 2009, did her residency with Therapeutic Associates in Washington state, and then completed her PhD in clinical  biomechanics at the University of Montana in 2015. She then did a post-doc at the University of Guelph before returning to UMPT as clinical faculty, training entry-level students and residents in the DPT program and in the UMPT clinic. Her primary area of research involves how psychological factors play into movement, particularly following knee injury. Most importantly, she loves being outside, whether skiing, running, hiking, paddle-boarding, or lounging around a campfire with her son and husband. Jenn is the Program Director and Director of Clinical Education at UMPT. She completed PT school in 2006, then completed her COMT in 2012 and her ScD from Texas Tech in 2013, all while treating patients in a variety of settings in rural Alaska. She has treated patients and taught in PT programs in virtually every setting all over  the world, including Kenya, Ethiopia, and Malawi, and is an internationally-recognized expert in inter-professional education and global health. She is also the co-Primary Investigator and Team Advisor for Montana Inter-Professional Student Hotspotting, improving outcomes in underserved populations in rural Montana. Above all, she is always, always, having a good time outside with family, friends, food, and an adventure, setting an example for her two young daughters. Together, and through the values of adventure, growth, authenticity, collaboration, and respect, Jenn and Audrey are working to build a collective of compassionate, confident, critical thinkers who utilize best-practices in their field.   Suggested Keywords Healthy, Wealthy, Smart, ConEd, Education, Learning, Research, Networking, Integration, Innovation, Collaboration,   Resources Prevention & Wellness for the Running Athlete. https://www.trailheadlearn.com/healthywealthysmart   Get 10% off your first retreat: Mention Healthy, Wealthy, & Smart at Registration.   To learn more, follow Audrey and Jenn at: Website:          https://www.trailheadlearn.com Facebook:       Trailhead Learning Collective Instagram:       @audreyroseelias                         @jennbell427                         @trailheadlearning   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.   00:35 Hey everybody, welcome back to the podcast. I am your host, Karen Litzy. I want to thank you all for joining us today. And again, if you haven't then definitely subscribe to the podcast on any platform in which podcasts are streamed. So today's episode, we are talking about doing continuing education different and my guest today are Dr. Jenn Bell and Dr. Art Audrey Elias. They are cofounders of Trailhead learning collective. Audrey is a clinical faculty in the University of Montana School of Physical Therapy and rehabilitative sciences. She completed her DPT in 2009 Did her residency with therapeutic associates in Washington state and then completed her PhD in Clinical biomechanics at the University of Montana in 2015. She then did a postdoc at the University of Guelph before returning to you and PT as clinical faculty training entry level students and residents in the DPT program and in the UN PT clinic. Her primary area of research involves how psychological factors play into movement, particularly following knee injury. Most importantly, she loves being outside weather, skiing, running, hiking, paddleboarding, or lounging around a campfire with her son and her husband. Jen is the program director and clinical and Director of Clinical Education at UMP T. She completed PT school in 2006 then completed her Colm T in 2012, and her side Dee from Texas Tech in 2013, all while treating patients in a variety of settings in rural Alaska. She has treated patients and taught and PT programs in virtually every setting all over the world including Kenya, Ethiopia and Malawi, and is an internationally recognized expert in interprofessional education and Global Health. She is also the CO primary investigator and team advisor for Montana interprofessional student hotspotting improving outcomes in underserved populations in rural Montana. Above all, she is always having a good time outside with family friends food and an adventurer setting example for her two young daughters together and through the values of adventure growth and authenticity, collaboration and respect. Jen and Audrey are working to build a collective of compassionate, confident critical thinkers who utilize best practices in their field. Now, like I said, they are the founders of Trailhead learning collective. And Jen and Audrey have a special offer for healthy, wealthy and smart listeners. If you go to their website, which is on the podcast dot healthy, wealthy dot smart page, and you want to check out their next learning opportunity. Then you get 10% off because you're listening to this podcast. So if you go to Trailhead learned.com Or go to the podcast website, and when you apply to be part of their next learning opportunity, and mentioned this podcast will get 10% off. So a big thank you to Jen and Audrey for that. And in the meantime, everyone enjoyed today's episode. Hello, Jen and Audrey. Thank you so much for coming on to the podcast today to talk about the innovative way you guys are doing continuing education courses. So doing Con Ed differently, and I love it. But before we get into that, Jen, why don't we start with you say a little bit about yourself. So the viewers know or the viewers, the listeners know who's who.   04:12 Yeah, it sounds great. So I'm Tim Doyle and I'm the Program Director and the Director of Clinical Education at the University of Montana's physical therapy program. I've been at UN for nine years. I'm just going in to start my 10th year there, which is wild to think I've been doing this for almost a decade. And prior to moving to Montana, I was in Rural Clinical Practice in Alaska. And so I lived in a town of 2500 people at the end of the road for bed hospital. So got to kind of treat whatever walked in the door. It was a really great opportunity. And during that time, I was working on my doctorate of science who Texas Tech University Health Sciences Center. So yeah, it's all about   04:53 Excellent, Audrey. Go ahead a little bit more about yourself.   04:59 Thanks, Karen. And I'm Audrey Elias. I am also at the University of Montana and clinical faculty there. I treat patients in the clinic, but most of my time is actually treating patients with students. So I'm a preceptor in our integrated clinical education program. And then I also teach in the DPT program, as well. I did my PhD at the University of Montana, I did my DPT at the University of Montana. So I pretty much have been in Montana for a very long time. But I also practiced in Washington, in the far west, on the Olympic Peninsula, in rural areas where we saw lots of different folk. Yeah, and then Jen and I are also cofounders of Trailhead learning collective. So we're heavy, heavy University of Montana. But we're also doing this other thing.   06:02 And we are going to talk about that today. But before we get into that, let's talk about the why behind it. So what has your clinical education or continuing clinical education been like in the past where you thought you know, this, I'm not connecting with this and I need to do something different. So talk a little bit about your journeys.   06:26 And you go ahead   06:29 yeah, um, so you know, carrying that's a great question kind of what informed us to get to this place or we decided to found Trailhead learning collective. You know, I've done I've been in clinical practice and a PT for 15 years, and I've done everything from going to CSM was 17,000 of my closest friends to Education Leadership Conference with the APTA Academy of Education, to, you know, the weekend course that someone brings into their clinic. And what I find oftentimes is that I'm in these courses. And, you know, I'm, I'm finding myself kind of not super engaged with the learning, there's a lot of lecture. And, you know, sitting around going from being in a really active profession where I'm doing everything from crawling around on the ground with my patients to helping them stand up and walk to sitting oftentimes at a plant in a clinic all weekend long, being lectured to. And so I was really looking for something different from that. Actually, what's your experience been? Well,   07:39 I did my orthopedic residency right out of school, and in private practice with therapeutic associates in Port Angeles, Washington, and I averaged one three day weekend of Con Ed a month for almost a year and a half. And I hosted those courses, I got the bagels, I got the coffee, I made sure the bathrooms were clean, I did all of that. So I've done a lot of that. And I've been I did my PhD and went to CSM was 17,000 of my closest friends over and over and over again. I've done like every kind of Con, as you can imagine, I've done you know, 45 minute online things through Harkness school for dance injury. I've done level one pelvic floor. And, you know, they got real intimate with 15 brand new people. And to be so to be my authentic self here, I will fall asleep if I am sitting down for more than 20 minutes. And I will not remember a single thing. Anyone tells me if I'm being lectured at, if I'm not actively engaged in I fell asleep in my first class in undergrad. I it's just how I work. So I have to have really engaging Con Ed, you know, if I'm going to learn anything, otherwise, I do it all on my own afterward, right? So I'll go to 18 hours on a weekend where I don't get to go on my run. I don't get to spend time with my family. I have a 10 year old now I don't get to do these other things that I wanted to do. And then I would have to go home and I'd have to review it all on the treadmill. Because now I'm moving I'm doing stuff and then I can actually learn or I'd have to like go for a run with Jen and tell her all about what we just did in order for me to actually process and I just thought to myself You know, I want something different. I want, I want to use this, I want to use this information immediately. And I also think, doing my PhD, we did, I did a randomized clinical trial, post ACL reconstruction stuff, and just trying to get help people understand how to use that. I can't just tell them, it does not work. It doesn't work. We have to do it, we have to not just show we have to do and work together on it. So yeah, I think it's just a long time of realizing that there's a place and a time for everything. And but there's but there needs to be this thing as well, that can serve people like me.   10:57 And, you know, you kind of described what a lot of continuing education courses are in the PT world where you go, you sit at a plan, you're taking notes, maybe you get a stretch break, you have like some sort of pastry, and coffee. And the question I always had with those in particular is, what if it's not your learning style? What if you need a little something different, like something that involves more demonstration, more movement, more, getting up more? Just a different style of learning. So what have Have you seen the current state of continuing education? And do you feel like we're really maximizing professional development? Go ahead, Jen.   11:44 Oh, Audrey, go ahead. Oh, well, I feel like what's really interesting is that in a physical therapists are super committed to learning. Just in general, I was actually so we're both huge nerds. So he's doing quite a lot of literature search on this. And if I was trying to write an abstract for CSM, I wouldn't be able to, because you have to have at least five papers within the last five or seven years or something. And there just aren't any, there's no literature on what's going on. With Con Ed, currently, there's a paper just this year about so in the PT and PT J, with continuing education courses for orthopedic and sports PTs in the US often lack supporting evidence. And so they went through and review available intervention courses. So great paper. But there was one by Adrian Lowe this year, looking at the impact of a three hour PMP course, on low back pain, and how people did. It was pretty good. It was really interesting. But otherwise, well, next paper is 15 years ago, that I combined. So we don't really know what's going on in the form of knowing that I'm familiar with, we don't really know, in terms of my anecdotal experience, go, the learning environments that I have experienced are not really set up to maximize learning based on pedagogical evidence. So we know that active learning is important. And it just, it makes it like it's really, really hard. We just don't see a ton of that. And I think what happens is that, then we get where content becomes like a chore, right? It's a box, you have to tick, I gotta get Montana, I have to have 20 hours every two years. So I think 3030 Whatever it is, I have to have it and I have to go and check in order to check them tick that box. And I think it ends up becoming problematic on a lot of different levels. Yeah. I don't know if I answered that question completely.   14:15 I think so. Jen, do you need to fill in any blanks there? Yeah, well,   14:20 you know, I think what Audrey was hitting on thinking about in our continuing education courses, we can bring in the pedagogical research, just like we bring in to physical therapy research. And until you know, we do this a lot in our entry level program, we're thinking about what are the best ways that adults learned? How can we convey this information in a way that's effective that's going to address our learning outcomes, not just our patient outcomes. And so that's really one of the things that Audrey and I are looking to bring to our Trailhead learning collective courses and retreats is bringing in the research on active and learning mean, and teaching adult learners. And so bringing that in, you know, really minimizing the amount of lecture that we do engaging in active learning techniques, whether it's going through cases together, having discussions, you know, putting up big whiteboards and doing some, you know, throwing out ideas and looking at other people's ideas, you know, that way really kind of shifting the paradigm from being teacher centered to being learner centered. So you know, when you're in that lecture based course, it's about this expert that's standing in front of you talking and conveying to you what you should be doing in clinical practice. We're really trying to flip that and bring all of these learners together, oftentimes have, you know, decades of clinical practice, have all of these pearls all of this knowledge, and asking them to share it with one another. And we'll bring in the evidence on, you know, the the content that we're teaching on. But really, not bringing a group of people together that have years of clinical practice, and have learned a lot and asking them to not talk to one another and just listen to what an expert says. So really trying to kind of flip that model and really focusing in on the learner experience, and learner engagement.   16:16 Right. And that kind of leads me to the next question, what a perfect transition is, you know, going from a traditional model, which can be effective in getting information from me, the teacher to you, the student? But is it effective when it comes to information processing integration into clinical life? So can you kind of talk about the those concepts as perhaps not being equal and not being the same? And how can we get better integration of information?   16:58 Yeah, can you make a great point, you know, lecture is a really effective way to just transfer knowledge. But that piece of integrating it and making changes is where we see that active learning tends to be more effective. Like Audrey said, there's really not great evidence about, you know, do continuing education courses, impact and change how people engage in clinical practice, we hope and we believe that, you know, if we can effectively teach you something, then you'll use that information. So that's like, that's a gap in the research. But we do know that active learning techniques, improve retention, and kind of consolidation of information, and kind of thinking that information deeper into our longer term memory. And so that's why we use active learning techniques. There's also some really cool, early research coming out on looking at the impact of exercise of aerobic exercise, on learning. And so boom strand and inco, Hall and 2020 published a study and they looked at a single bout of aerobic exercise. And what they found is that it improves attention, concentration, and learning and memory functions and young adults. And so there's some studies like that coming out showing that if we can incorporate this component of physical activity, with our learning, either right before, during or after there's some different sides looking at the different benefits of those, then we can improve learning and retention as well.   18:33 And can you give some examples of active learning techniques? Because we've said that a couple of times, and I can just picture people being like, Okay, that's cool.   18:42 But what does that mean? It was so fun. Because I mean, we've both been teaching. For so long, both I will say we've taught both in the entry level DPT program. And then we've also we teach continuing ed courses before this as well. And mostly in that lecture based thing, we're like, oh, I don't like to teach that either. And I think we both were like, Okay, we need to change this up. So we've gone to a week long training on for the National Institute of scientific teaching, and just teaching how to teach in this way. In the sciences. It's very, it's pretty easy to do in the humanities. But in the sciences, it can be very, like, Oh, I just need to get this information across. Right. So in STEM fields, it's like, well, I just need to know how to pipette or whatever in chemistry. So there are lots of different ways so we can do like gallery walks, put up things with small groups. They process the information put up different ways and how they would do it around the room the rest of the day, and then their entire group walks around the process, we can do two to one, activities, give a prompt, everyone has a minute, maybe, to think on their own individually, maybe write something down there is that reflective cognitive process that comes from actively hand writing something down, that there are mental changes who have to write it down, turn to their neighbor, talk about the individual thing, and then come back in a larger group and, and everybody has to go around and say what their partner did, and pros and cons thereof. So lots of discussion. Obviously, when Jen, you had a really good one that you are doing,   20:50 what are the ones that I do with some of my classes is that I, when I start to teach about a new topic, the first thing I do is kind of the same scenario that Audrey just talked about candidate seat by myself, think with a partner and think with a group. But I prompt the group and the learner is to think about what it is you need to know about this topic. So based off your experiences you've had so far, kind of brainstorm, what are the things that you need to know? So we're really priming them to, you know, what is it that I do know? What is it that I don't know? What are things that are what are those, maybe when we share out to group, then people are going to identify those unknown unknowns that they didn't know, they needed to know. And so we can kind of start off by kind of forming a list of everything we're gonna need to go through and talk about, it's great for me, because then I can be like, oh, I need to make sure that we you know, dig into this some more and, and then at the end, we can go back through that list and be like, did we do we know everything we needed to know going into this? And so oftentimes, you know, instead of just starting off with me, like, hi, welcome. And then I start lecturing, why don't we start with you kind of digging into what it is that you want to learn about a topic, and going from there?   22:07 Yeah, I love that that's very similar to a course that I took last year through Goldman Sachs called the Goldman Sachs 10 KSB program, which is 10,000 small business program. And it is exactly what you just described, we would get the information, we would they would give us prompts to do ourselves, we have a paired partner, where we would talk about them, then we go into the larger group and talk about what our partners did. And the partners would talk about what we did. And it was really, really helpful. And that's the first time I've experienced that I've never experienced that at a continuing education course. So in it, it it really, like when you're done, you're like, Oh, I yeah, I know this, I understand it, I get the concepts, it's like rooted in there, because you had so many conversations about it with one on one with your instructor and with the group.   23:00 I think physical therapy can be so at work, we are so busy, right? Seeing 12 to 20 people a day, sometimes you have to be going, I know, and getting your documentation done all this stuff. It's rote, you're just going, boom, boom, boom, boom, boom. And so going into a Con Ed course and learning a clinical Pearl for five minutes. And maybe you even talk briefly with your buddy about how you might use that. The sad fact is that on Monday, when you go in your brain, you are going to drop down into habitual levels that just are, especially if you've been in practice for more than six months. And it takes a lot of energy to, to, in the moment, reflect back on what you did and saw and actually incorporate it deeply into your body. But with these techniques, we can get at least a tiny little tendril, of a root. And hopefully that can grow and root a little deeper, so that we see more change in how we're actually working. And we're actually treating patients   24:17 and does it sounds like we're becoming a little too robotic. A little too robotic, maybe in work a little too robotic in continuing ed. You know, like, you're okay, I have to go. I'm going to sit, I'm going to listen to these lectures. I'm going to get through it. I'm going to get my CPUs and then I'm going to do this on Monday and then it just doesn't happen. So then what what happens to that continuing education? Does it just fall out of your head like what happens?   24:47 Well, how many times have you take learned anatomy of the hip? Every single continuing education course you teach anatomy of the hip? I have taught I learned it. I've taught it many, many times. Each and every single time, I forget it. And I need that review because those things do drop out of our heads so quickly. And it's not bad. It's not saying that we're wrong or awful, that is normal. That is being a human, we can't get away from it.   25:18 One of the things that we try to do with these opportunities to really engage with the different people that are there in this in this group with you learning together, is giving you the opportunity to take that that new knowledge, or maybe that review of knowledge you've learned before, and take it and look at it a different way. And think about how you know, the person you're working with is going to use that in their practice, and then really work as a team to think about how can I take this knowledge in on Monday, in my setting, I mean, you know, here in Montana, I have clinicians that are going back to, to dot Montana, and are practicing in the next PT is 100 miles away. So how can they incorporate that into their clinical practice, versus the clinician, you know, that's in a sports specialized clinic in Bozeman, Montana. And so we really want to empower clinicians not just to suck in all the information that we're giving to them, but actually really dig into the material and think about how they can use it. And so one of the things we're trying to do with our courses is challenge the assumption that in these 15, CEUs, that you're going to earn, that we have to pack in as much material as possible. That's really not an assumption that we're working off of. So we're we're going to kind of switch that paradigm and say, instead of having this massive breadth of information, we're gonna give you a smaller amount of information, but we're gonna go a lot deeper. And we're really going to dig into how you can use this in clinical practice. And so it's just a kind of a shift in that assumption.   27:01 Yeah. And that leads me into the next question, again, a great lead in how is Trailhead learning collective different? How were you set up differently,   27:10 one of the things that we talked about a lot. And going back to when you said, it sounds like we're getting a little robotic. I think one of our kind of prime values, our main values is authenticity and respect. And that's respecting everything from the land that we're on to the humans that we're working with. We are working with humans, our patients are humans, but are we as clinicians are human. And I think it's important to respect that, like taking that much time away is hard. And burnout is very, very real and extremely prevalent. So one of the things that we are really wanting to do is make a trailhead learning retreat, actually, that like it's a retreat, it is the time to rediscover joy. In physical therapy, it's a time to go to a cool place, have someone take care of you. So all inclusive, your housings included, it's delightful, you're on a mountain or on a beach or wherever we happen to be in the desert. In house chef cooking your meals that are delicious, and primed for you. And having active learning where you're an active participant and feeling engaged, and validated and real, and also get to go out and adventure like experience the place. Yeah, I've been to so many cool places for continuing education, and ended up sitting in a plant in a clinic or in a conference room for the entire day. And then, in order to get any exercise at all, I just went for a run on the treadmill in the hotel. And I didn't get to experience anything about that place. So I think one of the thing that is making Trailhead different is we're really trying to treat the learner as a whole human being and make this time worth it both personally and professionally. In kind of all of those different aspects when you go for a cool trail run, we can make that happen. And you can get 15 hours you can tick that box for sure. And we'll make it worth your time. And you get to be taken care of for a little while.   29:44 Yeah, kind of reminds me of when you see on social media people saying How come I didn't take Monday off of work after having this continuing ed course it was too much and now I'm like totally burned out. So it sounds like maybe this would quell that a little bit. it. And the other part I wanted to talk about is something that we spoke about before we went on. And that's making a connection with the people in the course with you. Because so often we go to these courses, maybe there's 20 people, maybe there's 100, and you end up knowing no one, when you leave. Right. So how, how are you addressing that?   30:21 Yeah, Karen, that's a great point, I went to a continuing education course, a few years ago in San Francisco, and coming from, you know, at the time I was practicing in rural Alaska. And so I really would have loved to get to know more about, like, what is clinical practice, like, in San Francisco compared to, you know, what I am navigating and I left not knowing a single person, you know, part of that is on me, I didn't, you know, I did the thing that a lot of us do it kind of courses, I sat at my phone in the plant, I said, some, you know, small talk at the coffee. And so we're making a really deliberate effort, we're all in the same housing, we're sharing all of our meals together, and engaging in physical activity together, in addition to the time that we're doing the act of learning and getting those continuing ed credits done. And so really creating a space for folks to show up authentically. So I don't expect anyone to show up to her courses, having had 100% success with every single patient they've ever treated, but we want folks to show up and, you know, talk openly and honestly about the places that they struggle in their clinical practice, and, you know, had those conversations and to have this network develop, as we're in this space together. The the course that we're teaching in October is, of course, provincial wellness for the running athlete. And, you know, Audrey is gonna start us off with some really great conversation about bias and how our beliefs about ourselves as runners impacts how we believe and talk to our running athlete, patients. And so you know, being able to kind of explore those parts of ourselves and how they inform our clinical practice, or maybe, at times, potentially cloud our judgment, we can start to have those more intimate conversations as clinicians and people and start to build that network so that when you leave, you have this collective of physical therapists that you know, that you've created some bonds with.   32:25 Yeah, so kind of being a little more social. And, you know, off it sounds to me, like business retreats that I've gone on, you know, even if it's a one day mastermind, you leave with these people who, even after one day, kind of stay with you, because you've purposefully made those bonds.   32:46 Yeah, exactly. And I think that's one of the things that, that the business role does really well is that if we're gonna bring all these people together, we're going to, you know, put them in spaces and create opportunities for them to network on that deeper level. And in physical therapy, we are so focused on getting our patients better at all are we're so focused on the patient, that oftentimes the time when we gather for continued education, we're not speaking about each other as clinicians. And, and like Audra said those hope people that show up. And so that's one of the ways that we are approaching this differently.   33:24 Yeah, it sounds it sounds delightful. And now as we start to wrap things up, what do you want the listeners to take away? What are your big talking points? Or maybe there's only one? I don't know. But what do you want people to take away from? How and why you're doing things differently?   33:47 I think one of the one of the things that I want people to understand for themselves is that there is a time and place for everything. And sometimes you need that quick online 30 minutes learning about FAI, or stroke or whatever, because you have a patient who's really like, right, then you need a little bit and you should get some credit for the work that you do in that moment. I think that's excellent. I really like the you know, read for credit that JLS PT does, I had a paper that was a read for credit paper and I was like, This is great. Somebody's gonna like get value, monetary value from reading my paper. That is excellent. traditional lecture has its place but then I think it's fine. I think it's important for people to say you know what, this is what I need. I I need this time and I'm okay with going and getting it I deserve that. I am a value as well. And this is important. So I think you know valuing Oh, that kind of experience a little more. want somebody to take that away? Well, you know, I think that   35:09 I have two small daughters. And oftentimes the parenting people say, you know, it's really important to take care of yourself so that you can better take care of your kids. And I think that we have to remember that as clinicians, and so finding ways to really take care of ourselves as, as people and humans, as we're doing this continuing education, certainly there's those times where like Audrey said, you need that quick Con Ed. But there, there is an alternative way to get your continuing education done. That also takes care of yourself.   35:43 Yeah, I love it. I love the concept around it. And I, I think you guys are going to be successful in this because it sounds like it's plugging a hole in the continuing education world that people really want. And I also think it's outstanding that you are both been educators for close to a decade. And you can bring all of that to, to continuing education courses. Because I think that's really important. Now, let's talk about when the course is where people can find it social media, where can they find you give us all the details.   36:28 Yeah, so our upcoming courses October 7, eighth, and ninth in Whitefish, Montana. So as I said earlier, so of course on prevention and wellness for the running athlete that is paired with guided trail running with our friends and partners with Alpine reading diets. So you can find information about our course and upcoming courses, we're about to announce a winter course that snowshoeing skiing, and biking, fat biking. That's all on our website, Trailhead. learned.com,   37:01 I wanted to say that we're gonna do 10% off the first retreat for healthy, wealthy and smart listeners, just we so the way we do it is we get your information, and then call you this is a very intimate environment. So we want to start off that way. So you would send us your information that you're interested in the course we call you, we get everything. And at that point, just say that you heard about it from healthy, wealthy and smart.   37:29 The last question is what I asked everyone, and knowing where you are now in your life, and in your career, what advice would you give to your younger self and your younger self, let's say maybe right out of PT, school,   37:43 you know, the advice that I would give to my younger self, is actually advice that I continue to get to my, I'm not gonna say older self, but current self. And we'll get to my future self. You know, I read this great book, by Adam Grant called Think again. And in the book, he talks about, you know, really staying flexible in your thinking. And I think there's been a lot of times in my life that I've had a five year plan, and I'm going to fix my five year plan. And I think I would encourage my younger self to have maybe a very loose plan, but to not get too stuck on what the five year plan is, there are certainly times in life where that five year plan helps you stick it out, like when you're doing your doctorate or science. But there's been so many opportunities that if I was, you know, had pigeon holed myself into that five year plan, I would have missed them. And so to remain flexible, and keep watching for those various opportunities.   38:42 Yeah, I love it. Audrey, how about you?   38:47 I think they would give the same advice to myself now that I did, that I would give to my younger self as well. And it's advice that I give to my students. And that would be that it's all worth it. Like all of those experiences are things that you can draw on for your as you're talking to patients. And as you're thinking critically, I teach clinical reasoning, and all of those experiences give you some flexibility of thought. And I think that's really important. So like going and just experimenting and being okay, like it's alright to go do different things that aren't exactly on   39:30 your path. Excellent advice from both of you. And I do want to thank you so much for coming on the podcast and talking about doing continuing education different with Trailhead learning collective. I think it's it sounds like a great opportunity, and I encourage all the listeners to check it out. We'll have links at the podcast, follow them on social media. So thank you so much for coming on and sharing all of your fun stuff. Coming up. Thanks so much.   40:03 Thanks for having us. Ontarian it's been great to chat with you. Yes. Awesome.   40:06 Thanks so much,   40:07 and everyone thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.   40:13 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media

In this episode, Founder of Enhanced Recovery After Delivery™, Dr. Rebeca Segraves, Co-Founder of Entropy Physiotherapy, Dr. Sarah Haag, Owner and Founder of Reform Physical Therapy, Dr. Abby Bales, and Co-Owner of Entropy Physiotherapy, Dr. Sandy Hilton, talk about the consequences of overturning Roe v. Wade. Today, they talk about the importance of taking proactive measure in communities, and the legal and ethical obligations of healthcare practitioners. How do physical therapists get the trust of communities who already don’t trust healthcare? Hear about red-flagged multipurpose drugs, advocating for young people’s education, providing physical therapy care during and after delivery, and get everyone’s words of encouragement for healthcare providers and patients, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Our insurance-based system is not ready to handle the far-reaching consequences of forced birth at a young age and botched abortions.” “We do need to know abortive procedures so that we can recognize when someone has been through an unsafe situation.” “We really need to take into consideration the ramifications of what this will do.” “This is not good healthcare and we need to do more.” “We’re going to have to know our rules, our laws, and what we’re willing to do and go through so that we can provide the care that we know our patients deserve.” “We’re looking at the criminalization of healthcare. That is not healthcare.” “We know who this criminalization of healthcare is going to affect the most. It’s going to affect poor, marginalized people of color.” “We can no longer choose to stay in our lane.” “We need to have a public health physio on the labour and delivery, and on maternity floors.” “We don’t get to have an opinion on the right or wrongness of this. We have a problem ahead of us that is happening already as we speak.” “We need to create more innovators in our field, and education is the way to do that.” “This is frustrating and new, and we’re not going to abandon you. We’re going to figure it out and be there to help.” “Our clinics are still safe. We are still treating you based on what you are dealing with, and we will not be dictated by anybody else.” “If you need help, there is help.” “If we believe in the autonomy of an individual to know all of the information before making a decision, then we still believe in the autonomy of an individual to know all of the information that is best for their body.” “This affects everyone. We’re dedicated to advocating for you.”   More about Dr. Rebeca Segraves Rebeca Segraves, PT, DPT, WCS  is a physical therapist and Board-Certified Women’s Health Clinical Specialist who has served individuals and families within the hospital and home during pregnancy and immediately postpartum. She has extensive experience with optimizing function during long-term hospitalizations for high-risk pregnancy and following perinatal loss and pregnancy termination. In the hospital and home health settings, she has worked with maternal care teams to maximize early recovery after delivery, including Caesarean section, birth-related injuries, and following obstetric critical care interventions. She is the founder of Enhanced Recovery After Delivery™, an obstetrics clinical pathway that maximizes mental and physical function during pregnancy and immediately postpartum with hospital and in-home occupational and physical therapy before and after birth. Her vision is that every person will have access to an obstetric rehab therapist during pregnancy and within the first 6 weeks after birth, perinatal loss, and pregnancy termination regardless of their location or ability to pay.   More About Dr. Sarah Haag Dr. Sarah Haag, PT, DPT, MS graduated from Marquette University in 2002 with a Master of Physical Therapy. She went on to complete Doctor of Physical Therapy and Master of Science in Women’s Health from Rosalind Franklin University in 2008. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health, becoming a Board-Certified Women’s Health Clinical Specialist in 2009 and Certification in Mechanical Diagnosis Therapy from the McKenzie Institute in 2010. Sarah joined the faculty of Rosalind Franklin in 2019. In her roles at Rosalind Franklin, she is the physical therapy faculty liaison for the Interprofessional Community Clinic and teaching in the College of Health Professions. Sarah cofounded Entropy Physiotherapy and Wellness with Dr. Sandy Hilton, in Chicago, Illinois in 2013. Entropy was designed to be a clinic where people would come for help, but not feel like ‘patients’ when addressing persistent health issues.   More About Dr. Abby Bales Dr. Abby Bales, PT, DPT, CSCS is the owner and founder of Reform Physical Therapy in New York City, a practice specializing in women’s health and orthopedic physical therapy. Dr. Bales received her doctorate in physical therapy from New York University and has advanced training through the renowned Herman and Wallace Pelvic Rehabilitation Institute, Grey Institute, Barral Institute, and Postural Restoration Institute, among others. She also holds her Certified Strength and Conditioning Specialist certification from the NSCA and guest lectures in the physical therapy departments at both NYU and Columbia University, as well as at conferences around the country. Dr. Bales has a special interest in and works with adult and adolescent athletes with a history of RED-S (formerly known as the Female Athlete Triad) and hypothalamic amenorrhea. A lifelong athlete, marathon runner, and fitness professional, Dr. Bales is passionate about educating athletes, coaches, and physical therapists about the lifespan of the female athlete. Her extensive knowledge of and collaboration with endocrinologists, sports medicine specialists, pediatricians, and Ob/gyns has brought professional athletes, dancers, and weekend warriors alike to seek out her expertise. With an undergraduate degree in both pre-med and musical theatre, a background in sports and dance, 20 years of Pilates experience and training, Dr. Bales has lent her extensive knowledge as a consultant to the top fitness studios in New York City and is a founding advisor and consultant for The Mirror and the Olympya app. She built Reform Physical Therapy to support female athletes of all ages and stages in their lives. Dr. Bales is a mom of two and lives with her husband and family in New York.   More About Dr. Sandy Hilton Sandra (Sandy) Hilton graduated with a Master of Science in Physical Therapy from Pacific University in 1988. She received her Doctor of Physical Therapy degree from Des Moines University in 2013. Sandy has contributed to multiple book chapters, papers, and co-authored “Why Pelvic Pain Hurts”. She is an international instructor and speaker on treating pelvic pain for professionals and for public education. Sandy is a regular contributor on health-related podcasts and is co-host of the Pain Science and Sensibility Podcast with Cory Blickenstaff. Sandy was the Director of Programming for the Section on Women’s Health of the American Physical Therapy Association from 2012 - 2017. She is now on the board of the Abdominal and Pelvic Pain special interest group, a part of the International Association for the Study of Pain.   Suggested Keywords Healthy, Wealthy, Smart, Roe v Wade, Abortion, Trauma, Sexual Trauma, Pregnancy, Advocacy, Pelvic Health, Healthcare, Education, Treatment, Empowerment,   To learn more, follow our guests at: Website:          https://enhancedrecoverywellness.com                         https://enhancedrecoveryafterdelivery.com                         https://www.entropy.physio                         https://reformptnyc.com Instagram:       @sandyhiltonpt                         @reformptnyc                         @enhancedrecoveryandwellness Twitter:            @RebecaSegraves                         @SandyHiltonPT                         @Abby_NYC                         @SarahHaagPT LinkedIn:         Sandy Hilton                         Sarah Haag                         Abby Bales                         Rebeca Segraves   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy. Hey everybody,   00:36 welcome back to the podcast. I am your host, Karen Litzy. And on today's episode, I am very fortunate to have for pretty remarkable physical therapists who also happen to be pelvic health specialists. On to discuss the recent Supreme Court ruling in the dobs case that overturned the landmark ruling of Roe vs. Wade. How will this reversal of Roe v Wade affect the patients that we may see on a regular basis in all facets, facets of the physical therapy world. So to help have this discussion, I am very excited to welcome onto the podcast, Dr. Rebecca Seagraves and Dr. Abby bales and to welcome back to the podcast Dr. Sandy Hilton, and Dr. Sarah Hague. So regardless of where you fall on this decision, it is important that the physical therapy world be prepared to care for these patients. So I want to thank all four of these remarkable physical therapists for coming on to the podcast. Once the podcast starts, they will talk a little bit more about themselves, and then we will get right into our discussion. So thank you everyone for tuning in. And thanks to Abby, Rebecca, Sandy, and Sarah.   02:03 I, my name is Rebecca Seagraves, I'm a private practice pelvic health therapist who provides hospital based and home based pelvic health services and I teach occupational and physical therapists to provide their services earlier in the hospital so that women don't have to suffer.   02:20 Perfect Sarah, go ahead.   02:22 I am Sarah Haig. And I'm a physical therapist at entropy physiotherapy in Chicago, and I'm also assistant professor and at a university where I do get to teach a variety of health care providers.   02:35 Perfect, Abby, go ahead. My name is Abby bales. I'm a physical therapist, I specialize in pelvic health for the pregnant and postpartum athlete. I have my practice in New York City called perform physical therapy, and I do in home visits and I have a small clinic location.   02:54 Perfect and Sandy. Go ahead.   02:56 Sandy Hilton. I'm a pelvic health physical therapist. I'm currently in Chicago with Sara entropy. And I'm in Chicago and online. Because we can see people for consultations wherever they are, and we may be needing to do more of that.   03:13 So the first question I have for all of you lovely ladies, is how will the recent Supreme Court ruling in the dobs case, which was overturning Roe v. Wade? How is that going to affect people who give birth that we see in our clinics in the hospital setting in an outpatient setting in a home setting? So let's start with Sara, go ahead. I'll start with you. And then we'll just kind of go around. And and and also feel free to chime in and you know, the conversation as you see fit? Got?   03:58 That's such a big question. And I get to go first. So the question was how, how is this decision going to affect people who give birth? And I would say it just it affects everyone in in kind of different ways. Because I would say what this will undoubtedly do is result in us seeing people who didn't want to give birth. And and I think, you know, the effects of that are going to be far reaching and that we I think maybe we in this little group can have an idea of, of the vastness of this decision, but I think that even we will be surprised at what happens. I think that how it will affect people who give birth. Gosh, I'm kind of speechless because there's so many different ways. But when we're looking at that person in front of us with whatever they need to do For whatever they need assistance with after giving birth, we're going to have to just amplify exponentially our consideration for where they are and how they felt going into the birth, how they got pregnant in the first place. And, and kind of how they see themselves going forward. We talk about treating women in the fourth trimester. And it's, I mean, I'm in that fourth trimester, myself, and I can tell you that it would be harder to ask for help. And I'm really fortunate that I, that I have that I do have support, and that I do have the ability to seek help. I have a million great friends that I can reach out to for help, but I'm just how the how it's gonna affect the women, I'll say, I'm scared, but it's not about me. I'm very concerned for other women who won't be able to access the care that they that they need.   06:05 Yeah, Sandy, go ahead. What do you think? How do you feel this decision will affect people who can give birth, especially as they come to see physical therapist, whether that be during pregnancy? As Sarah just said, the fourth trimester, or perhaps after a procedure, or abortion that maybe didn't go? Well? Because it wasn't safe?   06:30 Yeah, so I work a lot with pain. One of my concerns is, but what is the future gonna hold for some people who did not want to be pregnant not added some sort of convenience or concern for finances, both of which, you know, your spot in life determines whether or not you have the the ability to raise another person at that moment. So there are individual decisions that people should make, in my opinion, but also, there's the if something happens to you, that you did not give permission to happen. And then you are dealing with the consequences. In this instance, pregnancy, and you happen to have back pain or have hip pain, or have a chronic condition, or a pelvic pain history, where you didn't not want to be pregnant. How's that going to affect the pain and the dysfunction that you're, you are already happening? And will it sensitize people to worse outcomes and recovery afterwards, because this is a, you know, there's a perceived injustice scale, I want to pull that back out. I hadn't been using it very often in the clinic just didn't seem to change the course of care. But I think that when I'm working with the people pre post, during pregnancy, I think I'm going to pull my perceived injustice scale back out and see if that might be a nice way to find out. If I need to hook someone up to a counselor, a financial counselor, psychologist, sexual therapist, anyone who might be able to support this person, we already don't have good support systems for pregnancy. I just am astounded at how much what a bad choice it is to add more need to a system that isn't currently handling the demand. I know we're gonna need to get creative because these people will need help. But I am a little awestruck at the possible quantum s we're gonna walk into   08:51 an abbey you had mentioned before we started recording about you know, some of the folks that you see that may have a history of different kinds of trauma, and how that may affect their abilities are to kind of wrap their head around being pregnant and then being forced to give birth because now they don't have any alternative. So how do you feel like that's going to play out in the physical therapy world, if they even get to physical therapy if they even get to a pelvic health therapist?   09:34 Yeah, that's, that's one of the things that I was I was thinking about as everyone was chiming in was, we really are just at the precipice in our niche of our profession, where people who give birth are seeking or even hearing about pelvic health and postpartum care, pregnancy care there. Just barely hearing about it. And my I have, you know, a concern, a very deep concern that these people will go into hiding if they have had an abortion in the past, because are we obligated to report that, and what is the statute of limitations on that, and the shame that they might feel for having had an abortion, or having had give birth and didn't want to, and the trauma that my patients who have, for the most part, not everyone who have wanted pregnancies that either the birth is traumatic, the pregnancy is traumatic, they get to a successful delivery, or they have a loss during the pregnancy, the trauma that they are experiencing, and for the most part, I'm seeing adults, and I cannot comprehend children, because it's this gonna be a lot of children who are forced to give birth, or who are having unsafe abortions, and the trauma that they're going to experience, and how, how much it takes for a person who has sexual trauma or birth trauma to get to my clinic, how these young people how these people who feel that shame, I don't know how they're going to get to me, or any of us, except for a real team based approach with pediatricians, with hospitals, with OB GYN, with your gynecologist with people who might see them first before us. I just don't know how they get to us to be able to treat and help treat that trauma. And like Sandy said, that pelvic pain that might be a result of the trauma if if it's unwanted sexual intercourse, I just don't know how we get to them. And that is something that we struggle with now, with, for the most part, wanted pregnancies. And I don't know how we get there. And I don't think we're prepared as a profession. for that. I think the advocacy for getting ourselves into pediatricians offices into into family medicine offices, is going to be so crucial in getting to these patients. But there aren't enough of us. We are not prepared. And our insurance based system is not ready to handle the far reaching consequences of forced birth at a young age and botched abortions. It is not ready to handle that.   12:52 Rebecca, go ahead. I'm curious to hear your thoughts around this because of your work in acute care systems.   13:00 Absolutely. I believe that I'm beyond the argument of whether this is right, or whether this is wrong. I think that as a profession, we're going to have to quickly change to a mindset of can we be prepared enough to handle what Abby was saying the amount of trauma, the amount of mental health I think, comes to mind when when someone's autonomy is taken away from them in any regard. I was very vocal as to how dangerous it was to force, you know, mandates on people even last year. And now here we are, we're at a point in our profession where we have to now separate our own personal beliefs and be committed to the oath of doing no further harm because this will result in harm, having treated individuals after an unplanned cesarean section or a cesarean hysterectomy, because of severe blood loss. They had no choice in those procedures. And they had no choice in the kind of recovery or rehabilitation they would get. I had to fight an advocate for our services, physical and occupational therapy services to be offered to individuals. So when you're looking someone in the eye who has lost autonomy over their body as last choice has gone through trauma that changes you it changes me really as a profession, even on this a professional or even on this issue. I'm now pivoting as quickly as I can't decide, do I have the skills that's going to be needed to address maybe hemorrhage events from an unsafe abortion that's performed? Maybe the mental health of having to try All across state lines so that you can find a provider that will treat you maybe the, you know, the shame around, you know, even finding Well, you know, is there a safe space for me to be treated for my pelvic health trauma from you know, maybe needing to carry this pregnancy longer than then I would have wanted to, there's, there's so much around this that we really have to start looking at with a clinical eye with a very empathetic or sympathetic eye as pelvic health therapists because of the fact that there's so few of us. And because now we're in a scenario where there will be more people who will be needing services but not knowing who to turn to. So my my biggest hope from this conversation, and many more that we'll have is that there's some how going to be a way to designate ourselves as a safe space for anyone, no matter what choice they've made for their body, period, I'm really done with being on one end of the spectrum with this, I'm a professional that doesn't have that opportunity to just, you know, be extreme on this, I advocate for the person and for their choice over their body period.   16:17 I think we need to, and it's just beautifully, beautifully said, the the getting getting some small systemic procedures in place in the communities we live in, is most likely the first step is reach out to the pediatricians and the chiropractors and the massage therapists and the trainers and the school athletic trainers and whoever you find that can have a connection with people and let them know on an individual basis. So like how do you tell people hey, I'm a trustworthy clinic to come to is not usually by writing it on your website. But if you can make connections in your community and be a trusted provider, that's going to go further, I suspect. I'm assuming there's going to be a fair bit of mistrust. And we have to earn it once it's lost. We've got to earn it back. So yeah, I like the proactiveness of that.   17:22 I, I totally agree on something you said Sandy sparked something that I would love for a health care lawyer to start weighing in on is we want, I am a safe space. I think every patient I have ever met who sees me cries. And I hold I hold that part of what I do. Very close to me, it's it's an honor to be someone that my patients open up to. And I know all of you on this call feel the same way because we we are that place that they they I love hearing birth stories. I love it. Even it just gives me an insight into that person into that experience. I feel like I'm there with them. And I understand better what they have gone through. But what happens when the legal system is going to come for us? Or them through us? What happens to that? How do we continue to be a safe space where they can share their sexual trauma, their birth trauma, their birth history, their pregnancy history, their menstruation, history, their sexual history? All of those really, really intimate things? How do we continue to be that for our patients?   18:56 I think we've had to do this I've had to do this previously, for in some very, in situations of incest in for the most part, we need a trigger warning on this. But, you know, there you have an individual that is a minor, or, or for some reason not independent that is being abused in what is supposed to be their safe space. And then that person, the abuser can be like, Oh, look, I'm helping you get better. And they're actually not safe. So there's some things and if the person you're treating is a minor, that adult has access to their records. And so I've worked in places not I don't know how to do with an EMR but I've worked in places where we have our chart that we write down the official record and sticky notes, which are the things that will not get put in the official record. But we need to have written down so people know it. And we've had to do that in situations where the patient wasn't safe. We all knew the patient wasn't safe. was being worked on to get them safe, but they were not yet safe. And you had to make sure there was nothing in their records that was going to make them more unsafe. I don't know how to do it as an EMR, if someone has a clever way to do that, that'd be great. Or we go back to EMR plus paper charts.   20:18 Even to to add to your point, Abby, if we're looking now at possible, you know, jurisdiction, you know, lead legal their jurisdiction or subpoena of documentation, you know, after having intervened for someone who may have had to make a choice that their state did not condone? Yeah, no, I, I'm completely, you know, on guard against that now, and that those are things that I'm thinking about now and thinking about, well, what would my profession do? Would we back, you know, you know, efforts on Capitol Hill to advocate for, you know, someone who, who has lost their, their autonomy, or lost their ability to, to at least have a safer procedure, and we've had to intervene in that way. You know, I think about that now, and I, that makes me fearful that this is such a hot topic issue that, you know, we might not as an organization want to choose size, but we as professionals on the ground as pelvic health therapists, I don't think that we have that luxury and turning someone away. And so So yeah, I think more conversations like this need to be had so that we can form a unified front of at least, you know, pelvic health specialists that can really help with the the after effects of this.   21:38 And I think a big barrier to that legal aspect of it is, you know, what is our legal responsibility. And what happens, if we don't do XYZ is because a lot of the laws and a lot of these states, some of these trigger laws and other laws being that are being passed, the rules seem to be a bit murky. They're not clear. And so I agree, I think the APTA or the section on pelvic health needs to come out with clear guidelines as to what we as healthcare professionals, can and should do. But here's the other thing that I don't understand and maybe someone else can. What about HIPAA? Isn't that a thing? Where did the HIPAA laws come in to protect the privacy between the provider and the patient? And I don't know the answer that I'm not a lawyer, but we have protection through hip isn't that the point of a HIPAA HIPAA laws? I don't know what   22:44 you would think so. But unfortunately, one of the justices who shall not be named has decided that abortion does not fall under HIPAA, because it involves the life of another being in so I can only state what has been stated or restate. But yes, the those are the very things that I'm afraid we're up against as professionals.   23:12 Yeah, I think they're going to try to make us mandatory reporters. for it. I think they're gonna try to make all healthcare we are mandatory. For some things, the thing that's good for some things. Yeah, the   23:24 thing that bothers me about that is the where I'm in Illinois right now, Illinois is a designated, look, we're not, we're not going to infringe on people's right to health care. Just great. But some of the laws and I've lost track, I was trying to keep track of how many have are voting on or have already voted on laws that would have civil penalties, penalties of providers from other states, regardless of the Practice Act of that provider, to be able to have a civil lawsuit against that provider. So that's fun. And then we go back to what ABBY You had mentioned before we started recording about medicine, that that is considered an abort efficient, I have a really hard time with that word. But that is also used for other conditions that we see in our clinics for pain for function and things like that. And then where's our role?   24:33 Right, so does someone want to talk about these more specific on what those medications are and what they're for? So that people listening are like, Okay, well, what medications, you know, so do you want to kind of go into maybe what those medications are, what they're for and how they tie back into our profession. Because, you know, a lot of people will say, well, this isn't our lane. So we're trying to do these podcasts. so people understand it's very much within our lane.   25:03 Well, I yeah, it's just from a pharmacology standpoint, the one of the probably most popular well known drugs that's used for abortion is under the generic name of Cytotec misoprostol, and that's a drug that's not only only used for abortion, but if individual suffers a miscarriage is used to help with retained placenta and making sure that the uterus clears. What other people don't know is is also used for induction. So the same drug is used for three or four different purposes. It's also used for postpartum hemorrhage. So measle Postel, or Cytotec is a drug as pelvic health therapists we should be very familiar with. And we should be familiar with it. Not only you know, for, you know, this this topic, but it's also been a drug that's been linked with the uterus going into hyperstimulation. So actually putting someone at risk for bleeding too heavily. And all of this has a lot of implications on someone's mental health, who's suffered a miscarriage who's gone through an abortion that maybe was not safely performed, which I have had very close experience with someone who's been given misoprostol Cytotec, it didn't take well, she continued bleeding through the weekend, because she lived in a state where emergency physicians could opt out of knowing a board of medications. So as professionals, we do need to know, a board of procedures so that we can recognize when someone has been through an unsafe situation it is, it is our oath as metal as medical professionals to know those things, not to necessarily have a stance on those things that will prevent us from providing high quality and safe care.   26:52 Another one of the medications is methotrexate, and it's used to treat inflammatory bowel disease. And as public health specialists, we'd see people who have IBD, Crohn's and Colitis, who have had surgery who are in flareups who are being treated like that treated with that medication. And it is again used in in abortions. And when you're on that medication, you have to take pregnancy tests in order to still be able to get your prescription for that medication. And as a person who I myself have inflammatory bowel disease and have been on that medication before, I can tell you that you don't go on those medications lightly. It is you are counseled when you are of an age where you could possibly get pregnant, and taking those medications. And it's very serious to take them. And you also have to get to a certain stage of very serious disease in order to take that it's not the first line of defense. So if we start removing medications, or they start to be red flagged on EMRs, or org charts, and we become mandatory reporters for seeing that medication, God forbid, on someone's you know, they're when they're telling us what type of medications they're taking, that there would be an inquiry into that for for any reason is just it's it's horrifying. I mean, it's, we treat these patients and they trust us, and we want them to trust us. But as we get farther and farther down this rabbit hole of, of going after providers, pharmacists, people who help give them information to go to a different state, I just it is. Like I said before, the breadth and the depth of this decision, reverberates everywhere. And if if PTS think that they are in orthopedic clinics, that they are somehow immune from it, you're absolutely not. And for those clinics who have taken on or encourage one of their one of their therapists to take on women's health because it's now a buzz issue. It's really cool. You are now going to see that in your clinic. And you know, like Rebecca was saying before, you know any number of us who have really strong and long term relationships with patients who are pregnant who are in postpartum I have intervened and sent patients to the hospital on the phone with them because they have remnants of conception and they have a fever and someone's blowing them off and not letting them into the IDI and sending them home. And we we are seeing those patients, they have an ectopic they're, they're bleeding, is it normal, they're calling me they're not calling their OB they can't get their OB on the phone. They're texting me and saying what should I do? And they have that trust with me and what happens when they don't? And they're bleeding and they're not asking someone that question and they don't know where to go for help. And so I know I took this in a different direction and we talked about pharmacology, but I just thing that I have those patients whose lives I have saved by sending them to the emergency department, because they are sick, they have an infection, they are bleeding, they have an ectopic, it is not normal. And I don't know what happens when they no longer have that trust with us not not because we're not trustworthy, but because they're scared.   30:26 The heavy silence of all of us going   30:31 you know, it's, it's not wrong. And I think the like, it just keeps going through my head. It's just like, so what do we do? I mean, Karen, you mentioned like, it'd be great if somebody came out with a list of, of guidance for us. And I just, that just won't happen. Because there's different laws in different states, different practice acts in different states. And no one, you know, like you even if you talk to a lawyer, they're going to say, this would be the interpretation. But also, as of yet, there's no like case law, to give us any sort of any sort of guidance. So that was a lot of words to say, it's really hard. I can tell you in Illinois, like two or three weeks ago, I'd be like, like, I'm happy, I feel like Illinois is a pretty safe space. We have, we have elections for our governor this year. And I have never been so worried, so motivated to vote. And so motivated to to really make sure to talk to people about it's not just like this, this category or this category, it's like we really need to take into consideration the ramifications of what this will do, I think there was a lot of this probably won't affect me a whole lot. But I think I'm guessing I think a lot of us on this call maybe I think all of us on all of us on this call, have lived our lives with Roe v. Wade. And, as all of this is coming up, and just thinking about how it impacts so many people, and how our healthcare system is already doing not a good job of taking care of so many people, the fact that we would do this with no, no scientific, back ground, no support scientifically. Like I pulled up the ACOG statement, and, and they condemn this devastating decision. And I really, I was like, it gave me gave me goosebumps. And this was referred to in our art Association's statement. And it makes me sad that we didn't condemn it. Hope that's not too political. But I'm really sad that we didn't take a stronger stance to say, this is not good health care. And we need to do more. Again, and that's like, again, so many words, to say we're gonna have to make up our own minds, we're gonna have to know, our rules, our laws and what we're willing to do, and go through, so that we can provide the care that we know our patients deserve. And that's going to be really hard. Because, you know, if I talk to someone, and if I call Rebecca in Washington State, she's going to have something different than if I talk to Abby in New York. And you know, that so it'll be, it'll be really hard even to find that support. That support there's going to be so much support, I think, from this community, but that knowledge and that, that confidence, we have to pull together so we have to pull together with all the other providers, but also we're gonna have to sit down and figure this out to   33:59 the clarity. So it's, I think a practical step forward would be each state to get get, like, every state, come up with a thing. So pelvic health therapists in that state come up with what seems to work for them get a lovely healthcare lawyer to to work with them with it. And then we could have a clearinghouse of sorts of all of the state statements. I don't know that that needs to go through a particular organization. I I know that they're in the field of physical therapy, two thirds of PTS aren't members. And we need this information to be out there for every single person so that they know   34:44 that we'll have to be grassroots there's I don't think that there's going to be widespread Association support from anywhere. But that being said, I think it's a great idea.   34:58 What are we going to do about it? Hang on issues that are too divisive, you're absolutely right, individual entities are going to have to take this on and just put those resources out to therapists who need them need the legal support, need the need to know how and how to circumvent issues in their states. And, you know, like I said before, even how to just provide that emotional support, there's going to be needed for their, their, their patients, so, and that's okay, if the organizations that were part of are not willing to take a heavy stance, you know, even like last year, if you're not willing to take a heavy stance, on an issue where someone feels their autonomy, and their choice is being threatened, then it's okay, well, we'll take it from here. But, you know, that's, that's really where these grassroots efforts come from and abound, because there are a group of individuals who are willing to say, No, this is wrong. And I'm going to do something about this so that our future generations don't have to suffer.   36:02 Yeah, and I think, you know, we're really looking at the criminalization of health care.   36:09 That is not healthcare.   36:12 And we also know who this criminalization of healthcare is going to affect the most. And it's going to affect poor, marginalized people of color, it is not going to affect the wealthy white folks in any state, they'll be fine. So how do we, as physical therapist, deal with that? How do we, how do we get the trust of those communities who already don't trust health care, so now they're going to stay away even more, we already have the highest mortality, maternal mortality rates in the developed world, I can only imagine that will get worse because people, as we've all heard today are going to be afraid to seek health care. So where do we go from here as health care providers? I,   37:10 Karen, you're speaking something that's very near and dear to my heart, I act as if you had to take this on, I am very adamant that we can no longer choose to stay in our lane, we do not have that luxury. And I as a black female, you know, physical therapist, I don't have the luxury to ignore that because of the color of my skin, and not my doctor's degree, not my board certification and women's health, you know, not my faculty position, I when I walk into a hospital, and I either choose to give birth or have a procedure, I will be judged by none other than the color of my skin. That is what the data is telling me is that I am three times likely to have a very severe outcome. If I were to have a pregnancy that did not go as planned or or don't choose a procedure, you know, that affects the rest of my function in my health. And so given the data on this, you're absolutely right there, there is going to be very specific populations that are going to receive the most blowback from this. And as a pelvic health therapist, I had to go into the hospital to find them, because I knew that people of color and of marginalized backgrounds, were not going to find me in my clinic. And we're not going to pay necessarily private pay services to receive that care. But I needed to go where they were most likely to be and that was the hospital setting or in their home. And so, again, as a field of a very dispersed and you know, not very many of us at all, we're going to have to pivot into these areas that we were not necessarily comfortable in being if we're going to address the populations that are going to be most affected by the decisions our lawmakers are making for our bodies.   39:11 You know, there's something that I think about, often when I hear this type of conversation come up in, in sexual health and in in whenever I am speaking with one of my patients and talking about their menstruation history, and, and them not knowing how their body works from such a young age is I just wonder if we should be offering programs for young people like very young pre ministration you know, people with uteruses and their parents, and grandparents and online, online like little anonymous. Yep. nonnamous   39:51 for it's just   39:52 Yes. Yes, it's it's just, you know, Andrew Huberman talks a lot about having data Back to free content that scientific, that's factual. And I think about that a lot. And I think, to my mind, where I go with this, because I do think about the lifespan of a person, is that creating something that someone can access anonymously at any age, and then maybe creating something where it's offered at a school? You know, it's it's ministration health. And it doesn't have to be under the guise of, you know, this happened with Roe v. Wade, but this it could be menstruation, health, what is a person who menstruating what can you expect? What you know, and going through the lifespan with them, but offering them? You know, I think I think about this with my own children, as our pediatrician always asks the question of the visit, who is allowed to see under your clothes who is allowed to touch you? And it's like, you and my, I have a five year old. So it's Mom, when when when I go number two, a mom or dad when I go number two? And that's it. And you know, I think about that, and I think about how we can educate young people on a variety of things within this topic, and kind of include other stuff, too, that's normal, not normal, depending on their age. Absolutely, there   41:22 was what I was excited about in pelvic health. Before this was people like Frank to physician and his PhD students and postdocs are working on a series of research about how if we identify young girls that are starting their period, and having painful periods, treat them and educate them, then that they will not go on to have as much pelvic pain conditions and issues in the future. So we look at the early childhood events kind of thing, but also period pain. And How exciting would it be if we could get education to young girls about just how their bodies work. And to know that just because you all your aunties have horrible periods doesn't mean that you're stuck with this, just like maybe they just didn't know, let's help you out and constipation information and those basic health self care for preventative problems. So I was super excited about all that. And now it's like, oh, now we have to do it. Because in that we can do little pieces of information. So people have knowledge about their body, that's going to be a little bit of armor for them, that they're going to need and free and available in short, and you know, slide it past all the YouTube sensors. This is this is doable, but it's gonna take time money doing, but we can do it. Well, it sounds like, ladies,   42:52 we've got a lot of work to do. One other thing I wanted to touch upon. And we've said this a couple of times, but I think it's worth repeating again and again and again. And that's that expanding out to other providers. So it's expanding out, as Rebecca said, expanding out to our colleagues in acute care, meaning you can see someone right after a procedure right after birth right after a C section. And, and sadly, as we were saying, I think we they may start seeing more women, I'm not even set children under the age of 18. In these positions of force birth on a skeletally immature body. So the only place to reach these children would be maybe in that acute care setting. How what does the profession need to do in order to make that happen? And not not shy away from it, but give them the information that they need. Moving forward?   44:07 I was just gonna say that I've given birth in the hospital twice. Not at any time was I offered a physical therapist, or did a physical therapist come by and I am in New York City. I gave birth in New York City, planned Solarians because of my illnesses. And nobody came by I did get lactation nurses, any manner of people who were seeing me I was on their service. But that has been something that we needed anyway. We mean to have a pelvic health physio on the labor and delivery and on the maternity floors, who is coming by educating as to what they can start with what they can expect. When can they have an exam if they want to have one? Who is a trusted provider for them to have one. And we need to get the hospitals to expand acute care, physical therapy to labor and delivery and, and the maternity floors. As a routine, it's not something you should have to call for, it should be routine clearance for discharge the same way you have to watch the shaking baby video to get discharged.   45:27 I'm happy older than all of you. I don't have it either. But taking baby video is not something that even existed back in the day. But that makes sense. I mean, I once upon a time was a burn therapist, and I was on call at a regional Trauma Center. And you know, it's like you're needed your, your pager goes off, because that's how long ago it was. And you just came in, did your thing, went back home went back to bed. There is no reason other than lack of will, that PTS couldn't be doing that right now.   46:03 I'm now of the opinion where it's unethical to not offer physical or occupational therapy within 24 to 48 hours of someone who had no idea who did not have a planned delivery the way they expected it who has now and a massively long road to recovery. After a major abdominal surgery, I'm now of the opinion that is unethical for our medical systems to not offer that those rehabilitative services. And I've treated individuals who had a cesarean section but suffered a stillbirth. So the very thought of not providing services to someone who has any kind of procedure that's affecting, you know, their their their not only their pelvic health, but their mental function. That to me is now given the you know, these these, this recent decision on overturning Roe v Wade, is now now we're never, you know, either we're going to now pivot again as pelvic health therapists and start training our acute care colleagues, as we did with our orthopedic colleagues, as we've done with, you know, our neurology colleagues, whatever we've had to do as pelvic health therapists to bring attention to half of the population, you know, who are undergoing procedures, and they're not being informed on how to recover, we will have to start educating and kind of really grow beyond just the clinics and beyond what we can do in our community or community. But we are going to have to start educating our other colleagues in these other settings, we don't have a choice, we know too much, but we can't be everywhere. And not all of us can be in the hospital setting, we're going to have to train the individuals who are used to seeing anything that walks through the door and tell them get over to the obstetric unit. Okay, there's someone there waiting for you.   48:06 Yeah, I totally agree. I mean, when I think back I remember as a student working in acute care and how we had someone who's dedicated to the ICU, we had someone dedicated to the medical floor, we had somebody who was dedicated to the ortho floor, and most of the time they had their OCS, their, their, the one for for, for ICU care, the one for NeuroCare, or they have a specialty. And I think it is just remnants of the bygone era of it's natural, your body will heal kind of BS from the past. It's just remnants of that and it's just, we don't need the APTA to give us permission to do this, this is internal, this is I'm going into a hospital, and I'm presenting you with a program. And here is what this what you can build this visit for here's the ICD 10 code for this visit here is here is here are two people who are going to give you know, one seminar to all of your PT OTs, to you know, so that you are aware of what the possible complications and when to refer out and that kind of thing. And then here are two therapists who are acute care therapists who are going to also float to the maternity floor one of them every day, so that we can hit the we can get to these patients at that point, and that is just that's just people who present a program who have an idea, who get it in front of the board that that it is not permission from anybody else to do it. And, you know, it really it fires me up to to create a world in which you know, when you know people who are the heads of departments and chairs and you know on the boards of directors You know, being in big, big cities or small cities, when you know those people, you know, you can, your passion can fire them up. And if you can fire people up, and you can advocate for your patients and you can in that can spread, you can make that happen. And this is, you know, I feel radicalized by this, I mean, I'm burning my bra all over the place with this kind of thing. And I just feel like, if we can, if we can get to young people, and if we can get to day zero, of delivery, day one, post delivery, or post trauma, then then maybe we can make a dent, maybe we can, maybe we can try, maybe we can really make a go of this for these people. Because, like I keep feeling and saying I, we are not prepared for the volume.   50:54 If individuals are going to be forced to carry a pregnancy, that they may not want to turn because it's affecting their health, we're going to have to be prepared for this. Again, this is not an option really, for us as pelvic health therapists, because we know what's down the road, we've seen mothers who have or you know, or individuals who have suffered strokes or preeclampsia or seizures, or, you know, honestly, long term health issues because of what pregnancies have done to their body. And now if they want the choice to say, you know, I'm not ready, they don't have it anymore. So we really don't have a choice. We have to start expanding our services into these other settings, making our neurologic clinical specialists in the hospital, see people before they have a stroke before they have a seizure actually provide services that can help someone monitor their own signs and symptoms after they've had now a procedure or given birth or even had, you know, a stillbirth, unfortunately, because the doctor had to decide, well, yes, now we will perform the abortion because you know, your health is like on the cliff, I mean, we're going to be seeing these and we just have to prepare. And if it's not our organizations that are laying the foundations, we will, we'll take it from here,   52:15 we need to reach out across so many barriers, like athletic trainers, they're gonna see the young girls, they're gonna see their track stars that is not reds, it's pregnancy. And it could be a very short lived traumatic pregnancy, in girls that are just not develop. They're developed enough to get pregnant, they're not developed enough to carry a healthy baby to term. Kind of just makes me like. But Rebecca is right as we don't get to have an opinion on the right or wrongness of this, we have a problem ahead of us now, that that is happening already, as we speak, that people are going to need help. I love that we have more technology than my grandma did when she was fighting this battle. And we have YouTube and we have podcasts and we have ways to get information out. But we need to use every single one of them in our sports colleague or athletic trainer colleagues. They need to know the signs. Because they may be the ones that see it first.   53:21 Yeah. And Sarah as being the most recent new mother here. What kind of care did you get when you were in the hospital?   53:36 I was sitting here thinking about that. And I mean, I will say that the care I had while I was there, that I had an uncomplicated delivery in spite of a very large baby. And I was fortunate enough to leave the hospital without needing additional help. But I wasn't offered physio. Nobody really they're just really curious to make sure you're paying enough. And that's about it if you're the mom and my six week visit was actually telehealth and that was the last time I had contact with a health care professional regarding my own health so it is minimal even if you're a very fortunate white woman in a large metropolitan area and but I'm working now further north and with a pro bono clinic clinic and in an area where we do a lot of work with communities of color and I'm I'm like I honestly don't even know the hospitals up here yet. But I'm gonna I have so many post it notes of things that are gonna start happening and start inquiring because Rebecca like we need to get into the hospitals like if if I can Do that. And honestly, up until now, like my world and entropy was, and pre this decision was it, there's so many people out there who need help with pelvic issues in general, like we can do this forever. And we set our clinic up so that people who weren't doing well in the traditional health care system could find us and afford us. At least some people could, I realized that it wasn't in companies, encompassing everybody who could possibly need help, but we were doing trying to figure out another way. And so again, like, like, again, the offer of assistance I got was minimal. But also I didn't need much. And I was in a position where also, I knew I could, I could ask for it if I wanted it. And I could probably get it if I needed it. And I'm just thinking about, again, some of the communities I'm interacting with now, in some of my other roles and responsibilities, and I cannot wait to take a look and see, how can we get in there? How can we be on that floor? How can we? What What can we make, make happen like, because it needs to happen, these are these, this is the place where I'm scared to start seeing the stats,   56:21 wouldn't it be amazing if you can get the student clinic part of that somehow somehow and get, you know, young beyond that bias, but younger, most younger but but like the physicians the the in training the PTs and training the PAs the you know, and get like Rebecca had said, let's get let's get the team up to speed here, because there aren't enough pelvic health therapists already. And they're heavens, we need, we need to get everybody caught up.   56:58 And there's so much I was telling you that being around student health care, providing your future health care providers is really energizing and also really interesting. I mean, the ideas that come up with in the in the connections they make and and the proposals they make are just amazing. But two things that I've noticed that I think probably we run into in the real world, real world, outside school world as well, is one. The that's being able to have enough people and enough support to keep it sustainable. So you have this idea, you have the proposal, you made the proposal, how are we going to keep it going and finding the funding or the energy or the volunteers to keep it going. Things ebb and flow, you get a great proposal, you're like yes. And then I literally today was like, I wonder what's up with that one, because it was an idea for a clinic to help was basically for trans people to our tree transitioning and might not have the support that they need. And also I was reached, they come up here for women's health clinic. And I'm going to reach out to them now. Because this again, this decision changes that because it is a pro bono clinic that they would like to set this up in and before it was going to be much more more wellness. And now it could turn out to be essential health care. So that's one thing. But then the other thing is still the education, that in school, we're not taught about what everyone else can do. And I think again, figuring out a way to make sure that future physicians really know what physical therapists have to offer, especially in this space. Most people know that if their their shoulder, their rotator cuff repair, they should send them to pt. But really, we need to get in with OB GYN news, we need to get in with the pediatricians. And I don't want to say unfortunately, but in this regard, unfortunately, we're going to have to really make sure that they know what we're doing. And again, I'm already kind of trying to think like how can we make this just part of how we do health care.   59:20 So I think I'm following in your footsteps by going into education and by by being a part of our doctor of physical therapy programs. You know, I especially chose the program in Washington state not because you know, of just the the the opportunity to teach doctors or incoming doctors but it was also an opportunity to teach doctors of osteopathic medicine and occupational therapy therapists. It was you know, very intimate program and opportunity to make pelvic health or women's health or reproductive health apart of cardiopulmonary content, a part of neurology content, a part of our foundations a part of musculoskeletal and not a special elective course that we get two days of training on, I had the opportunity to literally insert our care, our specialized and unique care and every aspect of the curriculum, as it should be, because we are dealing with, you know, more or less issues that every therapist generalists or specialists should be equipped to handle. So in the wake of Roe v Wade, to me, this is an opportunity unlike any other for pelvic health therapists to really get into these educational spaces where incoming doctors are, you know, MDS or PA programs, or NP programs are our therapy practices, and start where students are most riled up and having those ideas so that they can go out and become each one of us, you know, go into hospitals and say no, to obstetric units being ignored, go into hospitals and give and services to physicians. You know, we need to create more innovators in our field and education is the way to do that.   1:01:12 I just wrote down check Indiana and Ohio, and then I wrote border clinics, because Because Illinois is a it's like a not a prohibition state. Having so many flashbacks, because Illinois, is, is currently dedicated to maintaining health care access for everyone. We have cities that are on the border. And I was thought of that when you were talking, Sarah, because you're up next to Wisconsin now. But we have we have the southern part of the state and the western part of the state. And those those border towns are going to have a higher influx than I will see in Chicago, maybe. But I would anticipate that they would,   1:01:56 you know, and again, this is where laws are murky. Every state is different. It's I mean, it's a shitshow. For lack of better way of putting it I don't think there's any other way to put it at this point. Because that's kind of what what we're dealing with because no one's prepared, period. So as we wrap things up, I'll go around to each of you. And just kind of what do you want the listeners to take away? Go ahead, Sandy,   1:02:33 this is this is frustrating and new, and we're not going to abandon you. We're gonna figure it out and be there to help.   1:02:41 I would say that our clinics are still safe, it is still a safe place for you to open up and tell us what you wouldn't tell anybody else. It's still safe with us. And we still have you as an entire person with all of your history. We are still treating you based on what you are dealing with and not. We will not be dictated by anybody else. Our care won't be mandated or dictated by anybody. Sarah, go ahead.   1:03:22 What I would say is I would echo your safe. If you need help, there is help. And I'm sorry, that that this just made it harder than it already was. And I would say to healthcare providers, please let remember, let us remember why we're doing what we're doing. And, you know, we do need to stand up, we do need to continue to provide the best care for our patients. Because to be honest, I've been thinking like, I think it's a legal question. It's a professional question. But ultimately, if we can't give the best care possible, I'm not sure I should do this.   1:04:01 Ahead, Rebecca,   1:04:02 for our health care providers, in the wake of Roe v. Wade, being overturned, wherever we are, you know, as an organization or on our stance, if we believed in the autonomy of an individual to know all of the information before making a decision, then we still believe in the autonomy of an individual to know all of the information that is best for their body. And that is the oath that's the that's the that's the promise that we've made as professionals to people that we're serving, and to the people that we're serving to those who are there listening to this. You have safe spaces with providers that you trust and we're going to continue to educate one another, our field and also you we're going to put together resources that really bring During this education to your families so that you don't have to feel like you're in the dark and you're alone. This is not something that is per individual or per person. This affects everyone. And we're dedicated to advocating for you.   1:05:18 Perfect, and on that we will wrap things up. Thank you ladies so much for a really candid and robust discussion. I feel like there are lots to do. I think we've got some, some great ideas here. And perhaps with some help and some grassroots movements, we can turn them into a reality. So thank you to Rebecca to Sarah to Abby and to Sandy, for taking the time out of your schedules because I know we're all busy to talk about this very important topic. So thank you all so so much, and everyone thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.   1:06:03 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com And don't forget to follow us on social media    

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

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

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

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

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.