Healthy Wealthy & Smart

In this episode, President and CEO of Sports and Spine Physical Therapy, Inc., Leon Anderson III, PT, MOMT, talks about AAPT. Today, Leon talks about the history of AAPT, working with his father, and AAPT’s networking opportunities. Hear about AAPT’s mission, encouraging minority students, and clinical research related to health conditions found within minority communities, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “We are still less than 3% of the profession.” “If you can expose a child and broaden their horizons, it gives them more options of what they can do and what they can be when they’re older.” “Just being associated with this network affords you such a wide array of opportunities and possibilities.” “We’re all connected, and we all need one another at some point.” “You won’t know what hits you until it hits you.”   More about Leon Anderson Leon R. Anderson III, is a native of Cleveland, Ohio. He graduated from The Ohio State University Fisher School of Business with a Bachelor of Science degree in Management Information Systems. His first job was as a Systems Analyst/Summer Intern for his fathers company Centers for Rehabilitation, Inc. There he discovered a passion for patient care. Subsequently, he pursued a degree in Physical Therapy at the University of Connecticut. After graduating, Leon was selected for a two year manual therapy residency program earning a masters degree in Orthopedic Manual Therapy from the Ola Grimsby Institute.   Leon is president and CEO of Sports and Spine Physical Therapy, Inc. (SSPT) The company operates three clinics in the greater Cleveland area and one in Charlotte, NC. Leon was inspired by his pioneering father Leon Anderson Jr. who was considered a vanguard of the profession for over 40 years. SSPT’s company culture and core values of providing high quality rehabilitation services are a direct result of Leon’s life long tutelage by his father.   Leon is a charter member of the American Academy of Physical Therapy. He served as a Subject Matter Expert for the American Physical Therapy Association's Orthopedic Clinical Specialist Exam. He also served as an on-site reviewer of the Commission on Accreditation in Physical Therapy Education. (The accreditation agency for entry-level physical therapist and physical therapist assistant programs in the US and UK).   Suggested Keywords Healthy, Wealthy, Smart, AAPT, Healthcare, Impact, Research, Opportunities, Mentorship, Equality, Connections, Education,   To learn more, follow Leon at: Website:          www.SportSpine.com                         https://www.aaptnet.org Twitter:            @LA3OSUCONN Instagram:       @osuconn   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.   00:35 Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found chosen and get those five star reviews. Right now if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic whim. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net health.com forward slash Li TZY to sign up for your complimentary marketing audit today. Now on to today's episode Dr. Jenna cantor. Cantor is back and being the host with the most for this episode. And we are happy to welcome Leon Anderson the third he is a native of Cleveland, Ohio. He graduated from The Ohio State University's Fisher School of Business with a Bachelor of Science degree in Management Information Systems. His first job was a systems analyst summer intern for his father's company centers for rehabilitation. There he discovered a passion for patient care. Subsequently, he pursued a degree in physical therapy at the University of Connecticut. After graduating, he was selected for a two year manual therapy residency program earning a master's degree in orthopedic manual therapy from the OLA Grimsby Institute. Leon is President and CEO of sports and spine physical therapy. The company operates three clinics in the Greater Cleveland area and one in Charlotte, North Carolina. He was inspired by his pioneering father, Leon Anderson Jr, who was considered a vanguard of the profession for over 40 years. SSP tees company, culture and core values of providing high quality rehabilitation services are a direct result of Leon's lifelong tutelage by his father. He is a charter member of the American Academy of physical therapy. He serves as a subject matter expert for the American Physical Therapy Association's orthopedic clinical specialists specialist exam. He also serves as an onsite reviewer of the Commission on Accreditation, physical therapy, education. So today, they talk about a PT so the history of AAPT networking opportunities and how that branch of our profession that organization within our profession profession came about so big thank you to Leon and Jenna and everyone enjoyed today's episode.   03:15 Hello, Jenna Cantor here with healthy, wealthy and smart I am super excited and honored to be here with the Leon Anderson, who is a major leader in the physical therapy community. He is the president and CEO of sports and spine physical therapy and is also a charter member of AAA, PT, the American Academy of physical therapy. Thank you so much for agreeing to come on Leon.   03:42 Welcome. It's good to be here. Thank you, Jennifer offering this opportunity.   03:46 Oh my gosh, I've just And it's funny, right people, we still we came on, I learned that you were just in Barbados, and you have a bunch of patients there and you were vacationing, that's incredible, you are living a life. There's so many opportunities and you're living that right now. I love it.   04:03 Absolutely. There are opportunities all across the world when it comes to physiotherapy. It's known as physiotherapy in most parts of the world, and physical therapy here in the United States. But just in the islands, you know, there's just a huge huge opportunity to bring the kinds of things that we do here to that particular population, because of the all the different technologies and nuances and things that we have, you know, that we have here. So, I was in addition to enjoying the beach in the sand, I was also enjoying given our advice on how to become a more functional individual, and whatever Island or whatever society or community that you live in.   04:42 I love that. Thank you. Thank you for your service series. That's incredible. I love that. I wanted to bring you on today to actually talk about a PT specifically talk about the history how it became to be in everything So I would love to just start with your perspective specifically, and how it came into your life.   05:09 Well, I grew up with, you can say occupational inheritance. My father was the 16th person in Ohio to be licensed as a physical therapist. He was a vanguard in our profession. He held many, many, I guess positions, if you would say, locally, nationally, even internationally, he was one of the first African Americans to be on the board of directors for the AAPT. In fact, there is a, a room at our headquarters in Alexandria. That is the Black Heritage Room, and it's named after my father and one of his protegees, who's also my mentor, the late Dr. Linda Woodruff, who was just an amazing, amazing mentor, and my father, Leon Anderson, Jr. and since I'm the third, but if you rewind back to when he got started, a PT that started mainly the the PTS of color that were involved in the APTA just didn't feel that their needs were being met, you know, as it relates to our communities. And so there are a couple of different little groups, like blacks interested in physical therapy or charm, I can't remember right now exactly what the term acronym is, maybe I'll think about that. But there are different groups that they would meet at the eight PTA annual conferences. And at some point, I think it was 1989. It was at 1989. In September, in Chicago, about 90 individuals met and I was actually a student, myself, and also donna, donna, it was not a fun doll, then. Now it was done in green Howard, that we were both students at the time. And now these individuals got together and they decided they wanted to do something that was going to be specific for the African American community and meet the needs of those communities that are disadvantaged and poor. And so that's where, you know, it was born out of and we have so many, I mean, just a plethora of talented African American PTS, in academia, in private practice, in the hospital setting, and, you know, in the military, just in all of the different different settings, and very accomplished, very accomplished ones also, I mean, it's just amazing. The BB Clemens, the, I mean, the mayor McLeod's, the Robert Babs, there's just so many that so many people who, who contributed so much to this organization early on, and we've done just many, many, many things to help students and then help our community. So that's, you know, in I hate the Babylon, but that is a kind of how we were born born out of a need, that needs weren't being met by the large the large organization, the APTA.   08:08 Oh, my gosh, this is a nerdy question. Okay. The meeting was in Chicago, was it over pizza? You know,   08:17 believe it or not see. So once again, we have such an accomplished set of founders. It was at like a, a Hilton, or a Sheraton, a Sheraton Hotel, where we all met. And, you know, they used Robert's Rules of orders, it was extremely, extremely organized. But remember, for years prior, there were these little interest groups that would meet over pizza and over coffee and over tea and you know, different things for many years, at the different organizational meetings, whether it be the annual meeting, or the combined section, or what have you. So at that meeting, we actually they actually established, you know, a skeleton of what our current bylaws are for the AAPT right now, so it was a very, very, very industrial meeting. And productive meeting over that weekend back in September 1989.   09:12 Wow, that is so cool. I love it. It really was from the ground up. It just organically. It happened so organically. And it was a major need and it just grew. I love that. That is so cool. And your legacy. Oh, you probably carry it. That was so much pride. I love that for you with getting involved. So your dad's involved. Did you feel pressure at the beginning? Like how did that happen? Because your dad is just so prestigious? And is it doing so many things for the profession? How was that for you?   09:47 Well, believe it or not, my first degree is actually in computer science at a computer science degree from The Ohio State University. And what I found was that by my junior year I was doing some statistics statistical analysis where my father during the summertime didn't do my summer off. And I was at a, a facility for the mentally and physically challenged. And while I was, you know, doing fixing the computers and trying to network computers and things, I also was a transportation aide. And I will transfer the patients from their cottages, to the main Physical Therapy Center. And I found that I fell in love with patient care. Although I'm the nerdy, mathematical computer guy and logical guy in my head, I found it to be extremely satisfaction, I found a lot of satisfaction, I should say, in interacting with these patients. And that's why I fell in love with this therapy, my junior year when I was at Ohio State. So I decided I wasn't going to just throw those three years away, I went ahead and finished out my, my, my career there ha state. And luckily, because my parents said they were not going to pay for a second education, I had to do it on my own. Luckily, I got a scholarship and academic and leadership scholarship because I went to our house State, I was on a board of this organization, students together against apartheid. And I was a peer counselor, I won the black leadership award my senior year. So with those along with my GPA, I was eligible for a scholarship. And I ended up at University of Connecticut, you know, on scholarship, so that worked out great, I wouldn't say that I felt pressure, it's my father just wanted to always want me to do whatever I was I was good at and, and to be happy, and to whatever I did wanted me to be the best at what I did, and to strive for excellence. But once again, I fell in love with patient care that that that summer 19, I think was 1985. And I really haven't looked back,   11:47 I want to get into the mission statement of a PT, I'm going to read them in sections because so that way it can be discussed each part in more depth, although I think it's quite, quite easy to interpret. So the mission statement is the American Academy of physical therapy is a non not for profit organization whose mission is to provide relief to poor and disadvantaged African Americans and other minorities by and let's talk about this first one, promoting a new innovative programs in health promotion, health delivery systems and disease prevention. Would you mind just talking more on the importance of that?   12:26 Well, we just have so many different talented individuals who are in all these different aspects, whether it be neuro, whether it be neurotherapy, whether it be sports and mettam, sports, med Med, whether it be dealing with childhood, obesity, bottom line is, I think it was back in 2010 with the Department of Human Services, Office of Minority Health and Health Disparities disparities came out with all of their initiatives, and we partnered with them. And I think it was probably 20 or $30,000. Grant, but I'm not sure right now. But But the bottom line is, is we partnered with them, because we wanted to really make an impact in our community, as relates to the health care disparities. So whether it's talking about diabetes are having different hypertension, and different organizational would you call them community health fairs, or programs, we even had a program with the Patterson cow foundation that they supported for childhood obesity. Our goal is for our individual members in their communities to make an impact and partner with the organization at large and use us, you know, to help them make the impact in our community using our resources. And our net network.   13:54 Yeah, yeah. It's funny as talking right now, everything you're saying is great. My husband's musical theater and he's singing full out right now. So I just want to acknowledge it is what it is love him. And you know what life is a musical? Isn't that great? Next, encouraging minority students to pursue careers in allied health professions. Oh, can you talk about the need there?   14:17 And on that note, we'll take a quick break to hear from our sponsor and be right back. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's digital marketing solutions have the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic win. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about his new integration. Head over to net help.com forward slash Li TZY to sign up for your complimentary marketing audit.   14:59 Also keeps me there, I think that we are still less than 3% of the profession. And the goal is to really expose the minority students to the profession as early as we can. So whether that means are different individuals, whether we're at one of our conferences, when we do some of the community outreach, or just someone in their own community, that's exposing individuals by going to health fairs going to speak at the local professional, and career career days, we've had so many opportunities. In fact, my wife and I, in conjunction with the American Academy of physical therapy, we ran a program called Let's Talk About program that did just that it really expose the kids to different professions until to improving their life skills and to becoming excellent and just empowering them to awaken the genius within them. And once again, that was one of those organizations that partnered with the APTA and use the 501 C three, until we got our own 501 C three, but then continue to partner with them. Because the goal is, if you can expose a child and broaden their horizons, it just gives them more options, on what they what they can do and what they can be when they get older. And it makes it makes perfect sense that if you can see yourself doing something, then or someone like you doing something, it increases the possibility that you have in your own mind that you can actually do it yourself. So when you look at Barack Obama, you have you have no idea how many, you know, kids right now can think to themselves that wow, Brock Obama was president I can be president or rob Tillman, or Leon Anderson, is, you know, high in an organization, doing things to help our community, I can do that same thing, I can make that particular impact. We've also had   16:51 visual affirmations, literally, yes,   16:54 we absolutely. We've also had many educational opportunities to help with our students. And just making sure that once you get into PT school, that you pass the exams, we used to hold many of the exam prep courts of the exam, prep organizations and courses around the country.   17:19 That's great. Yeah, it's all there's so much opportunity in this. It's a big one. It's a big one. And no, this speaks to any, any, anybody would like who is black, or in a minority, this speaks to you right away. Absolutely. And if you are wondering apps, yes, definitely reach out to AAPT. This is, this is part of their mission. Next, and finally is performing clinical research directly related to health conditions found within minority communities.   17:49 Same thing as as before, we encourage our, our members, and our constituents and our stakeholders, to engage with the professional organizations and do their poster research. And, you know, to really see, you know, what it is that our community needs, because most of the research that's done is just is or has been done historically, has been on the typical, you know, American, which may be a five, seven, you know, 40 year old white male. So the key is, we really want to make sure that we get data that lets us know, you know, what is the optimal amount of vitamin D, for a African American and living in the, you know, the Bible Belt, you know, that has this particular type of, of exercise level. There, this particular type of diet, you know, so, over the years, we've had many of those posters and the different organizations, annual conferences, and also in Chicago, Diane Adams, Saulsbury. And Vinod Rosebery, who's who's actually mayor now, they, in conjunction with the AAPT had a phenomenal he was a kid's fitness health club at an actual health club, and they were able to, to glean data on the health of our community, as relates to our kids and how they interact with an actual exercise routine. And a, a place to go that's safe, and also informative, and getting them to where they need to be. It was just it was just phenomenal. It was it was a phenomenal organization, and a phenomenal, healthy place to go.   19:47 I'm so grateful you have this research as part of your mission. I teach people how to treat dancers PTS PTAs. And we had a group discussion, one I, where we, we I pulled research and tried to find research on dancers, black dancers might be, where's that research black female dancers. And there was, there was one and it had clear bias. But it did show a little bit that there needed to be a lot more investigation. And, and then it just it was like crickets, it was crickets, when I was searching on PubMed, trying to find studies, specifically on minority bodies with that purpose for comparative data. And we didn't have in the little time I did to gather, we started talking about vitamin D, like you just mentioned, not from me knowing to bring it up. But from another black physical therapist in the room and other other black PCs in the room. Honestly, that became a topic. And it wasn't from research, it was was just from personal experience is and it's just, yeah, we need we need this information to do better for humans. so badly.   21:09 It's funny that you say that, Jenny, because one of my protegees it's interesting, because in when you talk about the academy, one of the one of the things that I think we're really, really famous for is it's an it's an N. It's been unofficial for many, many years. But we have a navigation program that helps not only students get into the profession, and get into school and stay in school, and then in addition to that, pass the exam, once you get into the to the profession, and how do you even navigate the profession. So when you mentioned the dancers, I immediately thought of one of my previous employer, employees and that one of my previous students, her name is Shane, I know I'm messing up her last name. And I think she's married now. So I'm really messing up her maiden name, but it's ojo, Fatima, I believe anyway, she is the she is definitely the TCS, the top physical therapist with the L Navy dance troupe. I think she might even be the medical director right now, I'm not going to be sure about about it. She's actually the medical director, I know that they really lean on her big, big time. But she's somebody who, you know, absolutely should be should be out front, not only giving you the information that you might need for your Google, you know, search. But once again, she's there to let that young girl or guy, you know, who's interested in dance, know that, you know, not only not only can you be involved in the performance arts as a dancer, but also as a medical or healthcare professional, or navigation program. So I think that she was a patient of I mean, a student of mine, at least 12 years ago, but our communication has never waned. We even talked as recently as last month, about her career, where careers going in and also getting other younger physical therapists and other parts of the country hooked up with her because as when they travel, they need to use local services, local physical therapy services, and whether that means, you know, a practice that they can come into while they're in that city or if there is a opportunity for an intern in a particular city where they are to come and spend some time with him. So our navigation program is so wide and it's so varied. When you look at just my career alone. I had my father I had Dr. Linda Woodruff. I had Rob Tillman. I had Robert Babs, I had at least 10 or 15, close mentors, role models, advisors, who could help me navigate where it is that I wanted to be, whether it's whether we're on Capitol Hill, doing some lobbying for physical therapy codes, whether I'm dealing with Ohio State University and their football team, or, or whether we're talking about trying to have a Howard University accredited exam. I remember I met with the president of Howard University because I was on the commission for accreditation for physical therapy, education. And I was there for an accredited accrediting visit. And now one of the people who's come in under our navigation, Vanessa LeBlanc, she is now a captive reviewer. So the reach is so wide and so long, that, you know, just being being associated with this network affords you such a wide array of opportunities and possibilities.   24:40 Absolutely. I'm just more than this navigation program. People might be perked up going, what is this? What is this? So I'm going to use some outsider terms on this. So yes, this is a mentorship program, but it's different. And it's really about when you connect with AAPT in court I'm where I'm mixing it up or saying it wrong. So when you connect with AAPT, anyone to a PT is they have a very large network of people with different expertise and you get forwarded to the right person. It's not just within the, the heads of the organization, because, I mean, everybody's doing this volunteer why so not? They can't, they can't, I'll take on everyone. But then from there, you go to this huge web, imagine like, Charlotte's beautimous beautiful web that's extremely expanded and connects you to all the multiple people that would advise you and take you through your journey to really accomplish a lot. It's very cool. And, and, and naturally expanding like you just said, with your your student, how you're now connecting her with students, you know, or people who could use her help. I think it's very, very cool thing that AAPT has going on. Did I explain that correctly?   26:00 I think so. I think he did a good a good summary job. Because it's not a instone program, what it is is right, right, exactly the way the way you the way you explained it was very, very, very good.   26:12 Yes, score. This AAPT has, has been around since 1989, as Leon was saying, and is an organization either, too, if you want to get involved, please reach out to them. Volunteers are always welcomed, there's plenty of opportunity, as you can hear from the mission statement. And, yeah, anything else you want to add on AAPT? A topic that I have potentially looked over because this is a big organ, this organization is a big deal. And I don't want to miss anything?   26:45 Well, no, I think you hit on the major things, I will say go to the website, if you have questions, then, you know, go ahead and submit them through the through the website. It's just a, an organization that I think is just very much relevant and needed to make sure that our community continues to be relevant, and get what get what it needs. That to keep us moving forward and moving in the right direction, because we're all connected. And we all need one another at some point, you never know when you're going to need need someone I remember, there was a member that was I would say he would come to the or to the meetings maybe every other year or something like that. I'll leave him nameless. But when he came, and he was actually being attacked by the State Board for a reason, that was not necessarily his fault. But because we had so many members that were involved in academia and also involved in the state boards that were able to help them out. But once again, you don't know what you need a lot of times until you need it. So just be involved, I would say it'd be involved in your, in all the associations that you can get that are professional associations, because you can glean information from from from everyone. Just because you're a member of AAPT doesn't mean you should not be a member of a PTA or any other healthcare or allied health organization that you think you're a possible stakeholder. And so yeah, I think that it just really makes sense to stay connected to the professional organizations because you won't know what hit you until it hits you. So what you want to do is stay ahead of the paddles, which is one of the terms that we use in our business, there's always a paddle coming after us at every every every point where there's legislation, or COVID It doesn't matter what it is. So the key is to be as prepared as you possibly can for each panels that come and if you can somehow anticipate what a panel you know might be booked for comps and by doing that you can be up on the current legislation you can be up on the current trends in the professor because we become about you know the current pitfalls you know, and then you're much more likely to be a successful individual and happy with your professor. I love it.   29:08 Thank you so much for coming on. I appreciate it and definitely to get connected with anyone AAPT like you said check go to that website. Thank you so much for coming on. We absolutely appreciate you Take care everyone.   29:23 And a big thank you to Jenna and Leon for a wonderful episode. And of course thank you to our sponsor Net Health. So again if you are looking to get your clinic found online, increase your reputation and your referrals then dead net house Digital Marketing Solutions has the tools you need to beat the competition get found get chosen get those five star reviews. If you sign up now for a free marketing audit digital marketing solutions from Net Health will buy lunch for your office head over to net health.com forward slash li T zy to sign up for you a complimentary marketing audit today.   30:03 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media

In this episode, Associate Professor and Associate Chair at the Department of Physical Therapy at the University of Delaware, Prof Karin Grävare Silbernagel, talks about her research into tendonopathy. Today, Karin talks about her historical perspective on tendonopathy, the future of tendonopathy research, and her presentation at the WCSPT. Is pain really worrisome? Hear about tendon loading, chasing the shiny new objects, creating expectations with patients, treating different kinds of tendons, and get her valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “If you just want zero pain, don’t do anything, but that’s really not what you want. You want to be able to move.” “Sometimes in our eagerness to do good, we get a little crazy.” “This is not a quick fix. This takes time.” “Just because it takes longer, does not mean a tendon has poor healing.” “Always have fun. If it’s not fun, it’s not worth doing.” “It’s a long life to work. Don’t hurry to get to the endpoint.”   More about Karin Grävare Silbernagel Karin Grävare Silbernagel PT, ATC, PhD is an Associate Professor and Associate Chair at the Department of Physical Therapy, University of Delaware, Newark, DE, USA. She is a clinical scientist with a strong record of mentoring clinical scientists (primary advisor for 10 PhD student – completed, and 8 current PhD students). Her expertise is in orthopaedics and musculoskeletal injury with a focus on tendon and ligament injury. She has been a physical therapist for over 30 years and performed research for over 20 years. At University of Delaware, she is the principal investigator of the Delaware Tendon Research Group and the Delaware ACL Research Group. Her work has been directly integrated into the clinical guidelines for treatment of patients with tendon injuries. She has presented her research at numerous conferences and published in peer-reviewed journals (100+ published articles to date). She has also been invited to speak about her research at conferences nationally and internationally. As the principal investigator of Tendon Research Group at the University of Delaware, she is working to advance understanding of tendon injuries and repair so that tailored treatments can be developed. The Delaware Tendon Research Group is an interdisciplinary team focused on improving treatment outcomes for tendon injuries. Her research approach is to evaluate tendon health and recovery by quantifying tendon composition, structure, and mechanical properties, as well as patients’ impairments and symptoms. Her research is funded by the NIH, Foundation for Physical Therapy, Swedish Research Council for Sport Science, and Swedish Research Council.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Research, Tendonopathy, Pain, Injuries, Treatment, WCSPT, Education,   World Congress of Sports Physical Therapy   To learn more, follow Karin at: Website:          https://sites.udel.edu/kgs                         https://www.udel.edu/academics/colleges/chs/departments/pt/faculty/karin-gravare-silbernagel Twitter:            @kgsilbernagel                         @udtendongroup Instagram:       @udtendongroup Facebook:       Delaware Tendon Research Group   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:03 Hi, Karen, welcome to the podcast. I'm so happy to have you on and really excited to talk about tendinopathy research and treatment and clinical application. Super excited.   00:14 Thank you. I'm equally excited to be here to talk about my favorite topic.   00:18 Yeah. And later on, we will talk about, we'll give a little sneak peek to everyone about your topic. At the fourth World Congress is sport physical therapy in Denmark happening August 26, and 27th. So for those of you who want that fun sneak peek, you'll have to wait until the end of the interview for that. Because what we're going to start with is, I really want to know, the historical perspective of tendinopathy research and how it's been translated into the clinic. So us, as we spoke, before we went on 18 years ago, you wrote your thesis. And so you've got a really great vantage point to look back on, what what tendinopathy research was, where we're at. And then later on, maybe we'll talk about where you see it going. But I'll just hand the mic over to you. So you can kind of give us that historical perspective.   01:20 Thank you. And I think that, as we spoke about, too, I feel like I'm getting older because more and more my historical perspective kind of comes in. But I think it's important when I started as a physical therapist, so I started clinically in 1990. And when I started, we had in my courses and things you know, talked about muscle, you talked about ligament injuries, and all these things. And then the tendon was just this rope that went in between the muscle and the bone. And that was kind of it. And then when I started practicing, and I worked in Baltimore, and we worked a lot with with baseball players and things, and everybody had tendinitis was super undisciplined ages, tendinitis, Achilles tendinitis. So everybody had this inflammation in the tendon that we never really talked about. So okay, I felt like I was no dummy. I learned medical terminology. So I know itis was inflammation. So obviously, they had inflammation in this tendon, because that was the name was. So I thought our treatments then really, were treating the word. So we were really trying to rest because it was acute inflammation. We tried ice we did I onto freezes and fauna, for races, and they weren't allowed to load and all these kinds of things. And surprisingly, hopefully, some patients got better anyway. But that really sparked my interest into tendon in general, like, what is this? And then later on in the 1990s, that came up more and more research, Korean and Spanish started thinking about, you know, Achilles tendon would hurt more maybe when they were loaded, ie centrically and running, so maybe we need to train that and people are starting more thinking about how do we exercise and mostly maybe the lower extremity, tendon tendinitis. And then we had more research looking at if there was inflammatory components in the tendon. So if you took out cells and things too, there wasn't actually an acute inflammation. So this idea is maybe wasn't true. And that really opened the door for if it's not an acute inflammation, what do we do? So then in the late 1990s, beyond the curve is in Standish, it was another researcher knees and we're Tolman that looked at concentric versus eccentric loading. And then Hogan offense on in Sweden to started to have patients that were waiting to get surgery and he started like, okay, we're really going to load them, you know, we got a heavy load them, because maybe that's what they need, if not an acute inflammation, and started to see people get better if you actually load in them instead of resting them. At the same time we did our I started my PhD things, too, we started looking at, okay, should it be more overload, and we used our pain monitoring model versus the standard treatment that was, you know, circulation exercises, bilateral up and down, but not really trying to load it heavy. And what we started to see those exercise program that loaded more had better effect than the more like generic, protective things kind of things, too. So that's really when things started to change. Right. So I think the historical perspective is we didn't do anything. And we started to do things. And we had these huge jump in outcomes, which is brilliant. And our studies then was, you know, we were looking more at, you know, the Sylvan angle protocol, comprehensive, we use pain monitoring model to guide but also the loading and the exercises to kind of low beyond and not be worried about the pain because if the pain wasn't acute inflammation, maybe wasn't so worrisome, and loading the tendon was painful, but that was also the treatment. So we needed something to kind of understand how much could you really load. So we started with this exercises and being able to load and having kind of achieved this kind of change. I think that was really the the ultimate thing that happened in the late night. 90s, early 2000 And it was the combination of Korean and Spanish hooking out for some did we had programs and kind of moving that forward.   05:10 And there's something that you said in that? Well, a lot of what you said in there that I just want to pull out if we can. So, one thing that you just said is, is pain worrisome? And I think that's a really, really provocative question. Because if you ask the person living with the pain, yeah. And so how, as the therapist, if we're treating someone with a tendinopathy, let's say it's an Achilles tendinopathy, and the treatment induces pain, how do we communicate to the patient? That it's not as worrisome as you think it is?   05:53 Yeah, thank you for that question. And I think that's why the pain monitoring model that we've had, and really the pain monitoring model started with roll on to me who was my advisor, in patellofemoral. Pain, and that's when we applied it. And I think from the patellofemoral, pain, we kind of seen the same path, right? Just resting, it doesn't help you need to get strong. And then we will the tendons seems to be the same thing. And I think the pain monitoring model has been a lot of discussion is, you know, we go up to five is okay, and those things, to tell you the truth, I really don't care if it's five, or four, or whatever, I think it's that communication to the patient and communication that waiting for this pain to become zero, if that's the goal. And what I say to everybody was my lecture, and you might have heard that too, I'm like, Well, if that's the goal, I can tell the patient come in here, lie down on my nice little plants here in the office, you lie there, and I'm gonna go get a cup of coffee. And when I come back, you don't have any pain. So I've treated your pain, right. So I kind of start, I think, with the education. So the point is, if you just want zero pain, don't do anything. But that's really not what you want, you want to be able to move. So if you want to be able to move, you also need to get this tissue to tolerate more loading. And in order to do that, we actually need to load it. So we recover. So I spent a lot of time kind of explaining talking about this thing, so that there might be some pain when we're loading it, or without load, you're not getting anywhere. And what happened to a lot of people, they had some pain, the rest of it did last and they tried to do something a pain and they just D decline. And I talk a lot about hardening your tissues, right? This is loading, hardening of tissues. So the conversation is my goal with treatment is to increase the tolerance of your tissue over time, while keeping your pain level the same. So that's kind of the thing. So so your pain level, I'm fine with that you're not going to rupture, which is good thing to say for Achilles tendon rupture. That's like the big catastrophe. If that's not an issue, then we can follow it to and then we have the discussion. You know, above five, it's not good, or I don't know, you've seen Twitter, sometimes Twitter, that I use five, right? And I, I really don't care. I think the point is, there is a point of pain when pain goes from, it's uncomfortable to Ouch, I don't want it to be Ouch, I want it to be in five seems to be around in that round, right? And people can understand the difference in that. And it's, you know, you have the other conversation with the people that says, But I have really high pain tolerance. So this might not work for me. Well, you know, it's subjective. So I always tell them absolutely works even better for people like you. So, you know, sometimes maybe I'm a little silly, but that's. So I think that's kind of the point of really using it. So for me, the pain monitoring model is a way for discussing it and then using it. Some people feel like it's focusing too much on the pain, I actually think is does the opposite, right? Because it removes the worry. So I'm going to put a number on it. And it's just a number and everything else. And then we use training diary. So I use training diaries, you write down, you know, morning pain, worst, lowest everything else that you do. And then if I have three or four weeks, we can start comparing, and then people actually start seeing the numbers change with the activity, or the number stays the same. So I'm using it more of a of a descriptor, because if you just ask somebody you have pain, it's like they're gonna ask them what they did earlier. Right? And none of us remember, we don't remember how much pain was when we not painful. And so that's kind of how we using it in my description.   09:23 Yeah, I think thank you for that. I think that's great. And that also kind of answered my next question is how much load? How much can you load? How much load isn't? Is is enough? How much is too much? And I think you kind of answered that within that. But you want to expand on that a little bit or I feel Yeah, so I think   09:39 I think that's within the pain monitoring model too. Right? We're looking at that. But then you also have knowledge based on how the cells responds how the tendon response and I think that's where the next thing in the history perspective is now we're starting to see you know, which protocol is better. So now they're comparing Silvernail and offer zones or East centric loading, and it's all these. And really when you compare them, it's not that big of a difference. Right? The heavy slow resistance. I just say that you know who canal for some was in northern Sweden, he trained twice a day. I'm from Gothenburg and middle, we do once a day. And then you go down to Denmark, they did the three times a week for heavy slow, right? So Danish people are lazier than you know. But I think the point is, when you're looking at the data, actually, the outcomes are not that difference. You know, there might be some, you know, we can always argue that we're more satisfied with this. But when you're looking at the mechanical properties and things, you don't see that big of a difference anymore. And I think because I think you reached a saturation point, right? We've done no loading to loading now everybody does good. And I think for us as PTS now we're trying to manipulate more and more in that little realm, that for everybody, we might not see it when we do big studies comparing one group to the other, because I think we need to talk about individualized instead of precision rehabilitation and things too. So I think kind of that's where we're getting at. And they've been great studies coming on from unstuffy Agha Gordon Denmark from her thesis looking at moderate versus heavy and patellar tendon. And so I think that for the loading, you need to load them, you need to use the pain monitoring model, we need to do the progressive loading. But I as a PT would less worry about if I if you did two sets too little or five pounds to less, I think that's less of an issue.   11:29 Yeah. And when you said individual, I actually just wrote that down individualized care as you were speaking, because if all of the different protocols have basically the same outcome, then does it come down to what can the patient do, given the constraints of their life? Or their schedule? Or you know, their job? So do you have someone who can do something three times a day? Or do you have does this person might do better three times a week with heavy slow resistance, or, you know, it really depends on what the patient can do. Because the best protocol, I would assume is the one that patient is compliant with.   12:12 And I think you and I have been around way too long for this too, right? So because, you know, when you started, when you were at least when I started when I was young, right? You were so excited for every exercise. So I guess kept on adding to my poor patients like removing something No, no, that's a really good exercise. And you're adding. And what I'm getting to is that if I can get you to do something consistent with two or three exercises, I'm much better off giving you two or three exercises that you do consistently, than trying to think that I'm going to give you a ton of things. And I have patients now that are you know, they they come back, they come back every four or five weeks and see me or they send me an email and they do their exercise, because I told them to do for Achilles like bilateral three sets of 15. And then do unilateral three sets of 15. And do that for your rest of your life. Like you're brushing your teeth, and I'm like, you could probably go down to doing them less, or you can do heavier in the gym. And some people don't go to the gym, they don't want to do that. So you kind of modify it to kind of get some of the exercises there too. So I think that I think the biggest key is that you need to load you need to do things. And then instead of getting too hyped up for all the specifics, I think that's really where we're moving forward. And I had I had a lady that you know, recently with insertional tendinopathy that had been to the doctor been to all these other clinics, and there's thrown all these things on or didn't get better. And then it was massaging it. And it was like dry needling and the instrument assisted and those kinds of things to me, she was just getting worse. And I'm like, Well, I just think you should do these three exercises once a day. And she's doing and she's like, I'm walking. I'm not limping, you know. So sometimes in our eagerness to do good, I think we get a little crazy.   13:49 Yeah, and that brings me to the next thing I wanted to talk about. And it's sort of the shiny new object syndrome that a lot of people will get. And we spoke a little bit about this before going on the air. And I said a lot of it is sort of the theatrics around different kinds of shiny new objects. So how how would you address that to say younger clinicians? In you know, obviously talking about tendinopathy   14:14 Yeah, so I think that that one thing and it's still hard, I mean, I teach Doctor physical therapy students and then they go out and they completely forgot what I said. Right? So I think there's certain things everybody wants to go to clinical course and learn something more hands on and something more specific but I think that to me, the attitude is what we really try to teach them is like what tissue is that? How does that tissue respond right? To start understanding the underlying mechanisms because then you have then you have an understanding to build the other thing on instead of not having the understanding and just thinking that you doing things and then then you might be changing the shiny objects without thinking about the mechanism. So I'm very much a mechanism person in to try to think about why would we do it, but you all No need to realize that just putting the hand on somebody is very, very strong treatment effect. That's not, that's the same as listening to somebody and paying attention. And I have a colleague Now Greg Hicks has done finishing a trial looking at strengthening specifically for low back and an older in the control group who got hot, hot pack and massage as the placebo control. And they did really well too, right. So even we have mechanism, we should not be afraid of doing things that might help the patient in that sense. But we the explanations and things for what you're doing, you got to be really careful for right. And I think that I have a great effect on my patients, because I think I have a good program. We know what we're doing. I know it works. But I'm also not under estimating that if you can Google me, you're going to get better just by coming seeing me because he's going to assume that at least I know what I'm doing. So, you know, I utilize that effect too. So you just need to thinking about what we're doing. And I'm very scared of chasing the shiny objects for the wrong reason, because maybe that shiny object would be really good for a specific reason. And if we throw it on everything, we've lost, what is good for?   16:12 Yeah, if you beat me to it, I was just gonna say also people probably come to you knowing your background, and the work that you do. So they're coming in, like primed, like, this is she is the expert, I'm in the right hands. I know, this is gonna, you know, this is a person who's going to help me and that's a huge part of the rehab process is that trust that you have in the practitioner and that therapeutic relationship, but it also sounds like you're giving realistic expectations, and describing realistic expectations to your patients, which, again, takes time. And I know a lot of therapists like why only have a half an hour with them, how can I how can I spend 15 or 20 minutes talking to them? So what would you say to that kind of a comment?   17:02 Yeah, and I think that's another thing that happens over the years. Like, I feel like I do less and talk more, but that might be just my personality, too. But, but I think that that's without that understanding, when you start that therapeutic alliance or understanding why you're, as you're doing, you're not going to get anywhere. And patients and especially patients with tendon injuries and tendinopathies. I mean, it takes six months to a year, I tell them that right away, it takes six months a year, you can do what I say, I'm pretty sure you're gonna get really well, you might not be 100%, I'm gonna get you definitely to 80 or 90%. If you don't do what I say, we can meet here in a year again, it doesn't bother me. Right? So it's handy because I think when I was younger, I tried to take on the problem and I I'm handing it back right away. I'm like, doesn't bother me if he doesn't do don't do it, you know, you can just come back to understanding and I think the other part from from the young clinicians were tendon injuries is the biggest thing is, this is not a quick fix. This takes time. And what you see a lot with the younger clinicians or maybe younger, my younger self, too, is like your to do treatment for two, three weeks, and they're not there yet. And then you get worried. And when you get worried the patient get worried. And then you start changing things. And then then they get more worried because you don't seem like you know what you're doing right, you know, it's setting the expectations. This is what you're going to do. It's not any cool exercises, this is going to take time, and having the training diaries that I follow over time and they say, You know what, I don't think much of happening. I'm like, Well, you weren't here three months ago, you could only walk one mile, but the pain of five. And now you're jogging for miles. I'm like, I think that's a pretty good improvement. Right? So having those to kind of working on and I think that's really, really important.   18:45 Yeah, and my next question is, is are all tendons created equal? So we sort of alluded to an Achilles tendon and a patellar tendon or we can talk about, you know, a golfer's elbow or tennis elbow. So when we're talking about all these different tendons, are they all created equal? And can we kind of throw the same treatments at each one, regardless of the part of the body?   19:10 Yeah, so again, it's kind of the same thing that attendance is a tendon in certain tendons structures, right? But all tendons are meant to connect muscle to bone and allow for mobility and that help us however, the design of those tendons are also meant for what they're good for. Right? So the Achilles tendon is the biggest tendon in the body because it's generates a lot of force and helps us move it move. patellar tendon is a little bit different isn't big, but it also tries to help change the angle of force around the knees. So then we put a patella and so all of a sudden we have compression and tendons are not very good for compression. The rotator cuff is more of a flatter tendon, that has a lot of curvature and the compression there is a problem right? So the flatter tendon combines more. Spread the force versus around tendon they kill As tenderness and then you're thinking about tendons in the hand, right, they are really long and thin, to be able to manipulate the fingers really gently build up the force gently. So they have different functions. And soon as you have different function, the tendon has to be slightly designed differently, which makes if it's designed differently, the treatment or the loading might be needed to be very differently. So I think one of the biggest thing is a tendon is really good for tensile forces, but not a good for compression forces. So for example, the rotator cuff, when you're talking about these overload tears is usually an inferior kind of compression that slowly degenerates, a tear. And the Achilles tendon is nothing like that at all. It's a high load, that kind of happen because you pull it apart just like Play Doh, you pull it apart from two different ends, and it kind of can rupture. So I think those are really, really important. What we also see as the lower extremity tendons seem to respond fairly similar. They're not as high in central sensitization indexes and don't have those things versus differently when you're looking at upper extremity tended to So there are definitely differences. So you need to kind of thinking about the basics, that it's not probably an acute inflammation that we need to treat it and then you need to start thinking about what does this tendon do? Is it being compressed as a flat? What are the other structures? Right? So Achilles tendon, you know, that is Achilles tendon. The real problem is, it's right there. There's not much else. That's why I study it, because it's easy to study versus the rotator cuff. We talk less about rotator cuff tendinopathy. And we talk more about shoulder pain, right? More because we not so sure. Is it purely the tendon? That's the problem and other things   21:40 add a lot more structures around it than just the Achilles tendon. That can adjust the Achilles. Sorry, but yeah, yeah. Yeah. So the little, a little more complicated area of the body will say, yes, yeah. So, you know, I think it's great to sort of look at that historical perspective. And I love that you kind of talked about where we are now, where do you see research moving towards, in the tendinopathy? field?   22:12 So now we're getting little bit into what I'm going to talk about in Denmark, too. But I think, yes, so one of the big things that we're really working on, is that, okay, I felt like we kind of reached this point, we're doing really well with everybody. But again, you know, if you look at average, with a big group, we're still not 100% On average, right? Some people aren't 100% recovered, versus some people are not. And why is that and we can't manipulate the treatment anymore. I need to figure out who do I treat how right we've been there in other areas, too. So really, what we're doing in our in our research now is really trying to use various statistical models and larger group data to really first evaluate, we'll be starting to call a tendon health, I'm really proposing that tendinopathy might be more of a biological disease, more like you're talking about knee osteoarthritis, there used to be just wear and tear, and now it's a biological disease, I think tendinopathy need to be considered the same way. And the reason I say that is because it's not just that the tendons structure had changed, or that you have pain, there's so many other variables related to it, like you have personal factors too, like BMI or diabetes affects them in differently cholesterol do so you have the metabolic factors, you have the personal factors, right. And you have, you know, the fear factors, and all these kinds of things play a role. So we call that our tendon health model. We really started with function, structure, pain and symptom, psychosocial factors. And then I realized it was a person too. So we actually have personal factors. And based on that we're trying to figure out are there different? Because you can't, we can in clinic, you can treat every person in singular, right? But, but we need to also to have more of the precision health understand what we do in the health system understanding are the various groupings. So who should we treat how to be very efficient. And that's some of the research that we're working on now. It'd be looked at my PhD students try and handle and found like, we have different groups, we have what we call activity dominant, which might be the one so we see a lot of them, the runner's active, they don't have a lot of symptoms, they don't have a lot of deficits, tenant is not that bad. versus group that we've called structure dominant, that are heavier, they have really horrible looking tendon, that poor function. And then we have a group that we call psychosocial dominant, that maybe the worst are not the best, but they're people with higher fear, decreasing function, but the tendon might not be so bad. And when we started thinking about that, well, now you can understand maybe how you can treat them a little differently. And then we can start looking at how should we treat them based on looking at randomized controlled trials because from a researcher perspective, if I threw all of those in, and I do the same treatment, some of them might benefit a lot and some of them don't and then the treatment is seared out right. There is no difference. But then I lost Ask the benefit for the ones that might benefit and I lost learning from the ones that didn't benefit the needed something else.   25:07 Fascinating. And you're going to be talking about this in Denmark.   25:12 Absolutely. And we have new data, how it changes over time and all those kinds of things. Yeah, well   25:18 don't give it all away. Now. Will we want people to go to Denmark to see you present this live? Demo? Yeah. Yeah. I mean, it sounds fascinating. I love the idea of a tendon health structure. And I love how it's it is, seems to be evolving to be more about the whole person, not just someone with a tendon injury. Yeah. Right. Because like you said, it could be like, two people can have the same injury. It could be one could be a postmenopausal woman who has the same injury as a young 30 Something male runner, maybe they both have an Achilles tendinopathy. But are you going to treat them exactly the same?   26:01 Yeah. And I think that's when we need to start thinking about this, some of the programs are maybe the same, but how do you modify them? And what are the expectations? And then what are the other things that you can add on to that, to really make sure that we get more people up to 100%, and really try to focus on them. And as a researcher, sometimes those things get lost. And that makes that's concerning to me.   26:26 But I for one cannot wait to hear that talk in Denmark. Now. Before we start wrapping things up here, what advice maybe give three tips, if you want to give more or less whatever you want. But what would you give to what tips would you give to clinicians who are treating patients with tendinopathy? Injuries? I don't know if I want to say injuries, if that's quite the word, but diagnoses let's say, so what are your top tips?   26:59 So my top tip is to kind of think about what that it is the structure and that structure responds differently than muscle structure and bone structure to thinking about it from that from the tissue level when you're designing the treatment program. And I think the number one is tendon takes longer to recover than other tissues. So setting that expectations right away. I mean, it's a clear indication when you're looking at hamstring injuries, is it purely muscle or is it more proximal with a tendon is clearly evidence to show that it takes longer. So if you have that expectation and sitting down to explain, but just because it takes longer does not mean a tendon has poor healing, it has very adequate healing is just healing that takes a little longer. And sometimes I even explain that that is a good thing. Because a tendon can last you for a very long time. Like for marathon runners, the Achilles tendon rebounds you so you can run a whole marathon, if your muscle was doing that, you'd be fatigued way earlier, and you wouldn't be able to do it. So the low metabolism is beneficial. But this is the rehab, it's going to take your time. So that's one of my biggest thing and taking time to kind of thinking through that. The other piece of advice is do not panic. And my clinician in our clinic, they tell me back to others what I say because I always tell the patient right away, you're going to get better. This is going to take time, and you're going to have setbacks. And I want to tell clinicians that to the patients are going to have setbacks, they're going to come but don't panic when they have setbacks. You know, it just is what it is. And if you set the expectations right away, the patient's going to come in and have a setback. Now they're like, Yeah, I have my setback. But you told me I would eventually have it right? Instead of not expecting them because then we react on a dime, oh, they're worse today. What am I going to do? And what am I to change? Like, no, this is part of life that goes up, it goes down and moving. So I think those two things, and along with really using the pain monitoring model, and training diaries are my key things.   29:04 Great advice. And I love that do not panic, because they know when you're panicking, yes, right? The eye you know, they see it in your face. And like you said, you start throwing everything in the kitchen sink on there. And they're like, Well, wait a second, what just happened here? I thought you said I could just do this. But I always tell patients like this is not a linear journey. It's not like you're going up a roller coaster and it's going to be linear and perfect. Like it's going to go up, it's going to dip down, it's going to come up maybe dip down but not as much and then you're gonna go up again and you know, it's a little bit more of a squiggly line and that's okay. And people really do appreciate that because setting expectations is paramount. I always feel like if I do nothing else, if they hear nothing else, at least they have an idea of what to expect. So that it's not crazy. Just   29:59 And I think the training diary to me, I use it for any patient for anything, I think that was really key too, because that calms all of us down. Let's see, let's go back here five weeks, wherever we're at what you were doing. And then we can see the pattern. And I even had one person that gave me like an Excel spreadsheet, and a color coded the pain. And if you looked over like a year, you can see that red and orange decrease and the green was increased, you know what I mean? Those are the patterns that you want to see. And it's hard to see those in your daily life. So that's why I think that's really important.   30:32 Yeah, that is a dedicated patient. Yes,   30:35 I do. But yeah,   30:38 yes, well, right. Right. But well, this was great. Where can people find you? If they have questions? Maybe you're on social media? Where can people find you?   30:51 I am on social media at kg silver Nagel, I think I'm on Twitter, is the main one is that but I also run the Delaware tendon research group, and attend them on a ligament research group. So on Twitter, we also have the UD tendon group. We're also on Facebook, and we're also on Instagram. And I'm easily found the University of Delaware and Department of Physical Therapy to please feel free to reach out and connect with us, you know, on the social media and those kinds of things that we're doing. And I'm very excited to discuss these clinical things.   31:26 And if you don't mind, can we talk a little bit about the Delaware attending group because you guys have some projects that you're working on to do you want to tell the listeners about those projects? In case you know, you need recruiting or you need volunteers? So go ahead.   31:42 Yes, we always need volunteers. So we actually have we have a lot of ongoing studies, but one of the big ones that NIH funded right now is we're looking at comparing men and women with Achilles tendinopathy. So we're up to 145 recruited patients out of 200, we had a little dip around COVID. So we're actually providing treatment for anybody that is around the Delaware Philadelphia area, please feel free to reach out or send your patients. We're also have ACL studies ongoing. One of the big ones also been relating to tendon is looking at the recovery from patellar tendon grafts to see how they change over time, how does that tend to actually recover? And could that if the doesn't recover fully, can that explain some of the deficits that we do see their ACLs injuries to we're also hoping to soon start more of looking at insertional, Achilles tendinopathy, with treatments we have. And one study with shockwave treatment, we have studies that we're hoping to start now looking more at metabolic factors, and getting a little blood draws and those things. So we have on our website with all of those things going on. So if anybody's interested, please feel free to reach out or look at our website.   32:53 Perfect. And we'll have a link to that at podcast at healthy, wealthy smart.com under this episode, so one click and we'll take you right there. So before we end, I have one question. Question I asked everyone and knowing where you are now in your life and in your career, what advice would you give to your younger self, and you can pick which ever age of your younger self you   33:14 would like. So I'm going to pick myself before I even went to PT school, because one of my mantras is to always have fun, and I will stick to that now. And I'll stick to that younger because if it's not fun, it's not worth doing, even if it's research and those things. So do anything that's fun. But I was did not want to go to school in Sweden, I wanted to do sports medicine wanted to go to the US. But I was very worried that if I didn't get in, when I was 20 that I wasn't going to go to PT school because it took four years and then I would be too old when I graduated before I was ready. So I wasn't going to go luckily I got in and I stayed on. So I think to to my younger self. It's a really long working life. So just keep on having fun and plugging along and learning more things. And I have taken the really long path to academia with the clinician for many years and doing those kinds of things. So that I'm happy for so I'm glad I got in and didn't say I wasn't going to do it. Because who cares if I was 2425?   34:14 Yeah, and that's so young. Yes, but isn't it funny when you're 1819 20? You're like, Oh, forget it. I'll be an old person by then 25 behind the eight ball when of course, now that were a little older, we can look back on that and be like, Oh my God. Yes. And   34:34 I mean, it's like it's, it's a long life to work. Don't hurry to get to the endpoint, right? Enjoy it get experienced during that time, because as I tell our students, I've had a lot of fun during my years and worked with sports workers, clinician travel, research, academia, you know, you got to have fun.   34:53 Absolutely. Well, and on that note, I want to thank you for coming on the podcast and having such a fun conversations. Well, thank you so much. And everyone, if you want to get a chance to see current speak live, then join us at the fourth World Congress, a sports physical therapy, it is in Denmark and August 26 and 27th of this year. And not only will you get to see speakers like yourself, but there's also going to be great networking, activity breaks, things like yoga, or running or walking tours, paddle paddleboarding, all sorts of fun stuff. So it's again, not going to be quite your average conference, and a lot of it is going to be clinically focused and clinically based. So I think that's really important. I think a lot of times people think, Oh, we go to these conferences, it's going to be researchers just talking about their research and how's that going to affect me clinically? Well, this conference is all about that. So I think, right? Absolutely agree. Yeah. So come join us in Denmark. Again, thank you so much for coming on. And everyone. Thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, Aalborg University Professor, Prof Michael Rathleff, talks about his role at the upcoming WCSPT. Today, Michael talks about how he organized the congress, creating tools for clinicians to educate their patients, and his research on overuse injuries in adolescents. What are the barriers between the research and implementation in practice? Hear about the mobile health industry, exciting events at the congress, and get his advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “The clinicians out there have a hard time both finding the evidence, appraising the evidence, and understanding [if it’s] good or bad science.” “There’s a lot a clinician can do outside of a one-on-one interaction with a patient.” “It’s our role to understand the needs of the individual patient, then make up something that really meets those needs.” “It’s okay to say no. You have to make sure to say yes to the right things.”   More about Michael Rathleff Prof Michael Rathleff coordinates the musculoskeletal research program at the Research Unit for General Practice in Aalborg. The research programme is cross-disciplinary and includes researchers with a background in general practice, rheumatology, orthopaedic surgery, physiotherapy, sports science, health economics and human‐centered informatics. He is the head of the research group OptiYouth at the Research Unit for General Practice. Their aim is to improve the health and function of adolescents through research.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injuries, WCSPT, Education,   IFSPT Fourth World Congress of Sports Physical Therapy   To learn more, follow Michael at: Website:          https://vbn.aau.dk/en/persons/130816 Research:       https://www.researchgate.net/profile/Michael-Rathleff Twitter:            @michaelrathleff   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hello, Professor Ratliff, thank you so much for coming on the podcast today to talk a little bit more about your role at the fourth World Congress is sports, physical therapy in Denmark, August 26, to the 27th. So, as we were talking, before we went on the air, we were saying, man, you're wearing a bunch of hats during this Congress, one of which is part of the organizing committee. So my first question to you is, as a member of the Organising Committee, what were your goals? And what are you hoping to achieve with this Congress?   00:35 I think my role is primarily within the scientific committee. And one of the things we discussed very, very early on was this, like, you know, when you go for a conference, you go up to a conference, you hear a bunch of interesting talks, and you feel like, I'm motivated, I'm listening, I'm taking in new things. But then Monday morning, when you see the next patient, it's not always that all the interesting stuff that you saw, is actually applicable to my patient Monday morning. So we wanted to try and emphasize more. How can we use this conference as a way to translate science into practice? So the whole program and the like, the presentations will be more about clinical applicability, and less about more p values and research methodology. So not that the research is not sound, but there'll be more focused on how can we actually apply it in the context that were working. That's why also, we had the main title of translating research into practice, which I think will be hopefully a cornerstone that people will see, well, if there's really interesting talk about, it could be overuse injuries in kids, which will be a lecture that I'm having, then they'll also be a practical workshop afterwards to kind of use that what's been presented, and then really drill down on how we can use it in in clinical practice. So the goal is to, to get people to reflect in your network, but also take a lot of the things and think, Wow, this is something that I can use next Monday for clinical practice.   02:09 And aside from a lot of lectures and talks, you've also got in informatics competition. And so could you explain that a little bit and why you decided to bring that into the Congress?   02:23 Yeah, so this was a major, not a debate, but an interesting discussion on how we can even in the early phases of the conference, when people submit an abstract, make sure that the abstract can actually also reach more end users target audiences for that case. So we decided that people actually had to submit an infographic together with their the abstract. So normally, you send in like, 250 words, for a conference, but for this conference, we wanted them to submit the abstract, but also the visual infographic to go along with Olympic Well, am I making an infographic that is tailored to patient? Is that a patient aid that I'm trying to make? Is it something that's aimed but other researchers? Or is it clinicians, so they have to tick off? Which box Am I infographic actually intended for? So when the audience or the participants come and join the conference, they can actually take these infographics for those that want to print them they can use in the clinic afterwards, just another layer of trying to make some of this research more easily communicated to the audience, but also, the things that can be used in clinical practice, like some of the people have submitted abstract, have some really, really nice infographics that I expect will be printed and hang on, on a few clinic doors around the world afterwards, I hope.   03:48 And when it comes to dissemination of research and information from the clinician, to the patient, or even to the wider public, where do you think clinicians and researchers get stuck? Like where is the disconnect between that dissemination of information as we the information as we see, and by the time it gets to the consumer or to let's say, a mass media outlet? It's like, what happened?   04:15 Yeah, that's a big a big question. Because it's almost like why are we not better at implementing new research into our clinical practice? And I think there's heaps of different barriers. We've we've done a couple of studies, something new was also in the pipeline where we look specific, get the official context, and we can see that this barriers in terms of understanding the research, that's actually one of the major barriers that the clinicians out there have a really hard time both finding the evidence, appraising the evidence, and also actually understanding is this good or bad science. And then you have the whole time constraints on a clinical practice because who's going to pay you to sit and use two hours On reading this paper, and remember, this is just one paper on ACL injuries. But in my clinical practice, I see a gazillion different different things. So how am I going to keep up with the with the evidence? Is it intended that I'm reading original literature? Or how am I going to keep up with it? So I think there's a lot of different barriers. But at least one of the ways I think we can overcome some of these barriers is that researchers climb out of the ivory tower and think of other ways that we can communicate, research, evidence synthesis, it could be infographics, it could be sort of like decision age for clinical practice, at least that's one of the routes we're taking in terms of also the talk I'm giving at the conference that we're trying to think of, Can we somehow develop AIDS that will support clinical practice something that scene but the physiotherapist something that's aimed at the patient, that will sort of make it easier to deliver evidence based practice? So we've done one, one tool that's being developed at the moment is called the Makhni, which is something that can assist clinicians in the diagnosis, the communication of how do you communicate to kids about chronic knee pain? How do I make sure that they have the right expectation for what my management can be? And how can we engage in a shared decision making process. And we have a few other things in the pipeline as well, where we want to, to build something, build something practical that you can take in use in clinical practice to to support you in delivering good quality care, because just publishing papers is not going to change clinical practice, I think,   06:45 yeah, and publishing papers, which are sometimes wonderful papers. But if they're not getting out to the clinicians, they're certainly not going to get out to the patients and to people, sort of the mass population.   07:02 I completely agree. It's a bigger discussion, I'm really focused on how to reach clinicians, because I see the clinicians as the entry point to delivering care to patients and parents and, and the surrounding surrounding community. But if you think of, like wider public health interventions, we have the same problem as well. And also we create this sort of like, No, this inequality in healthcare, but that's another   07:30 line, although there can of worms. Yeah, we could do a whole series of podcasts on that. Yeah, yeah. And I agree with you that it needs to come from the clinician. So creating these tools to help clinicians better educate their patients, which in turn really becomes their community. Because there's a lot a clinician can do outside of just a one on one interaction with the patient. And so having the right tools can make a big difference.   07:58 Like in, if you look at a patient that comes to you for an ACL injury, or long standing musculoskeletal complaint, they're going to spend maybe 0.1% of their time together with you and 99.9%, they're out on their own. And I think it's important that we when we're one on one with them, sort of like make them develop the competencies so they can do the right decisions for their health in the 99.9% of the time that they're out there alone, when they're not with with us, I completely agree with you that there's a lot of things we can do to make them more competent in thriving despite of knee pain, or shoulder pain or whatever it might, it might be. And I think that's one of the most important tasks, I think, for us as clinicians is to think about the everyday lives they have to live when they leave us and say see you next time.   08:51 Yeah, and to be able to clearly communicate whatever their diagnosis by might be, or exercise program or, or any number of, of 10s of 1000s of bio psychosocial impacts that are happening with this person. Because oftentimes, and I know I've been guilty of this in the past, I'm sure other therapists would agree that they've this has happened to them as well as you explain everything to the patient, and then they come back and it's, they got nothing zero. And it might be because you're not disseminating the information to them in a way that's helpful for them or in a way that's conducive with their learning style. So having different tools, like you said, maybe it's an infographic that the patient can look at and be like, Oh, I get it now. So having a lot of variety makes a huge difference.   09:48 And I think you touched on a super important point there that patients are very different, that they have different learning styles, they have different needs. And I think it's our role to enlist Send the needs of the individual patient and make up something that really meets those needs. So more about listening, asking questions and less about thinking that we have the solution to it, because I think within musculoskeletal health or care, whatever we call it, some clinicians would use their words to communicate a message that might be good for some other patients would prefer to have a folder or leaflet. Others would say, I want a phone, I want an app on my phone, something that's like learning on demand, because at least that's something we see regularly. Now that we have the older population that wants a piece of paper, we have the younger population that wants to have something that they can sort of like, rely on when they're out there on their own one advice on how do I manage this challenging situation to get some good advice when you're not there? When I'm all on my own? So, so different?   10:57 Yeah, and I love those examples. I use apps quite frequently. And I had a patient just the other day say, Oh, my husband put this, the app that that you use, because I was giving her PDFs, and she's like, Oh, my husband put the app on my phone. Now it's so much easier. So now I know exactly what to do if I have five minutes in my day. So it just depends.   11:21 And I think the whole like mobile health industry, there's a lot of potential there. But I also see, at least from a Danish context, that there's a lot of apps that is very limited. It's not not developed on a sound evidence base, or it's just sort of like a container of videos with exercises. And I think there's a huge potential in like thinking of how can we do more with this? How can we make sure that it's not just the delivery vehicle for a new exercise, but it's actually the delivery vehicle for improving the competencies for self management for individuals? I think there's, yeah, I'm looking forward to the next few years to see how this whole field develops. Because I think there's really big potential in this.   12:12 Yeah, not like you're not doing enough already. But you know, maybe you've just got your next project now. Like, you're not busy enough already. So as we, as you alluded to a few minutes ago, you've got a couple of different talks you're chairing, so you've got a lot going on at the World Congress. So do you want to break down, give maybe a little sneak peek, you don't have to give it all away, we want people to go to the conference to listen to your talks. But if you want to break down, maybe take a one or two of your topics that you'll be speaking on, and I give us a sneak peek.   12:48 I think the talk that will be most interesting for me to deliver and hopefully also to listen to is is the talk that I'm giving on overuse injuries in adolescence, because I think it's we haven't had a lot of like conferences in the past couple of years. So it will be one of these talks will be meaty in terms of of new date, and some of the things I'm most interested go out and present is all the qualitative research we've done on understanding adolescents and their parents, in terms of what are the challenges they experience? How can we help them and also, we've done a lot of qualitative works on what are the challenges that face us experience when dealing with kids with long standing pain complaints, we've developed some new tools that can sort of like, help this process to improve care for these young people. And I really look forward trying to Yeah, to hear what people think of, of our ideas and, and the practical tools that we've that we've developed. So that's at least one of the talks, that's going to be quite interesting, hopefully, also, we're going to actually have the data from our 10 year follow up of so I have a cohort that I started during my PhD. They were like 504 kids with with knee pain. And now I follow them prospectively for 10 years. And this time period, I've gotten a bit more gray hair and gray beard. But this wealth of data that comes from following more than 500 kids for 10 years with chronic knee pain is going to be really, really interesting. And we're going to be finished with that. So I'm also giving a sneak peek on unpublished data on the long term prognosis of adolescent knee pain and at the conference. So that's going to be the world premiere for for that big data set as well.   14:36 Amazing. And as you're talking about going through some of the qualitative research that you've done, and you had mentioned, there were some challenges from the physio side and from the child side in the patient and the child's parents side. Can you give us maybe one challenge that kind of stuck out to you that was like, boy, this is really a challenge that is maybe one of the biggest impediments in working with this population.   15:06 I think I think there's multiple one thing that I'm really interested in these in this moment is the whole level of like diagnostic uncertainty and kids, because one of the things we've understood is that if the kids and the parents don't really understand why they have knee pain, what's the name of the knee pain, it becomes this cause of them seeking care around the healthcare system on who can actually help me who can explain my pain. So so at the moment, we're trying to do a lot of things on how we can reduce this, what would you call diagnostic uncertainty and provide credible explanations to the kids and then trying to develop credible explanation for both kids and parents? That's actually not an easy task, because what is a credible explanation of what Patellofemoral Pain is when we don't have a good understanding of the underlying pathophysiology? So there, we're doing a lot of work on combining both clinical expertise, what the patient needs, what we know from the literature, and then we're trying to solve, iterate and test these credible explanations with the kids. And yeah, at the conference, we'll have the first draft of these, what we call credible explanation. So that's going to be at least one barrier one challenge, I hope that some of the practical tools we've developed can actually help   16:25 i for 1am, looking forward to that, because there is it is so challenging when you're working with children, adolescents, and their parents who are sort of call it doctor shopping, you know, where you're, like you said, you're going around to multiple different practitioners, just with their fingers crossed, hoping that someone can explain why their child is in pain or not performing are not able to, you know, be a part of their peer group or, or or engage in what normal kids would would generally do. Exactly. Yeah. Oh, I'm definitely looking forward to that. So what give us one other sneak peek? Because I know you've got the, you're also chairing a talk on the first day. But what else I shouldn't say I don't want to put words in your mouth. What else? Are you looking forward to even maybe if it's not your talk, are you looking forward to maybe some other presentations,   17:26 I'm actually looking forward to to the competitions we have as well, because I've had a sneak peek of some of the research that's been submitted as abstracts, and the quality is super high. So both the oral presentations but also the presentation that the best infographics because they'll also get time to actually rip on the big screen and present their infographic. And I look forward to see how people can communicate the messages from these amazing infographics. And I think these two competitions are going to be to be a blast and going to be really, really fun to, to look at. And amazing research as well. So I really look forward to the two events as well. And then of course, oh no, go ahead. No, I was just talking about look forward to meeting with friends and new friends and be out talking to people once again in beautiful new ball in Denmark in the middle of summer. It's hard to be Denmark in the summer. We don't have a lot of good weather, but Denmark in August is just brilliant.   18:31 Yes, I've only been there in February. So I am definitely looking forward to to Denmark and August as well. Because I've only been there for sports Congress when it's a little chilly and a little damp. So summer sounds just perfect. And I've one more question. Just kind of piggybacking off of your comments on the amazing research within these competitions. And since you know you have been in the research field, let's say for a decade plus right getting your PhD a decade ago. How have you seen physio research change and morph over the past decade? Have you seen just it better research coming from specifically from the physio world?   19:20 I think it's the first time someone said it's actually more than a decade. So, but that gives me a time perspective. But yeah, I've actually seen that. My perception is that physiotherapy research in general but also sports physiotherapy research went from being published in smaller journals we published in our own journals to now there's multiple example of sport fishers performing really, really nice trials that have reached the best medical journals that have informed clinical practice. So I think we see this both there's more good research Basically out there. And I also see that we've moved from, like a biomechanical paradigm to being more user a patient center, we see more qualitative research, we see that physiotherapist, sport physiotherapist, they sort of have a larger breadth of different research designs, they used to tackle the research. I think, like looking even at the ACL injuries, if you go back 10 years in time, looking at the very biomechanically oriented research that was primarily also joined by orthopedic surgeons to a large extent. Now, today where fishers have done amazing research, they understand all the the fear of reentry, they're trying to do very broad rehabilitation programs, ensuring that people don't return to sport too rapidly. And and also understanding why they shouldn't return back to his board now developing tools that you can use when you sit with a patient to try and and educate them on what are the phases, we need to go through the next nine to 12 months before you can return to sport and so on. So I think I'm just impressed by, by the research. And when I see the even the younger people in my group now, they start at a completely different level when they start their PhD compared to what we did. So I can only imagine that the quality is going to improve over the years as well, because they're much more talented, they're still hard working. And they have a larger evidence base to sort of like stand on. And they already from the beginning, see the benefit of these interdisciplinary collaborations with the whole medical field and who else is is relevant to include in these collaborations? So yeah, the future is bright. I see. Yeah,   21:50 I would agree with that. And now as we kind of start to wrap things up here, where can people find you? So websites, social media, tell the people where you're at.   22:04 So I think if you just type in my name on Google, there'll be a university profile at the very top where you can see all my contact information. Otherwise, just feel free to reach out on LinkedIn or Twitter, search for my name. And you'll find me, I try to be quite rapid and respond to the direct messages when, when possible, at least   22:25 perfect. And we'll have all the links to that in the show notes at podcast at healthy, wealthy smart.com. So you can just go there, click on it'll take you right to all of your links. So is there anything that you want to kind of leave the listeners with when it comes to the world congresses, sports physiotherapy or physical therapy, sorry.   22:52 Be careful not to miss it, it's going to be one of these conferences with a magical blend of practical application of signs, it's going to be a terrific program in terms of possibilities to to network and engage in physical activity, whatever it's running, or mountain biking, and with an amazing conference dinner as well. So I think it's, so this would come to be one of one of the highlights for me this year. So and I think the whole atmosphere around this conference is also that if you come there, as a clinician, you don't know anybody, that people will be open and welcoming and happy to engage in conversation. There's no speakers, that wouldn't be super happy to grab a beer or walk to discuss some of the ideas that's been presented at the conference. So I think it's going to be quite, quite good.   23:45 Yeah. So come with an open mind come with a lot of questions and come with your workout clothes. Is is what I'm hearing?   23:56 Yes, definitely. Definitely.   23:59 And final question, and it's one that I asked everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self, and you can pick whatever time period your younger self is.   24:13 So I think in if I had to give myself one advice when I was in my sort of like, MIT Ph. D, time coming towards the end, I would say to myself, that it's okay to say no, you have to make sure to say yes to the right things because it's very easy to say yes to everything. And then you create these peak stress periods for yourself that would prohibit you from from doing things that is value being with friends or family and so on. You don't have to say yes to everything because there will be multiple opportunities afterwards. So practice in saying no and do it in a in a polite way. People actually have a lot of respect for people that say, No, I don't have a time or I'm I'm going to invest my time on this because this is what I really think is going to change the field. And this is my vision. So So young Michael, please please practice in saying no.   25:11 I love that advice. Thank you so much. So Michael, thank you so much for coming on the podcast. And again, just a reminder, I know we've said this before, but the World Congress is sports, physical therapy, we'll be in Denmark, August 26 and 27th of this year 2022. So thank you so much for coming on the podcast and thank you for all of your hard work and getting making this conference the best it can be.   25:36 Thank you, Karen, thank you for the invitation to the podcast.   25:39 Absolutely. And everyone. Thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, Owner of Access Physical Therapy, Clarence Holmes, Jr, talks about generational differences in physical therapy. Today, Clarence talks about burnout, the idea of value, and the different ideas of pay structure. Why is the measurement of productivity problematic? Hear about the promise of mentorship for lower pay, the problem of toxic positivity, and finding the better way in each new generation, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “The reason why things are fluid and changing with every generation is because there’s always a better way.” “We have to be open to that better way.” “No one loves PTs as much as PTs love PTs.” “It is so heathy to have a full well-rounded conversation that points out the bad and the good, and you don’t have to finish with a positive statement in a conversation.” “Get comfortable with being uncomfortable.” “It’s become an expectation in this country to overwork.”   More about Clarence Holmes, Jr Dr Clarence Holmes, Jr is a native of Cleveland MS. He attended Mississippi State University for his undergraduate studies and received his Doctor of Physical Therapy degree from the University of Mississippi Medical Center in 2014. Dr Holmes then completed an orthopedic residency with Mercer university in Atlanta GA in 2015. He has worked in various settings to include sports/outpatient orthopedics, acute care, and the state jail system. Now, he owns and operates Access Physical Therapy, a concierge cash based physical therapy practice in the Atlanta metropolitan area. He also works as a staff physical therapist with Kindred At Home. Dr Holmes has been involved with APTA at various levels to include 2 terms on the Student Assembly Board of Directors, delegate for the state of Georgia to the House of Delegates, and currently serves as a board member for the Georgia Foundation for Physical Therapy. In his free time, he also owns and operates The Travel Doctor, a full service travel agency as well as tackling small woodworking projects. He also scuba dives and enjoys traveling the world with his beautiful wife, Turquoise and their golden retriever and chihuahua/terrier mix puppies.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Burnout, Generational Differences, Productivity, Mentorship, Improvement,   To learn more, follow Clarence at: Website:          https://www.accessptatl.com Twitter:            @matterundrmined Instagram:       @caholmes6 Facebook:       @clarenceh3   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  Hello, this is Jenna Cantor with healthy, wealthy and smart. I'm really excited. I am interviewing Dr. Clarence a Holmes Jr. Just wrote on Zoom, or we're doing the interview. And Dr. Clarence who said, just call me clearance. I'm like, Okay, hi, Clarence, said that he works with home health and is the owner of a concierge cash based practice, which everybody who listens knows I'm cash based. I'm like, Yeah, hello, Conrad. I love that so much. Let's serve our people, our patients. We are coming on because we met at a conference. And there was a discussion on generational differences in physical therapy. And Clarence had some real interesting thoughts on this. And I was like, this is a podcast in the making. So I approached him right away. And I said, Can we do this topic and a podcast? And fortunately enough, he said, Yes. Like a proposal. It was beautiful. So here we are talking about generational differences in physical therapy. I think this is a really, really important topic. Now. I just let's just start diving in to one we're saying general racial differences, everyone, please don't refrain from getting offended with how we, how we try to describe this, because this is one we're differentiating between ages. And I saw I saw individuals struggling with that trying to be appropriate. So if we do say anything in our descriptions, inappropriate, feel free, please absolutely correct us. But be nice, because we're doing the best we can. But this is a very important conversation. So we'd rather take the risk in in really diving into the topic. So yeah, just let's all be nice. Okay. So regarding generational differences, I'm assuming that we're talking about the more seasoned crowd, people who have been around for a long period of time, compared to newer people in the physical therapy. Oh, right. Correct. Am I missing anything? Or is there any other way we need to define it?   02:39 No, I mean, and honestly, you're talking about me when you said if you recognize people being uncomfortable, trying to differentiate between these these generations, in conversation without trying to fin that was me at our conference. I didn't want to say the boomer generation, I didn't want to say the millennials simply because a lot of people tie a lot of negative connotations to those. And we're   03:03 also missing Gen X, because Gen X is actually the y'all are the youngest practitioners right now. Not millennials. Yeah.   03:09 Yeah. And I think there's a lot of similar Z   03:12 is Z. Oh, my God, ie, Z. Oh, my gosh, I missed the letter in the alphabet. Yeah. It might   03:17 be x. I don't don't hold me to it. But But, but yeah, so that was one. But But no, you captured it perfectly. I do think there is a a riff between the older generation and the younger generation to just put it put it lightly. Yeah. Just simply because and I mentioned it in the conferences that the older generation are the ones who are owning these practices, traditional practices. And the younger generation, our generation are the ones who tend to be more of the employees. And that's natural. But what's what's unnatural? Well, this is also natural to have some generational difference was unnatural is the riff, the, the battle that kind of comes along with it, and how we respond to it. So   04:03 yeah, so let's, yeah, I love that. Let's do what we're aware. I was very interested. Let's go back and and just do one general generational difference at a time and then if we okay, I feel like that's what pops in our head for now. And that's it. That's great. So one, just named one at the top of your head one Gen. Gen. Oh, my gosh, why is this? So? General? generational difference, let's start with one.   04:29 So I mean, there's two big ones that stick out to me. One is just this idea of pay structure. And specifically in the PT realm of, of how long has someone been here? versus what is this person doing for my company? And the best example I can give is me personally, of working in a job my first job post residency. I'm an ortho I'm a lover, or I will consider myself an ortho PT, even though I work in the home health arena, and the concierge cash base, I will consider myself an orthopedic physical therapist. My first job post residency was at a private practice in Atlanta, and I was paid the least amount of all the therapists across the entire company, which was four practices in Atlanta. But I was the second highest producing therapists in the company. And so, you know, generational differences comes down to the old way of doing things was, who has the most experience, they get paid the most? My personal opinion is, that's not logical, we're, I'm a logical being and a lot of my generation are, if it doesn't make sense to us, we're going to be vocal about it. And it didn't make sense to me that I was producing one paper, more money, better outcomes than the majority of the therapists and I was paid the least, that's one major win. And it kind of feeds into the second you asked for one, but this kind of feeds into it. Younger generations, older generations value loyalty. You know, they expect somebody to come in and work for them for 10 to 1520, almost 30 their entire careers. And my generation just, we're not happy, we're going to move on. And so that puts a lot of responsibility on the employer to find out what makes us happy. And sometimes that just doesn't, that doesn't translate well.   06:39 Yeah, I see where these connect, let's focus on the first one, because that is a really good, interesting point, I have definitely mentored some dance PTS who are burnt out, and they are in a situation where, Oh, Gosh, darn it, what is it productivity, productivity is measured. And that has been very problematic for them, because they'll come in, and they see that they are, they know, they're getting paid less. But they're not more because in your case, you actually saw the data, but they're seeing the, they are seeing the exact number of patients as a seasoned professional, there, and they're just they don't understand why they're getting paid less, if they're seeing the same amount, then they were there, they would imagine, I would be seeing less patients, then that would make more sense, you know, but no, that's not the case. And therefore, that income would still be it is assumed that income would still be made. So it's almost like they're being profit, they're more of a profit is being made off of them. They're exhausted, you know, but they're not getting a lighter load to feed that exhaustion, that adjustment, they're getting treated just the same. And so they don't understand that pay difference when they come in. And I'm going to bounce off this a little bit more because of what the reasoning so it's going to get a slightly off topic, but I'm always okay with that is the promise of mentorship as a reason for why they are paying less that can be a reasoning behind it, which still, there are some clinics that actually provide mentorship, but the majority of them do not actually provide that mentorship, so it's more verbage. Or they have some sort of automated system, that's there maybe videos or something. So there, it's not really an extra effort. It's something that's already there that can help streamline what's going on. Especially if you're in a place that measures the productivity. You can promise it as a as a somebody owns a clinic, however, who's the physical therapist, and how much time do they actually have to really mentor? So if there really, it doesn't make sense, right? This reasoning of oh, why, you know, and these are generational, different thoughts, but for I think that's what you're hitting is that the younger generation will speak their minds and say, hey, you know, they're not getting that mentorship, they're not getting that value for them to go. Oh, that's why then because they get oh, you know what, I'm getting great mentorship, kind of like where people think residencies, getting great mentorship that get one in paying less I get it. I totally get it. That's not the case. No, no, in a lot of circumstances.   09:33 Seven years, I think I've been out seven and a half years for a PT school. And I've never been in an environment outside of residency that that had any type of formal mentorship. But you're correct in that I've have had several interviews with several companies that have promised mentorship because that was important to me. I kind of did less the reason I worked at the job that I did that I'm mentioning in this in this interview. This conversation. The reason I took that job, and I knew I was getting paid less than I was worth. Um, the reason I took it was because my clinical manager and the only person who was more productive than I was a personal mentor, who was my was one of my direct mentors in residency. And so I saw it as an opportunity to continue getting mentored. And so I'm getting an exchange of additional mentorship. I will take less pay.   10:32 Okay, yes. And your, your through your apps, you're like, Oh, yes, yes.   10:36 Correct. But there was no formal mentorship. Now, I did continue work with this guy. I did learn a lot from him. But there was no formal.   10:45 That's a big, that's a big deal. It's not exactly,   10:48 exactly. And there's no when is the end point? I mean, when is the point where I say, Okay, I've received enough mentorship now I'm ready to get paid. Okay. Right. There has to be some kind of trade off there. So. But you're absolutely correct that that is there is a common promise of these employers to employees, younger, generational PTS, of mentorship, in exchange for, you know, lower, less than ideal pay, but is delivered upon.   11:20 Right, right. And I think that's the thing, because there's different ways to work around depending on the clinic, and everything that can happen in these rooms for negotiation. So when these different mindsets come into the room, for it to work out, but you got to follow through on both sides. One is providing the mentorship and the other side is accepting, that's what you accepted, and knowing that owning that. So, but it can be I mean, you know, what I was about to go into different things you can negotiate, but this is not a lesson on negotiation. So I'm going to skip over that. So yeah, when you when you are going into a clinic, I feel like that is a way to potentially solve the problem, but it's just not being solved right now. It's it's still, these gentlemen are the we have people who own these businesses who are getting annoyed about the the younger generation talking about money, but then they're not looking at, they're not really listening and taking in what is being said, because it's it's a block that we can get our own bias on how we lived our lives. And, and we need to get out of ourselves. I say that, as a practice owner, myself, we have to always work to get out of ourselves all the time, in order to better listen, to be with the changes of the world. And the reason why there are changes, but the reason why things are fluid, and it's always changing with every generation and so on, is because there's always a better way. Right? And we may not answer to it. But But there's always a better way. And and you got to figure out, you know, what's what's going to if you really care so much about keeping them around for a long time. And that's, that's a big deal for you. And absolutely, totally get that it's great to have somebody there for a long time, then what is it that they care about? What is it that they care about? You know, and how do you and then if you want to do something that is not financial? Because your your clinic can only afford so much? What are those intangibles that you can bring to the table? Or even the physical therapist coming into work for them? What are those intangibles, and that's where you can really come to the table for a better exchange with those generational differences. I think, you know, and,   13:36 you know, and one of the things that you kind of touched on is that we have to be, there's always a better way, and we have to be open to that better way. And I think that's where we run into an issue of when a younger generational PT says, well, this doesn't make sense to me, I want this amount of money. That's not us complaining. And I think that can be perceived as, as as, as a complaint, US whining, because we were known as the whiny generation. We you know, we complain a lot and what compared to what we're told is that we complain a lot, we're whining, we're never satisfied. And it's not that we're whining. It's not that we're sad. It's just that we grew up in the information age, we know what the PT next was making. Well, we know what the average PT makes. And so we come to the table and ask for this. It's not as whining and it shouldn't be perceived that way and we shouldn't be promoted as the whining generation is annoying. Having the information available to us and trying to benefit on or not even benefit just just be pay. We're given what we're worth. You know, we're rainbows and clouds profession. I mean, we we are a just a happy, just beautiful people and we just love people love everybody. And we're so happy go lucky and lovey dovey and I love that about us. But one thing that we do tend to forget is that the word can mean that we are healthcare practitioners first, but this is also a business. We have to be sustainable, to be able to provide the jobs for our employees, we have to be fulfilled in our careers to be able to provide the care the level of care that our patients deserve. And some of the ways that we do that is to ensure that our employees are happy. Somebody brought up at the conference, the idea of valuing your employees. And value in itself. I think, for us as this lovey dovey profession means so many different things, but value in itself as a word is a financial word. What is the value of me as a a physical therapist? I know my financial value, if you cannot meet that, as you've already touched on, if you can't meet what I'm asking for what else can you meet me, meet me halfway meet me with increase vacation days, maybe with an increase a formal mentorship program. We're supposed to meet and you're supposed to meet me where I am as an employee. And so I think that's where there's a big barrier as well. And that sometimes we're a little bit too focused on intangible things where a lot of or several of us are looking for tangible benefits in my generation. So I think that's a big riff. And it's a it's got to do with our identity crisis in our profession that I said this at the conference. Nobody loves pts. As much as PTS love BTS. And that's our issue as as a profession that we have to address. And I think that kind of that kind of flows over into this this generational difference. Oh, my God, it does. It does. Absolutely. Absolutely. And so that's, you know, I don't want to get too deep here, but I want I actually   16:55 want to bounce off you because, yes, because they popped in my head earlier. And I was like, I just let the idea, you know, because I just want to listen to you. But yes, it's the Pete, the best thing to T PTS, you know, and there's nothing wrong with us, the more seasoned professional that I mean, yes, ever. When I say this, I know they're seasoned. Like, I know, they're sick, we're not perfect. But the C's, they they live on this rainbows and clouds. I'm just saying, I know, it's a harsh way to say it. I hear I hear what I'm saying. But whatever I'm gonna say it. And then we have where the younger generation, I think it's Gen Z, because Gen X is before. So okay, so we have the Gen Z, and the millennials are newer in the profession. And they're not afraid to point out things that they think are wrong. But I think then with that in mind, I think from higher up there is toxic positivity. And I think that's where that comes in. Where it's pushed upon, you cannot say anything bad. But then we lose this honesty and transparency in what's going on in the communication. And, and God forbid, something bad is said, you know, boy, and guess who's on social media, everyone? So if you're talking about, you know, like, oh, there's younger people are complaining. Facebook is older people, man, Twitter is older people. Like there's some younger on there too. Yeah. But like the hotspots to be at are tick tock and mostly ticked in my opinion. Tick tock. Yes. And then I think I never looked at the data. So yeah, but I think Instagram is secondary, but that also has to do with like, how I like to watch the videos personally, I can I can scroll through the Tick Tock thing and then I can go to Instagram Instagrams a little bit not as smooth I go back to tick tock okay. So um, but but that's you know, that's where it's so far talking about all the younger they all they do is complain that's, that's all ages baby. That's all ages, we all we we all like don't I think it is so healthy, to have a full well rounded conversation that points out the bad and the good and you don't have to finish with a positive statement in a conversation about it's okay to end in a gray area. It's okay to end in a dark area and both see it you know, yeah, that is I don't have a solution. Like that's actually that's not a good thing. It's okay. But we but this toxic positivity puts anybody going through anything on the spot if you're anybody who might be oh gosh, dealing with somebody who is has poor health in your family and you can't talk about it or mention it at all and you're yet to put on this face. I get it. That's you know, I'm putting in air quotes professionalism, but professional professional only means literally other profession. Everything else is defined by you. Or defined by me. So literally, that's all perfect. Like everything else is like up in the air up for grabs. however you interpret it. So the you know, took like, place these these random rules on what professionalism, professionalism is from that point on is is purely subjective. And that's where that toxic positivity comes in. Yeah. And then in then we get these risks these butting heads, because everybody has different core values, which is great. And I think that is a huge generational difference and where we lose and miss out on opportunities to listen and hear more.   20:29 Correct, correct. And that's where the issue becomes. I spoke on generational differences, as in the context of what is leading to burnout in early career professionals are the career pts. And I spoke on generational differences as one of the things that I thought was a key key difference. And one thing to note to note is that this isn't specific to pt. It's not burnout is not specific to PT, these generational differences is not are not just specific to physical therapy. This is a doula globally, this is definitely an issue in our country. There are, you know, I'm gonna make this a political conversation. But you know, there are, you know,   21:16 whatever all's fair game when you're with me,   21:20 you see, there's a group of people that believe that, you know, there's no, this is the greatest country on Earth. And that this is there, they would, they would know, they would not live anywhere else. And to say anything bad about our country is anti American. And then there's another generation that says, this is a good country to live in. This is, hey, I'm happy to live here. But there's a crap ton of issues that we need to address to make this country as great as it could be. And so that is, I say all that to say that there is no, I don't think we solve this issue. I don't know if there is a solid solution to the issue. But as I stated before, I do believe there are pptx, specific generational difference issues that we can address. And we should address. And as long as everybody is willing to hear each other out. Yeah, compromise, which is kind of where my conversation was with with the gentleman at the conference that we spoke about earlier. I had an opinion, but I heard him out. And I still don't agree with him. 100%. But I can identify a little bit more with where he's coming from. And I think that's key, I think it's important to have these conversations get uncomfortable with being, you know, get comfortable with being uncomfortable. And have these uncomfortable conversations to say, yes, these are the issues we have with your generation. These are the issues y'all have with mine. Where is that common ground? You know, is they always is, like you said better than we are? And so So, you know, I don't know, I don't know, I'm not the visionary, I see that you I can't give you the solution. I   23:08 don't know where I know, it's just to have a conversation. So that's all we're just having a conversation about this, which I think is great. You know, to get your minds and everyone's minds to start to think you know, are there you know, generational differences and everything. And be careful as you listen, it can be very hard because we there are a lot of people we're going to people help, we're a service business. And with that we get these people pleasing mindsets, where we can lose ourselves. And I would actually say definitely big time in the younger, newer generation. And in order to please the generation that has been around longer, we don't listen to ourselves and just agree it's okay to disagree. It doesn't mean you have to disagree. But really keep challenging yourself to get more and more in tune with what you believe in. And greater conversations can happen, greater solutions, greater growth and progress between all of us can happen, which is so cool. And it may not happen overnight, where you feel comfortable to talk about it. But keep I definitely agree with what you're saying. It's just if you can just keep even if it's a little bit challenge yourself a little bit more every time to just, you know, get there, you know, not easy, not easy. No. I love it. Any any other generational differences that you think oh, Jenna this or have we reached kind of your like, those are kind of the main ones where we   24:41 Yeah, no, I I do think those are my, you know, very inter intertwine those two that I talked about. I don't think that as as a this is sort of like a final word if you Yes, yes. I do think that specifically to this country, we value overwork For example, I, you know, I think that we value the the clinician or the co worker, not just in PT, but in general, we value the person who does the things that they're not required to do as a part of their job. That's what we use to determine who is who's that shining employee, who's the one that that goes above and beyond. Right. And it shouldn't be that I mean, for example, I remember, at this same job, we hit a low point, we hit a low point, always in January, it's an outpatient clinic, deductibles reset, so we're January, it was a low period, had a lot of openings on my schedule, so that everyone else and I was sitting in and getting caught up on documentation, going over some things with my mentor, learning new skills, in walks the owner, are asked, What are we doing? I tell him, you know, I'm trying to learn some things. And he says, Well, why don't we are marketing? I say, What do you mean? He said, you know, your patients, your schedule is low, why aren't you are out, you know, getting us new clients. And I'm like, that's not my job. Is that is you are the employer, you hired me to see the patients that frequent your establishment. Okay, I'm not the one to go out and beg these physicians to send us, okay, how much begging you do, the deductibles reset, that's going to be a phenomenon that happens every single year. So, but that's what the expectation from some employers have. Yes, I hired you to see patients and turning the documentation on time. But in also, I expect you to do these things, these these things that I didn't tell you about in your interview, but we expect you to do these things is become an expectation in this country, to overwork to do things that are not required to view and that is how we measure our employees and not on the job that they do. If you see all the patients on your schedule, go home on time, get your documentation in on time, and it's all you did for the rest of your life as a PT you'd never be promoted and you know in traditional practices so I say that's that's another generational thing is that I think we older generations value overwork working you all you need to be busy all the time. And we value we being the younger generations, a healthy balance of work and home life. I think that is another riff all of these are intertwined, but I think that's a another riff that's that's that's causing an issue, not just in our not just in our profession, but but across this whole country.   27:42 Now, yeah, definitely. I love it. Thank you so much for coming on to talk about this. If you are listening to this podcast, and you have some other ideas and stuff, feel free to write in the comments, just keep the conversation going. I think it's always good to just talk about it. And then And then if you're somebody who's about to go in for job interviews, write these things down for you to consider what you're going to bring to the table for your negotiations track on both sides, what was discussed in that interview? So it's very clear. If things come up that are that we're not included, it's so you can have a better chance of being on the same page. Yes, you're correct. We didn't bring that up, or you know what we need to make sure we bring that up, because that does come up, the more we can be on top of that transparency in the communication can better help address generational differences right off the bat, do keep in mind seasoned professionals owning your own practice when these students are graduating, they have a very low sense in general sense of self worth. So for the overwhelming majority, they usually jump at a job faster than they should. Because they are so excited. Anyone wants them. And that is a big thing that happens often at clinics. So just be aware of that them saying yes doesn't necessarily mean they were listening to what they wanted in the first place. Because they feel so grateful that they were not rejected, they were accepted. And that takes over everything. It helps it feeds into them eliminating what their core wants are because they struggle with self value. Alright, that's it. Where can people find you on the social or email, whatever you feel comfortable with sharing.   29:40 So I laugh when you say the old people are on Facebook and Twitter because that's really what I use is   29:48 and I'm in that category. So I feel comfortable saying   29:51 I'm not a Snapchatter I do have an Instagram. My Facebook name is just mine. That's what I'm primarily on. That's where I'm most entertaining. Book   30:00 is it clearance a home's nobody's claiming homes, clients homes,   30:05 parents homes as well. I'm the one that's scuba diving in my photo.   30:11 If it changes to hiking, everyone's gonna get confused.   30:14 I know why it's not going to just all my photos are nice. And then my instagram name is CA Homes six ca h o l mes the number six. Oh, I   30:27 love it California. You're not from there. But it's fun to say. Wonderful. Thank you so much for coming on. Everyone. If you're listening, please be nice. Be nice. Yeah, you can communicate but be kind. If there is any possibility that what you wrote might be in a way interpreted in a mean tone. Don't write it. I just don't I don't see. Like, honestly, it's just why and I'm not being toxic positive. I'm just being real. Like it's only going to just why why? Like go speak to your legislative representative about it, you know that you can actually make changes. Alright, that's it. Thank you for coming on.

In this episode, President of IFSPT, Luciana de Michelis Mendonça, talks about her research and the upcoming World Congress of Sports Physical Therapy. Today, Luciana talks about the importance of the WCSPT and the results from her research. Why are organisations like IFSPT important? Hear about why sports PTs are important in injury prevention and reduction programs, pre-season assessments, implementing prevention programs, and get Luciana’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “We should assess our athletes to make the most amazing tailored prevention program.” “Injuries happen, but if you can decrease the time that the athlete is spent outside the game, then that is a win for the team.” “Warm-up sessions with the physical therapist were the methods used to prevent injuries.” “Be lighter, less stress, [put] less pressure on yourself.” “I am where I am because I’m good at what I do.”   More about Luciana de Michelis Mendonça Luciana is a professor in a federal university in Belo Horizonte (Brazil) and develops research in the field of sports physical therapy. She has participated in the last four IOC world conferences on injury and illness in sport with poster and workshop presentations. She was involved in organisation of physical therapy services for the Rio 2016 Olympics and Paralympics Games. She was the first female president of the Brazilian Society of Sports Physical Therapy (SONAFE), in a country with many restrictions to women's participation in sport and politics. Since 2017, she has been an executive director of the World Physiotherapy subgroup International Federation of Sports Physical Therapy (IFSPT) and is now IFSPT's president. She is committed to enhancing the dissemination of sports physiotherapy good practice and knowledge globally and to increase equity in sports physiotherapy.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injury Prevention, Prevention Programs, Exercise,   Recommended Reading How injury registration and preseason assessment are being delivered: An international survey of sports physical therapists How injury prevention programs are being structured and implemented worldwide: An international survey of sports physical therapists Sign up for the Fourth World Congress of Sports Physical Therapy To learn more, follow Luciana at: Website:          https://ifspt.org Twitter:            @luludemichelis Instagram:       @lucianademichelis   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here: 00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.   00:35 Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today I'm very honored and excited to have on the program Dr. Luciana de mckaela Mendoza. She is a professor in a Federal University in Belo Horizonte in Brazil and develops research in the field of sports physical therapy. She has participated in the last four IOC world conferences on injury and illness in sport with poster and workshop presentations. She was involved in organization of physical therapy services for the Rio 2016 Olympics and Paralympic Games. She was the first female president of the Brazilian society of Sports Physical Therapy in a country with many restrictions to women's participation in sports and politics. Since 2017, she has been the executive director of the world physiotherapy subgroup, International Federation of sports, physical therapy or ifs PT, and is now IFSP T's president. She is committed to enhancing the dissemination of sports physiotherapy, good practice and knowledge globally, and to increase equity in sports physiotherapy. And in today's podcast, we will talk about some of her research into injury prevention and the role of sports physiotherapist in those programs. And of course, we will also talk a lot more about the fourth World Congress is Sports Physical Therapy, which is happening in Denmark this August 26, and 27th. That's 2022. So if you want to find more information about that, you can click on the link at podcast at healthy, wealthy smart.com. To find out more about the fourth World Congress is sports physiotherapy, again, taking place in Denmark. So we will talk a lot about that. And we will also get a sneak peek of some of Luciana has talks there. She's speaking and she is moderating. So she's got her hands full for sure. So I want to thank her for coming on the podcast and everyone enjoyed today's episode. Hi, Luciana. Welcome to the podcast. I'm excited to have a conversation with you today. Hi, Carrie. Thank you very much for having me. Yeah, it is my pleasure. And now before we get into the meat of our interview, can you tell the listeners a little bit more about you about your history in sports, physical therapy. And as I mentioned, you are the current president of ifs pts. You can talk a little bit about that as well. So I will hand the mic over to you.   03:06 Okay, Karen, so I'm from Brazil. I'm a sports physiotherapist and I graduated in 2003. So I'm 20 years as a physiotherapist. And I'm also a professor in diversity here in Brazil. I'm based in Belo Horizonte. And   03:28 I started to work. Since the as a students and sports team, I wanted to do physical therapy because of sports. I am passionate about it. And I, I started in this political scenario in the Brazilian society of sports, physical therapy. And I started it was in 2016, it was the year of real to tastic significant part Paralympic Games. So it was a really big challenge. I also work in the physical therapy services during the Olympics and Paralympic game here. And I started being part of the Executive Board of the IFSP CI in 2017. So I learned a lot during the presidency of Anthony Schneider's in Christian torborg. And now I have this big challenge to be IFSEC. President so I'm balancing this actions related to if activity and also with teaching and also research about sports, physical therapy. And my research is mainly directed to injury prevention, and also injury risk profile. So I think that's perfect. And can you talk a little bit more about IFSP T and kind of the importance of having these organizations and what they what they do, what are they there for   05:00 Yes, so the International Federation of Sports Physical Therapy is a subgroup of the word physiotherapy. That's our main our mother organization. So as a subgroup, we have to engage countries all around the world that have specific group related to sports, physical therapy to join the IFSP team. So nowadays, we have 34 member organizations in the SSP T. And our main mission is related to disseminate good practices, support research on sports, physical therapy, of course, and also promote actions to support our members, the whole community. So improve the practices around the world. And also it's a good it's an important way to connect with people. So I think the most amazing gifts that I had, being in IFSP T board is to network with people around the world. So it's a really   06:18 important way to have our professional, our profession, organize it. And so I probably will be in the presidency for the next four years. That's the plan. Yeah, that's, that's amazing. And one of the things that, like you said, as part of the organization is networking, and we'll say this will probably repeat this a couple of times, but the Fourth World Congress is sports, physical therapy is coming up August 26 27th, of 2022 in Denmark, and obviously, you will be there and you are a part of several presentations.   06:57 But like you said, your research is around injury prevention and assessment in sports, in sports. So can you talk about why the sports physical therapist is an important component of these injury prevention programs or injury reduction programs?   07:19 Yes, I just want to stress that, yes, the Congress of sports, physical therapy, it's important action that IFSP t also have, we are one of the main organizations, the main sub groups of world physiotherapy that deliver International Congress. So we have the first one in Bern, the second one Belfast, the third in Vancouver, and now illegal in Denmark. So I, I went to Belfast to Vancouver, and now I will be enabled for sure. So   07:55 I'm sorry, Carrie, I forgot your question. Oh, yeah. No, so my, my question, like I said, you're doing you're doing a ton. You'll be doing a ton in Nyberg. But one of the things that I know you are talking about is about your research that centers around injury prevention, and something that you're passionate about as if the sports physical therapist should really be involved. So why is that?   08:19 Yes. So I always thought that the main action as a sports physical therapy in a sports team, of course, I should be aware that, for me, I need support all athletes available to the coach to the head coach to train. So for me, it's, it was always a good time to have like the physical therapy department, empty without athletes there, because all athletes should be on the fields playing and training.   08:56 So for me, prevention was always important action that we as therapists should be aware of. So I, when I finished my PhD and start to be a teacher in university in Brazil, I started to wander, especially after I started to work in the IFSP. Board, I started to wonder if the prevention, the role that the Sports Physical Therapy had in prevention, and I know that how this works in Brazil because I was sports physical therapist and the volleyball team and soccer team. I was wondering if it was like the same, or I was wondering if it should be the same. Or if we are here in Brazil, we're doing like similar things that other professionals data around the world. So I have a sabbatical year in 2020 and I went to Belgium to work with Eric FitPro.   10:00 I was there in Uganda, the University of Ghana, as a visiting professor. And we started to develop a surveying to understand what role the sports physical therapists had in injury prevention. So I will talk about some of our results, we have two papers about this survey that were that are published in physical therapy in sports. And this helped me to have   10:33 sort of idea about the role. And we have really interesting information about this, that, of course, I will share here in this podcast, and also in the World Congress of sports, physical therapy. And also we develop a Delphi design to establish a consensus on sports injury prevention programs. So this is also an interesting   11:01 study that we could deliver an IFSP participated to, with this Delphi study linking   11:09 people from different countries. So I'm really excited to talk to you about this caring and say something that should make people a little bit curious and participate in the Congress. In Denmark. Yes. So when can can you give us a little bit of info, you don't have to give it all away? Of course, people can go and read the the   11:36 published papers, but in this   11:40 in this study, you had, how many people? What did you find? How did you do it?   11:50 So yes, for sure, I can share some of the data that we had the papers are published. And also you can indicate for your audience, I can send you the links. It's important, I totally understand caring that sports injury prevention area, we need to move forward related to research, we need to understand a lot of things. But I think it's interesting to understand what the professionals what the sports physical therapists are doing, because this can bring up some questions for future research. So   12:29 on the survey, we   12:32 we had 414, sports, physical therapists participating around the world. So I think we had like, people from 32 countries. So I know that the amount is not so high, we could have more people participating, but it was delivered in 2020, during the pandemic. So this is one thing that I should stress because, yes, we had 32 countries participating, but I, for sure, I expected to have more people there. But we had questions in this online survey that was related, link it to the synchronous sequence of prevention that were Matalan delivered, and maybe it's the the most use it, model or to make decisions about prevention. So we ask it if this sports physical therapists participated on injury prevention, sorry, injury registration. It's common here, Brazil, but I didn't know if my colleagues in other countries participating in the injury registration. We also asked if they assess it, the athletes to build the prevention program. So if they did, for example, preseason assessment, that's the more common way at least in Brazil. So I was curious about that. And also, I we asked about their prevention program. So if the pieces participated in this action or not. So about equal registration, the first thing this I think this is an amazing result, because we had more than then 80% of the sports physical therapists that participate in this study, were responsible for me to reverse the situation. So we can now say that maybe the sports physio are the are the person like more important more responsible to properly register injury in their sports team? So this brings brings up a lot of other questions. So for example, maybe we should IFSP T should deliver some actions to maybe   15:00 increase the knowledge and maybe the competence on this matter on our community. Because of course, if we are responsible for this, we want to do an amazing job. So it's, it's interesting. And it's good also to exchange some experience and learn from good examples. So this is really good. And we also ask about the main barriers.   15:29 So for sure now register the injuries. So more than a half of this physios said that lack of time in their routine was the main factor to not properly register injuries. So maybe we need to discuss also about the sports physio routine, inside the sports team. I think we talk we should talk more about this, especially in conferences that we can get together a lot of professionals from different countries, and we can learn from their experience.   16:08 So can I move forward? You have a comment about registration? Nope, I think I think that's good. And I do like that. You said, Hey, maybe this is a chance for us to get together learn from each other. Because perhaps there are ways to streamline this that people just haven't thought of that other people are doing. So you're right. It's a great opportunity for sports organizations, like if SPT to bring sports physical therapist together and say, Well, wait a second, some of you are doing this with some of you aren't. And if it's a lack of time, what can we do to give you a structure that can streamline your process? Yes, exactly. And it's one thing that here needs to be done. We just We can't like, Okay, I'm not going to register injuries, because how can I be sure if I'm going to prevent the injuries if I'm not registering? So if you're not registering, is it like they didn't happen?   17:09 Yes. And another another thing that is really interesting, what is the injury definition? That is sports, physical therapists are using my understanding, we can select different definitions, because this maybe rely on the sports modality.   17:32 But we need to talk more about this, I think we should   17:37 exchange and learned and maybe from this, maybe if aspartate can deliver some guidelines, I don't know, because it's one of our missions. Also to make the FSB T is the main resource for the Sports Physical Therapy community. So I think we will maybe in the future, we are going to have more actions based on the findings of so I'm really excited about this. Okay, so let's move on to preseason assessment. So how many are performing? And what are the barriers? I know that this is this, topics of little bit controversial, I know that we have a group that thinks that we should assess, and another group of sports physio, or research thinks that we, we don't need to. But our survey shows that 77% of the participants perform preseason assessments in their athletes.   18:45 So 222 sports fields, said that they do. This is amazing information. And I didn't expect for this high percentage.   18:59 And I was happy because I believe that we should assess our athletes to make the most tailored, most amazing tailored prevention program for our athletes. I know that this is a challenge. I totally understand this. But if I think about myself as a sports, physical therapy, if I'm working in a sports team, I will like I will do my best to assess the athletes and try to deliver   19:30 into an individualized prevention programs. So but we have like, opposite side here because only 30% of these sports physical therapists that do preseason assessment, customize the provincial program bases in the results of the assessment.   19:54 So this is a point that we need to understand better. We need to understand what is happening. Why   20:00 They sports fees you give energy to assess the athletes, but they don't apply the results to build the prevention program.   20:11 So we didn't   20:14 ask it like specific questions about this. To understand this, we only asked about the barrier. So the main barrier   20:23 that was indicated to not before assessment, it was lack of structure and organization of the sports team.   20:33 So about half of the participants indicated this barrier.   20:38 I understand makes sense, but I'm not sure if this barrier explain 100% of the reasons to not perform the precision assessment. And I think maybe this is also relied on the evidence that we have related to these. We have big discussions about injury prediction probability. So maybe we need to make some advance in research about this topic. And maybe we need to talk more about this to make more like have this issue more clear to everyone, specially the clinician.   21:22 Because I think so now, it's my opinion. Okay. I think we need to assess our athletes, and maybe maybe even the process of assessment should be discussed. Because if we, if we are here in a roundtable with sports, physical therapists, and we ask how you assess your athletes, which tests do you select, probably carrying, we are going to have different answers. So I don't I'm not sure what this means. It means that we don't have standards. We don't have like a protocol. Should we have a protocol? I don't know. But what I know is that we need to talk more about this. Yeah, I mean, oh, go ahead. Sorry. No, no, I just like, I just want to say that I was really happy with the the results that sports fields with a majority is performing a preseason assessment. But on contrary, I was I get a little sad to see that not like 1/3 of them are really applying the Results to Build provincial programs. And yeah, and so I brings up a couple of questions for me, and that is, have you seen preseason assessments? Decrease injury, are they and again, this goes on? I think what you just said that sort of prediction and probability. So if you do a preseason assessment, does that predict less injuries? I don't know. Have you seen? What are your thoughts on that?   23:06 Thank you for asking this caring, I think   23:10 preseason assessment. The main propose is not to predict injury, they may propose is to identify those athletes with more susceptibility or probability to get the injury and then we can act before this happened. I'm not saying that if we perform a preseason assessment and beta prevention program on the results, our athletes not going to get into I'm not saying that injury, always going to happen sports, but we can, for example, decrease the severity.   23:52 So if I have one athlete that I can, for example, I apply the stars question balance test, and I see that this athlete have a really low stability, functional stability in the lower league. So I can include in their provincial program, exercise to improve the stability, and maybe he will, he will, like have the ankle sprain, but I can decrease the severity.   24:26 So I will decrease the time loss. I will make this athlete more available to the head coach at the end. That's my reasoning on preseason assessment. And I think there is a misconception about this issue also. Right? Because I think, you know, if we're playing devil's advocate, some people may say, well, the preseason assessment isn't going to eliminate injuries. Why am I why am I doing it? Right? But like you said, injuries happen. But if you can decrease the severity if you can decrease the time that the athlete is spent out of the game   25:00 Yeah, then that's a win for the team. And it's a win for the coach in the organization. But if only 30% If if you have all of these sport physiotherapist doing a preseason assessment, then only 30% customize the program. Now we have to come up with some incentives for that physiotherapist to customize   25:19 the program for the athlete. And again, that may be like you said resources available to them, if it's one person and 50 players,   25:30 that it's difficult, you know that that's that that's quite difficult. But   25:37 I can understand how this can be a very frustrating part of research, because there's a lot of moving parts. And it's not just the sport physiotherapist, who has all best intentions and at at the heart of, of of their work. But there's a lot of external factors that need to come into play. But   26:03 I do I also like your that idea of being on a round table with sport physiotherapist and saying, Well, what do you do? What do you do? And maybe like you said, I don't know if a protocol is right, but maybe some sort of a roadmap where you have some basic assessments, and then you have the freedom and the ability to get creative, but to have certain certain things in there that makes sense for that sport?   26:31 Yes, I totally agree with you. Here in Brazil, I have a lot of colleagues and friends that came from the Brazilian society of sports, physical therapy. So we talked a lot in exchange a lot. So I, I myself, I have my challenges related to really delivering the prevention program that I i understand that would be like the best thing to do. But of course, this also relies on the relationship with the head coach, district parenting coach. So it's a lot of factors variables that we need to understand. And that's, that's really individual. It depends on the context of each sports team. So that's what I when I say that maybe we don't, we will not have like a protocol, because it depends on the sports team reality. But I agree with you that we can give maybe some roadmap to help everyone to organize better, considering the context, right? Yeah, exactly. Exactly. Oh, that's yeah, that's that really opens up a can of worms for people. That being said, let's move on to prevention programs. So what did you find with that?   27:53 Yes, so about the prevention program, we see that warm up.   27:59 sessions with the physical therapists were the methods more use it to prevent injury. And I think about warm up this was already expected because it was one roadmap that FIFA 11 Plus gave to everyone, not only for soccer, we have evidence on basketball, handball players. So FIFA 11 Plus really helped in this maybe this   28:31 basic organization, and how to deliver some preventive action in a more easy and accessible way. So I think it's really interesting that this survey, like confirm that one map, it's a really good strategy to include the provincial probe on athletes routine, because the athlete will need to warm up. So we have this moment, and why not. So instead of make the athlete do like,   29:06 whatever exercise or just running on the field, why not to be more specific and includes exercise that the athletes really need to do based on the sport modality.   29:20 Epidemiology. So for example, we know that in soccer, we have a lot of famous hamstring strain, we have a lot of ankle sprain, knee sprain. So why not to include some melodic at the size it some balance exercise? I think this is a really   29:38 important action that every old sports physical therapist needs, so be engaged and participate and about the individual sessions with the sports physical therapists. It's important to us and then I really expected some information around this   30:00 because we know that we have some time zone athletes that need a specific exercise that needs to be delivered by the physical therapist. So I was happy to say this because this was the methods more use it more indicated by our participants. And above the barrier, we saw that lack of time in athletes routine was the main barrier to perform the provision. This was indicated by 66% of the participants.   30:34 Of course, I expected results. And that's why warm up, it's important action because this is already in adults routine, we don't need to change the routine to include one more time and period to do   30:51 the exercise related related to prevention. So again, carry I don't know if this only this area only about athletes routine, we can understand why we can't perform major prevention. And as I said, Before, I understand the challenges. I think it's not easy. But I think it's a wonderful, it's a wonderful action that sports physical therapists participate. And it's really, of course, important for our athletes health, not only performance, because we have evidence that provincial programs also increased performance. But also I'm concerned about athlete's health, we need to, of course, help the athlete because no one wants to get into it. So this is really, it was really important.   31:49 For information that is the also indicated and these information helped us. So sort of build the questions related to the consensus, that was our second step during my experience in Ghent University with Eric.   32:11 Right. And so at W CSPG. You're going to show some data about the Delphi consensus, so you don't have to give all that away, people can go to the conference to hear more about that. But if you want to give a little preview, now's your time. So you what are the main topics investigated?   32:31 So about our Delphi, we organized the consensus in three parts. So the first part was related to how the thesis should plan the provincial programs. So this planning was about the information or the reasoning to develop the injury prevention program. So this is interesting, because we have information that, for example, sports, physio, use the reasoning related to biomechanics, or the base decision only on evidence and injury, Epidemiology, or athletes, injury history. So we have this kind of information and result and this is really brings up some discussions. So I hope that on the conference, I can, we can have this moment to discuss about our information, our data. The second part was about the organization. So how work environments before the implementation, how this affects the delivering the injury prevention programs. And the third one is about the implementation phase that I know that there is a lot of discussion and research, we have a specific we have specific groups of research that really go deep in this matter of implementation. So in this third phase, we identify barriers and facilitators to implement the injury prevention programs, and also related to compliance, if visibility. So this is how we organize the Delphi. It was a huge amount of work from all the core authors that participated in this study, and really happy that we can now say that this is accepted in physical therapy in sports generally, we can now really disseminate   34:39 this information, and I'm really happy to be part of this. Yeah, well, congratulations because that is a ton of work. And again, if people want to learn more about this, then you can come to Nyberg August 26 27th The Fourth World Congress is Sports Physical Therapy in Denmark.   35:00 And I mean, who doesn't want to be in Denmark in the summer? Right? I mean, amazing. Yeah, this will be my first time in Denmark. So my I am excited. So of course, no Denmark, but also to meet my friends from Sports Physical Therapy community, specifically before this, sorry, after this pandemic. Yeah. So I really miss my friends. And I really excited to talk more about injury prevention. And so our consensus results, and exchange and networking with everyone there. Yeah. And where can people find you? If they have questions? If they you know, we'll have the links to the studies that you mentioned in the show notes. So if people read that, and they have questions, where can they find you?   35:53 Yes, Carrie, so I am on social media. So I have my Facebook profile, Instagram, it's with my name, no change at all. And also in Twitter, is Lulu the chalice so you can find me there. And we can keep talking about information. IFSEC. I invite everyone for be like in the World Congress of sports, physical therapy, it's in August. So I'm really excited to be there. And I hope to see you there all for caring. Yeah, I will be there. I'm looking forward to it. And now final question that I asked everyone knowing where you are now in your life and in your career, what advice would you give to your younger self? Good question. Okay. So maybe, first, I would say to my own self, congratulations, you are an amazing woman in you accomplished a lot.   36:52 For sure, I never thought that I would be where I am now. As IFSP President working in federal, probably the most important federal university here in Brazil. So I'm really happy. If I could give her some advice should be be more lighter, less stress, less pressure on yourself, Luciana.   37:23 But at the end, we don't don't care if this increased pressure or stress, help in a way.   37:31 me to be here where I am. Or if I could go through this path. Be more.   37:41 I don't know light. I think the word is like, Yeah, I think so. And, and I love the fact that you said you know, you would congratulate yourself. And I think celebrating wins and celebrating what we do are things that women don't often do. Right? We're always sort of congratulating others and putting others up, but we never sort of congratulate ourselves and celebrate our wins. And, and I think if I were to go back and tell my younger self, something that would be it, like stop making yourself smaller so that other people can be bigger. It's a constant exercise. I didn't accomplished my winnings, my victories so often, but now I can see clearly that I am where I am, because I'm good in what I do. So perfect. What a way to end the podcast. I think that's great. So again, people can see you live in Nyberg, August 26 and 27th. At the fourth world, Congress is sports, physical therapy, you again will have the link on the conference and how to sign up. And we certainly encourage everyone to do that. Like you said, What a great way to meet up with colleagues to get some really great information and be in a beautiful place while you do it. Yeah, exactly. And on August 25, five, we are going to have a network session delivered by FFTT. So we are going to have also this moment to get together and exchange. Perfect. Is there anything else? You know, you're the president? So is there anything else that we missed? Talking about the conference that you want to let people know is is also happening? We are going to have an interesting conference because it's going to be I think the first World Congress of sports, physical therapy that we're going to have specific moments to do sports in the program. So we are going to have this more serious moments to talk more about our practices and research but also light moments to practice sports and be more friendly there. Yeah, so basically bring your workout clothes is what you're saying. Yeah,   40:00 Oh, yeah, that's exactly perfect. Perfect. And I don't think I mentioned that when I spoke to Katie so I'll be mentioning that moving forward that bring your sneakers bring your workout clothes, that traditional   40:13 well here in the US for whatever reason, people like always wear suits to these things.   40:20 So don't don't worry about the suits, but definitely bring your workout gear. Yes. Perfect. Perfect. Well, Luciana, thank you so much for taking the time out today and coming on to the podcast to talk about all the great stuff you're doing. Thank you so much. My pleasure, Kara. Thank you so much, and everyone thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.   40:43 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media.    

In this episode, Nigerian Sports Physiotherapy Association Founding Member, Ummukulthoum Bakare, talks about her important research and advocacy of sports physiotherapy. Today, Ummukulthoum talks about her research on women’s football, the issue of compliance and adherence, and the next steps in her research. What are the challenges for women football players, and how are they mitigated? Hear about her experience advocating for sports physiotherapy, her presentation on The Unbreakable Young World Athlete, and get her advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Passion will drive you.” “The increase in projections of the numbers of registered football players has skyrocketed by the participation of women in football.” “Coaches need to understand that they can be empowered to take charge.” “You don’t have to think of injury prevention as this thing that is separate. It needs to be integrated.” “Nothing is impossible. If you can dream it, you can do it.” “The sky isn’t the limit anymore.”   More about Ummukulthoum Bakare Ummukulthoum Bakare is a Doctorate Candidate in Sports Physical Therapy at the University of Witwatersrand in South Africa. Her research is focused on women’s football and injury prevention. She is a founding member of the Nigerian Sports Physiotherapy Association and is active in disseminating the FIFA11+ injury prevention programme in her native country and across Africa. Her passion has centred around the sports of football, basketball, and para-athletes and injury prevention. She received her Bachelor of Physical Therapy and her Master of Physical Therapy from the College of Medicine, University of Ibadan, Nigeria. Ummukulthoum has worked as a physical therapist since 2001 and has won several awards for her service locally, regionally, and internationally. She is a member of the Medical and Scientific Commission of the Nigeria Olympic Committee and an Associate Editor for the British Journal of Sports Medicine.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injury Prevention, Women’s Football, Empowerment, Advocacy,   Third World Congress of Sports Physical Therapy   To learn more, follow Ummukulthoum at: Website:          https://www.facebook.com/nspa.org.ng/ Twitter:            @koolboulevard Instagram:       @koolboulevard   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.   00:35 Hey everyone, welcome back to the podcast. I am your host Karen Litzy. And in today's episode, I'm really honored to welcome UMO cooltone Bukhari she has a doctorate candidate in Sports Physical Therapy at the University of Witwatersrand in African South Africa. Her research is focused on women's football and injury prevention. She is a founding member of the Nigerian sports physiotherapy Association, and is active in disseminating the FIFA 11 Plus injury prevention program in her native country and across Africa. Her passion has centered around the sports of football, basketball and para athletes and injury prevention. She received her Bachelor of physical therapy and her Master of physical therapy from the College of Medicine University of Ibadan in Nigeria UMO kooltherm has worked as a physical therapist since 2001, and has won several awards for her service locally, regionally and internationally. She is a member of the medical and scientific commission of the Nigeria Olympic Committee, and an associate editor for the British Journal of Sports Medicine. So in this episode, we give you all a sneak peek of what she is going to be speaking on as one of the guest speakers at the fourth World Congress of Sports Physical Therapy, which is taking place August 26, to the 22nd 2022 and Nyborg Denmark. If you want more information on the WC SPT conference, head over to podcast at healthy wealthy smart.com. Click on the link in the show notes under this episode. If you can, I highly suggest signing up and joining us in August in Denmark. So Lumo coutume is just one of many speakers that we're going to be highlighting over the next couple of months. We have a great conversation today about the unbreakable Young World athlete which she will be speaking about Nyberg. So everyone enjoyed today's episode and be on the lookout for more speakers coming up in the next couple of months. Hey, Katie, welcome to the podcast. I'm really happy to have you on.   02:43 It's lovely to be here, Karen. Thanks for having me. Yes. And like I said in the intro, gosh, you are a real rock star in the physiotherapy world. So you are a founding member of the Nigerian sports physiotherapy Association. You are a member of the medical and scientific commission of the Nigerian Olympic Committee and an assistant editor for the British Journal of Sports Medicine. And so that leads me to my first question is How important do you feel these associations are for the profession?   03:20 Thank you, Karen. It's is really very important, especially from my side of the   03:27 of the continent where we have very limited resources. And it's always a good opportunity to connect with other colleagues from around the world. When we first started the the Nigerian sports physiotherapy Association, were just a handful of people who, you know, came together to say, look, if we did start an association like this, it would help us be able to connect with other colleagues and associated other associations from around the world. And then we connected with IFSP T, which also given us a lot of opportunity to connect with the rest of the sports PT world globally. And that has kind of enriched us over the years. And I'm happy to say that Nigeria was also the first African country to be affiliated with IFSP T. And we still have a great relationship till today. And I'm also actually, I think, the first African and the IFSP T board. The executive board. I was elected in 2019 in the last Congress in Canada, for the Nigeria Olympic Committee. That took a lot of work because it's actually by appointment. And over time, it had only just been physicians. There hasn't been any room for physios to get on board, but I think for somehow I just kept well with the National Society. I'd be the Nigel site of physiotherapy, I just kept pushing to get on visit   05:00 ability for physios get us to get, I mean, get the Olympic Committee to also organize specialized training for physios and all of that, and I was doing all this work, making sure that where they were conferences happening, I wanted them to, you know, support people to attend and all that, and a former vice president of the Olympic Committee, and as I look, I think you'll bring your loved one on board. And I'd like to nominate you to be on the on the medical commission. And I was like, Okay. And   05:34 when I got in, I was the only female and I was the only physio. But I am glad that we time a lot of things have changed. Because one of the key things I'm passionate about is to give room to allow upcoming and early career sports medicine stakeholders, be it physio psychologists, you know, doctors, physicians, but give room for the younger ones to be supported and, you know, have access to all the IOC courses and things like that. So I it's been, it's not been an easy journey, but I think you can change a lot more from the inside than the outside. And that's, that's why I took on the assignment. And so far, so good. It's, it's worked out. Yeah, it's slow. But it has worked out a bit. Yeah, amazing. And I was going to my next question was going to be what, what has it been like for you to kind of be the first to have a seat at the table? Right, the first woman which I'm not surprised, and the first physio to kind of have that seat at the table, what has that been like for you? And what lessons have you learned?   06:43 Um, to be honest, it was not a really easy thing to do, especially when you are in the middle of about, you know, 12 other people who, and you probably also are the youngest. Let me add that, even though I don't consider myself young, per se, but in that tool,   07:06 I was the youngest. So but I think luckily, I What sort of helped me was that I spoke with the chairman. And I told him Look, this is   07:18 this is the ideas that I have. And I feel like I know there's a lot of work that needs to go on behind the scenes, I'm happy to do all the heavy lifting, or writing and all that, but we need to push for more things to achieve our mandate. And he was very happy with that. And later, a lot of a lot of the other board members just felt like Okay, it looks like we have somebody who's willing to do all this heavy lifting with you know, writing proposals and stuff. And we just kind of make things work. And somehow they just realized that I wasn't really doing it for any self. For myself, as it were, I was trying to get us to have a better a wider ecosystem for sports medicine resource, be it physios, doctors, you know psychologists, pharmacists, nutritionists and stuff like that. And so far, so good. We've we have quite a sizable number of young, early career people coming on board, a lot more people are not interested in sports, physio and all that. And which is because before now, nobody really wanted to do sports physio, they felt like,   08:26 you know, you're, you're never going to be rich. Like you're always just   08:31 the government is always owing you money. And so why are you a physio per se but then I tell them that look, passion will drive you it is just a calling and you really need to understand that.   08:44 What can in any another prefer in any other specialty or physio? It's quite rewarding as a sports physio as well, if you if you're driven by the right   08:55 circumstances. So yeah, it's not going to be easy, because half the time you'll find yourself like a fish out of water, especially being a female   09:05 where you're working multisport settings and you have to work with male team and all of that you have to hold your own. But it's it is rewarding. And yeah, so yeah. And it sounds to me like some of my students. Yeah, some big lessons. There are one, being willing to put in the work and to opening the door so you can help bring other people in. It's not opening the door for yourself and closing it on everyone behind you. No, no, because there definitely has to be a transitional plan. What is the sustainability of whatever you're doing? Because at the end of the day, your time is going to come and go. So who are the people that you're empowered to continue that journey, the vision and to be able to achieve   09:51 you know, the end goal of making sure that there is that continuity, and that you have, you know, so they pay forward and they can   10:00 didn't pay forward until, you know, for as long as as needed. And we would have a big pool of sports physios because I can tell you that Nigeria is over 200 million people, and maybe about 10 million active Lee involved in sports at a competitive level. And we still don't have enough physios to cater for that number.   10:27 So there's still a lot of work to be done. I can't do it alone. It's a collective team effort. Yeah, I mean, you have to increase the capacity. Exactly. Right. So that that all of these 10 million people, which is a huge number of people cannot be seen by estimating. It could be more, right. Definitely. Yeah. So obviously, you don't have the capacity for all of that. So if you can open that door and bring in a lot of like enthusiastic, like you said, physios, physicians, psychologists, nutritionists to help you continue to build up the capacity of a sports medicine program across the country, you'll be able to reach more people. Exactly. And that's what it's all about. And now, let's talk about your research. So you've got this passion of building up the capacity for sports medicine in Nigeria, let's talk about your research, which I know you're also passionate about. So I'll hand it over to you.   11:31 Okay, so I'm currently working in women's football. I mean, it is what it is because women really don't get much attention for anything, even in football, and for research specifically, as well. But as we all know that the   11:49 increase in projections of the numbers of registered football players has skyrocketed by the participation of women in football. And we know that for women's for women, we are more or less we have certain   12:08 certain factors, that puts us at higher risk of injuries. We know football has burden of you know, contact injuries and all that but can reduce the injury rates of non contact injuries. Now, because women I hire, that when population were what areas due to biomechanical factors, biological factors as a result of hormones and stuff, biological become biomechanical because of, you know, pelvic hip ratio, you know, being at higher risk of ACLs. So you want to be able to minimize that risk. And how to do that is to actively engage in injury prevention. So trying to bridge the gaps, especially in a low resource setting where we don't really have much human resources, infrastructure and all of that, and people still want to play football. So my research is trying to bridge the gap with the population of women playing football, and the use of an evidence based, comprehensive warmup program, which is the FIFA 11. Plus, it is a basic injury prevention program, but it works. But it's not going to work if people don't know about it and compliant with using it. So it's trying to find out what are the challenges in the setting? And how can we mitigate these challenges to be able to improve compliance and adherence, and be able to achieve injury prevention goals, because even on a global scale, compliance, and adherence is a big issue with anything. So, um, since we also know that we have to always tailor things to the broader ecological context, or whatever we're doing. It's not one size fits all, because you have to figure out what are the things that can work in this setting? How can we adapt that can we adjust certain things and whose responsibility is going to take the leadership of the injury prevention philosophy, how this behavioral change is gonna affecting? So this is this is a research that I was working on, or I'm concluding at the moment. And I'm really excited because now I think FIFA also is doing trying to do a lot of stuff for women's football. So hopefully, that can help. You know, in the next five years, we'll see women's football going to a different level than we are right now. Yeah. And you know, as you're talking about that and talking about the resources or lack thereof, it really makes me think I'm in New York City. I'm in the United States where we have an abundance of resources, and people still don't comply with injury prevention programs, right. And so I can't imagine being in   15:00 In a part of the world where you don't have the the manpower, the end all of the things that we have here, yeah, yeah, in order to make these programs stick.   15:13 Exactly. So this is one of the things that I found out is, along the course of my research, is that coaches need to understand that they can be empowered to take charge, rather than coach to see me as a medical person, like trying to take over their job, I'm not trying to take over your job, I'm only trying to help the team so that he can have more players available for selection and team can do better because at the end of the day, it's inversely proportional, the less injuries in the team, the more the team, you know, can can can progress and be successful. So at the end of the day, I think the messaging also matters, the messaging about, Okay, Coach, if you do this, you're going to have more players available for selection. And when you do have more players available for selection, then your team has a better potential to fight for the title to get to win a trophy. And when that happens, you get a bonus or something in your pocket. And it all everybody sort of it's a win win situation when your players do or injury free. They have longer carrier carrier longevity and so many other things. So the reason begins to change, you know, begins to change and at the end of the day. And then another thing I say to them that look, you don't have to think of injury prevention as this thing that is separate. It needs to be integrated. And there is no flexibility to adapt   16:45 and just integrate, it will still work. The most important thing is that you are committing at least twice a week for these exercises to be done. And you will see the difference that it brings to your team. Yeah, it's all about incentives. Right? How can you how can you meet the people where they're at with the incentives they need? And like you said, it's all about the messaging? Yes. Okay, wait, mindset changes, right. And that kind of takes us into I think what you're going to be speaking about at the fourth World Congress is sports physiotherapy, which takes place August 26 and 27th of this year in Nyborg, Denmark, and that is the unbreakable Young World athlete. So talk to us a little bit about that, and a little bit about your presentation. We don't give it all away, of course, you know, we want people to come and see you live, so we're not giving it all away.   17:46 We can dangle some highlights out there.   17:50 Okay, so the first thing is, I think that right now, everybody knows the potential of sports. So   17:58 everybody wants to start young. Now the pressure there on the young athlete is to begin to perform at a professional level at a young age. And that impacts a lot of things in terms of because you know, the type of dedication that you need to, to perfect, whatever sport that you're doing. And, you know, many parents and guidance, everybody wants, oh, I want my child to be Cristiano Ronaldo, I want my child to be messy. Now the pressure is much on these kids. And one of the biggest challenges that then these the burden of having to deal with that kind of pressure, whether physically, psychologically, and every other thing that makes up these young athletes would really be a huge load for young athletes out there. How can we balance that? Now, I will be talking from the perspective of law resource where I'm coming from a lot of many people.   18:57 In the developed countries, they have a lot of support for young athletes. And be it nutrition wise psychology, and so many other things that you we don't have the luxury of that. And many times, the kids who just want to play like they don't want to do anything serious or anything like that. But there's still the pressure and demand on them to excel. Because people see that if you if you're a good sports person, or you're able to make a break in either football or basketball, which is one of the top spots in Nigeria, then we can change our economic situation. And that helps us out of poverty, and all this kind of and all this type of thing. So I'm just going to be talking from that perspective of low resource and how the young athletes   19:50 as much as you want to encourage sports participation, but there has to be that striking balance to enable them to succeed   20:00 That's a lot of pressure on a young kid.   20:03 Yes, yeah. Yeah. Well, I mean, I know I'm definitely looking forward to that talk in Nyborg. Is there anything else that you're working on projects moving forward? Anything you're looking forward to in the future, whether it's future research, speaking gigs, getting more involved in in the profession as a whole? What do you have coming up?   20:30 Okay, so I'm trying, I'm rounding up my doctorate right now. So hopefully, I can get a postdoc position as well to continue to work in women's football.   20:44 That is what I'm hoping for the next maybe six months there about, but other projects that I'm passionate about involves power athletes, I'm very, very passionate about walking with our athletes, because also they too, were like a minority   21:01 group. But I see that they are really the super humans, you know, with everything. And with the limited resources and everything you can think of the still strive very hard I want to get on on the world stage. They are the ones who put Nigeria on the on the on the map for medals, because I was with the team in 2016, in Rio, and   21:27 we won eight gold medals, set new eight world records.   21:33 So I feel like yeah, there's a lot more that I want to learn. And   21:39 I'm also trying to do some technical courses. And   21:44 there's something called classification for power athletes, where it's like, you're trying to make sure that all the athletes are classed,   21:53 in in the desired classes that they can compete on a level playing ground. So apart from the technical officials, they also need the medical people to come and do all the assessments of you know, movement, muscle power, and all these things, just to be sure that, okay, we have classes athletes properly, and they can compete without having undue advantage over the other colleagues in a similar category. So yeah, so I think that's really the next thing that I want to do. It sounds amazing.   22:27 Some of my students trying to move on to postgrads. I've just provide them some of my own shares, some run experience, support them along the way as well. And so that's, that's what I think I'll do. Amazing. Well, it sounds like you have a busy time coming up and doing really, really great work. So congratulations on all of that. And now where can people find you? If they want to reach out to you? They have questions. They have thoughts, where can they find you?   22:56 Okay, so you couldn't find me on social media? You'll see on Twitter, it's at cool Boulevard.   23:04 And it's also the same handle on Instagram at cool Boulevard. So and that's cool with a K, correct? Yes. K with the K Yeah, yeah. And we'll have all of that information and links directly to all of your social media in the show notes for this podcast, so people won't have to search too far. And now as we wrap things up, one last question that I asked everyone, it's knowing where you are now in your life and career, what advice would you give to your younger self?   23:35 Um, nothing is impossible. If you dream it, you can do it. So just surround surround yourself with people who will always find your flames. People will always ginger you to keep going. And I think, you know, the sky isn't the limit anymore.   23:55 You can keep going so that I'll give to my younger self. Excellent advice. And just if people want to see Katie speak in person, like I said a little bit earlier, she will be speaking at the fourth World Congress is sports, physical therapy, August 26, to the 27th of this year, 2022 and Nyborg, Denmark. So again, we'll have a link for that as well. So you can go on and take a look at the whole program and sign up and come to Denmark in the summer, which I'm assuming is going to be great. I've never I've only been there in February when it's pretty chilly and snowy and rainy. So I'm excited for I'm excited to go. And I'm excited to listen. I have never been to Denmark. This will be my first time. So yes, I am looking forward to meeting you. And the rest of the delegates from around the world. Yeah, it's gonna be great. So Katie, thank you so much for taking the time out and coming on today and talking about all the great work you're doing. We are all inspired. So thank you so much. Thank you for having me.   25:00 and looking forward to see you soon. Yeah and everyone thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.   25:08 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media  

In this episode, Physiotherapist and Sports Injury Researcher, Kerry Peek, talks about sports injury research and the neck. Today, Kerry talks about her research into sports injuries, developing training programs, and evaluating feasibility and adherence to programs. How can greater neck strength assist in reducing head and neck injuries? Hear about measuring neck strength, defining “normal” neck strength, and get Kerry’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “You wouldn’t send an athlete out without doing knee exercises, and yet we do it quite regularly with the neck.” “We need to do some isometric exercise but with ballistic intent.” “I don’t think isolated neck exercises is going to give you the best bang for your buck.” “The best exercise is the one they’re going to do.” “We need to make sure that the research in this space is high-quality research.” “We need to be more critical in the way that we apply research in neck strengthening.” “If you’re really good at designing exercise programs, get creative.”   More about Kerry Peek Dr Kerry Peek (PhD) is a physiotherapist, behavioural scientist, strength-and-conditioning coach, and sports injury researcher with the University of Sydney. She has over 20 years of clinical experience in both Australia and the UK working with many athletes across a range of sports, age groups, and playing levels, including elite athletes in football (soccer), rugby, motor racing, American football, and athletics. Her current research is focussed on mitigating sports related head and neck injuries and has just completed a project on neck strengthening and heading funded by a FIFA Research Scholarship. Kerry has presented to the UEFA medical committee and assisted in drafting UEFA's heading guidelines. Kerry is the Chair of the New South Wales State Council for Sports Medicine Australia.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Research, Injury Prevention, Neck Strength, Exercise, Training,   Recommended Reading The Effect of the FIFA 11 + with Added Neck Exercises on Maximal Isometric Neck Strength and Peak Head Impact Magnitude During Heading: A Pilot Study Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review Purposeful Heading in Youth Soccer: Time to Use Our Heads Higher neck strength is associated with lower head acceleration during purposeful heading in soccer: A systematic review The effect of ball characteristics on head acceleration during purposeful heading in male and female Heading incidence in boys’ football over three seasons The incidence and characteristics of purposeful heading in male and female youth football (soccer) within Australia Neck strength and concussion prevalence in football and rugby athletes    To learn more, follow Kerry at: Website:          Kerry Peek Twitter:            @peek_kerry ResearchGate: Kerry Peek   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read The Full Transcript Here:  Hey, Carrie, welcome to the podcast. I'm so happy to have you on.   00:06 Thank you so much for inviting me.   00:09 And just so people get our connection, I was in Monaco for the IOC conference, and I went to one of the platform presentations, and you were discussing your research, and I found it to be fascinating. So you do a lot of work with the neck and head and I just absolutely loved it. I loved your presentation. I learned so much about it. And then as I dug deeper into you, I realized that you and my friend Evangelos Pappas, there was a connection there. So I texted Evangelos. And I said, you know, Carrie peak? He said, Yeah, I'm like, Oh, cool. Could you like, tell her that? You know, I really liked her presentation, because I was like, and, and I'm, I'm sitting right behind her. I don't know if he texted you that you're like that. It was like a psycho or something. I'm like, I'm sitting behind her.   01:01 He did text me that and it was just really funny to have this funny conversation between Australia and we're in Monaco, and you're American. And yeah, saying, oh, Karen sitting behind you make sure that you introduce yourself. Yeah. After the presentations are finished.   01:15 Yeah, that was funny. But I loved your presentation. So now I can't wait to talk about your research on this episode. So I'll just kind of throw it over to you to talk about kind of the body of your research and why you chose the topic that you did.   01:30 Yes, I am. I'm a physiotherapist. And now a sports injury researcher and I started in the early 2000s, working with Don gatherer, who is the former England rugby physio, and was the Chief Medical Officer The is the Chief Medical Officer. Sorry, I'll start that again. So yeah, so I started as a physiotherapist, I graduated in the late 90s. I graduated in the UK and I worked with Don Gajraj, who was a real mentor to me, and he was the former England rugby physio and also went to two Olympic Games. And he'd really developed a practice which specialized in neck rehabilitation. And this was an area that I don't really remember studying an awful lot at university, like we did manual therapy. And really, as soon as you got patients pain free, they were free to go like I don't remember really doing a lot of neck exercises. And so we had lots of players that played rugby, we had OpSite athletes, and we had Formula One drivers coming into the clinic, who had had a history of head or neck injuries. So concussion, which wasn't really talked about much in the 90s. But looking back, a lot of them work and cast. And we started doing a lot of rehabilitation, and I really am an exercise based physiotherapist. I really like doing manual therapy. And so it was just fascinating to to really come from that perspective to see, okay, what's the mechanism of injury? And how can we replicate this, you know, doing various exercises are really sports specific. I then moved to Australia and had children and got distracted bit by doing other things for a few years. And it wasn't until my son as an eight year old was heading a football, that I thought, actually, we should probably be looking at neck exercises in this cohort, considering they're using their head to you know, deliberately redirect the ball. And that really sort of got me down this, I suppose research rabbit hole, because at that time I was doing my PhD. And since then I've moved to the University of Sydney. And so really what my research is focused on now is how we can mitigate sports related head and neck injuries.   03:39 And so of course, you know, my next question is, what is the rationale for why training the muscles around the neck can play a role in reducing sports related head and neck injuries? Because, boy, it seems like some low hanging fruit right doesn't cost a lot of money, easy to implement. So what's the rationale there?   04:02 So I mean, first of all, I want to say that I don't think that next month is going to solve every head and neck injury. You know, I think it's part of a multifactorial approach where we will look at more changes and look at, you know, whether that's body checking or collision. But it when we're talking specifically about neck exercises, I mean, the notion that greater neck strength can reduce head acceleration, particularly during heading or during collision sports is that stronger, stiffer, next, increase the coupling of the head to the body, and then help to stabilize the head on contact. So whether that's body contact or head contact, and so really, we're looking at the stiffness, which is the ability to resist defamation, and then the strength which is then you know, being able to increase neck stiffness. And so it is really that coupling between the head, neck and torso.   04:54 And how do you explain this to a patient that you're giving these exercises As to increase neck stiffness, because I know a lot of people might think well wait a second, I don't want my neck to be stiff. So how do you can? And I love that you define that? Would you mind repeating it? Because I think it's really important. And how do you explain that to a patient.   05:14 So I tend to explain to my patient by using sort of the picture of a bubble head, so I do call them bobble heads. So you've got this figure, and then this head that moves really freely. And you think if you, if you nudge the, the head, it wobbles, you know, quite a lot. And so that's a lot of head acceleration, even if you touch the body, the head will also move. And so if you think if you are being tackled in sport, or you're heading the ball, then there's a lot of head acceleration there. And we use sort of head acceleration, we measure it, you know, with inertial measurement units, thinking that you know, this, if the head is moving a lot, the brain is moving a lot. And so if you can reduce the amount of head acceleration by increasing the strength and the stiffness between that bubble head and that fixed body, then that's a way to hopefully reduce some of the movement of the brain within the skull.   06:08 And that makes a lot of sense. And I think that is a great way to say that your patient, because they'll better understand what you mean by neck stiffness. Because I can just see, like, eyes getting wide, like, I don't want a stiff neck. But you're like, Well, when I wait a second, that's not what we're saying, We want you to be able to the neck is still mobile, but we want you to be able to accept those forces when they're placed upon you. Right?   06:35 Exactly right. And, you know, we know that head injuries and things are getting more prevalent in, in sport, and whether that's because of increased reporting, or whether it's just because the athletes are getting fitter, faster, stronger. And so some of the hits that you see in American football, and in rugby league and rugby union, I mean, they're horrendous. And, you know, if you've got this head that is really not well connected to the body, and you're being hit by a, you know, 100 kilo athlete, then that's such a vulnerable component. And I think that the neck, really working in this space, it's the last area of the body that we routinely exercise, you know, you would never send an athlete out, whether they're that's a prevention or whether they're post injury, without doing the exercises, you know, you wouldn't have an ACL and say, right, there's no pain there, off you go. And yet we do it quite regularly with the neck.   07:29 Yes, very much. So. And now when we're talking about strengthening the neck, how do you measure this, the strength of the neck.   07:40 So there are lots of ways that you can measure the strength of the neck. And a lot of these different methods have been shown to have good reliability. My issue is whether they're valid, and they're valid within particular sports cohorts. So when you're looking at assessing neck strength, I mean, generally, when you're looking at any assessment of muscle strength, there's reasons why you do this, you might be using it as an outcome measure. But generally, you're doing it to inform the load that you will input you you will apply when you're then exercising. So when you measure neck strength, it has to have some carryover to the position that the athlete is going to be in for their sport. And it also has to have some carryover to what you're trying to resist. So in with the neck, for example, you're trying to resist lots of head accelerations. So generally, you need to assess the neck using isometric or maximal isometric contractions, because you want to resist movements. Most sports are upright, you know, they're running, jumping, walking, running, and, and so you need to be upright when you test them. If that's how you're also going to exercise them. Now there may be differences. So if you're a rugby forward, you're going to be in a scrum position. So there may be reasons why you want to replicate a scrum position to test an athlete. But some measurements of neck strength are done in a supine and prone position. And these can often give you very different neck strength profiles, to when you actually assess somebody's upright. And there's problems if you are assessing someone in supine or prone, but you want to exercise them upright, because because you just don't know what the actual maximal strength score is in that sport specific position. So the way that I mentioned extreme is that I get them fixed in a seated position because I can standardize that position much better. And I use a break technique. So this is really looking at eccentric loading in an isometric position until you can break the contraction, I guess, of the neck. And this is shown in lots of different areas of the body that a brake technique will yield much higher scores than a mate technique. And so again, if you're using the brake technique, particularly because you're generally trying to keep the head and neck still when there's contact placed on the head or body, and then that is sort of like an eccentric load. So this will give us our maximal score, for which Has the flexes extensors left or right side flexes. And then this gives us a much better maximal result that we can use for percentage of one rep max when we're thinking about load.   10:14 And are you using a handheld? dynamometer? for that?   10:18 Yes, I probably should have said that first. Yeah, but I am using a handheld dynamometer with a load cell in series that's placed on the head with a with a head harness. And so yes, you do incrementally load that.   10:31 Yeah. Nice. And now, how, how do we know what normal is? Like? What's a normal strength profile for NEC? And and then how do we know what's normal for a position within a sport?   10:43 And that's a great question. Because when you when you look at the literature that's out there, the first thing I always do is I look at what was the method to assess neck strength. And if it is in a lying position, then I take the results slightly with a pinch of salt, because they too tend to give you a different neck strength profile. So there are a lot of studies particularly in rugby that have been tested using the same method that I that I use. And this was first developed by by Don gatherer. So it's not any great surprise that I use that because we used in clinic for a very long time and tested hundreds of athletes. But now having moved into that research base and had a look at all the different ways that you can test neck strap, it's still my preferred method. And so we've tested rugby athletes, we've tested football players. And what we're generally finding, and this is sort of consistent with the literature. And what we expect a neck strength profile to look like is that the extensors should be the strongest. So if you look at a result, and the extensors are not the strongest, is it related to the testing technique or the position that they're tested in? Or is there a problem there, so it isn't an injured population, that might give you something that's a bit different. So extensors should be strongest flexors are generally the weakest. And side flexors will sit somewhere in the middle there, depending on the population. So in rugby and American football, you often do want to have the side flexes to be stronger, and a lot stronger than the flexes. So they tend to have a very wide sort of neck radar if you were to plot this on a graph. Whereas if you have football players, for example, because of the conditioning from hitting a ball, they may actually have quite strong flexes. So I always have a look and plot the results on a radar. And then I also calculate the flexure to extensor ratio to see what that looks like. And so in the literature, normal is often considered around point six of a flexor extensor ratio, but I have seen it as low as point five as high as point seven. But I always think if in a sporting population, if it's below point six to me, that's that's honestly a red flag, but it's certainly a yellow flag.   12:47 It's problematic, or can lead to can lead to more problems. Yes. And where can people if they're wondering like, hey, where can they find the method that you use to strengthen? Is there a paper? Is there something you can point to because we can sort of put it in the show notes?   13:04 Yeah, so I do detail the the method for assessing neck strength and a paper that we published earlier this year in sports medicine. So we looked at the neck strength of football players, adolescent football players from 12 to 17. And then we implemented an X strengthening exercise program and to see whether by strengthening the neck this actually had an impact on reducing head acceleration during heading, and we found that it did so that the neck strengthening method is is detailed in that paper.   13:34 Perfect. So we'll have that paper, we'll put it in the show notes a link to it so that people can read it at their leisure. Now, we talked about why you're looking at it, how you're evaluating it, what does a training program look like?   13:50 So that's, that's really interesting as well, because I think, because there's not a lot of published literature on neck strengthening, I think you tend to find that you have different camps of people, some that are very pro neck strengthening, and that that certainly is myself. And, you know, a bit like you were saying earlier is that it's low hanging fruit, you know, why wouldn't we try and strengthen it because the potential gain is huge, and it wouldn't not strengthen any other area of the body. So I kind of think what, you know, why wouldn't you do it? But on the back of that, we also have to think what's the best way to strengthen the neck and I think some people are quite negative towards neck strengthening, because some of the papers that have been published, the exercises that they use are sort of self resisted exercises where they're pushing against their forehead and holding that and doing isometric holds. And a number of studies have shown that this doesn't really have an impact, it may not even impact in which increasing strength and it may not have an impact in reducing injury risk as well. And that makes sense. You know, I don't implement those exercises because When you're talking about reducing something like concussion or heading in football, those hits happen in fractions of seconds. So we don't need to have high insurance of the neck or just isometric control over a long hold, what we need to be able to do is fire those muscles really, really quickly. And so we've been playing with some neuromuscular exercises. So it isn't our paper that was published in sports medicine, but I'll try and describe it, but you're kind of in a setup position, but you're rolling backwards and forwards, and you're trying to stop your head from hitting the ground. And so the idea from that is really to try and contract the neck flexors really quickly if the heads in neutral, and then we turn the head to the side and the other side, and we do the same exercises. But the idea is that you've got that anti gravity strengthening, but you've also got, you know, you're trying to stress the muscles to fire really quickly. And that's what they have to do. So most of the the literature that is talking about neck strengthening is sort of indicating that we need to do some sort of isometric exercise, but with ballistic intent, and that's the bit that is often missing, for most of the neck exercises in the literature.   16:10 Yeah, and that's the exercise you described in Monaco, sort of, for people, if you've ever taken Pilates, it's rolling, kind of like rolling like a ball is kind of what that's kind of, you know, that's, that's at least what I got from it. And I remember I got back to my room, and I was like, we're gonna try and see what happens here. And it is it not as easy as it sounds.   16:32 No, and, and it does, it does work the net quite hard. And you can see it, you can see the net contractions in somebody else that's doing it. But the way that we sort of played with this exercise, and I will just credit to bursting, but also, we meet on a regular basis. And we talk about neck exercises. And he's also widely published in the neck strengthening arena, and was part of this paper as well. But what we were trying to do was come up with an exercise that use no equipment that didn't take long. So these exercises take 90 seconds. And that could be added to an existing neuromuscular program. So in this case, we added it to the part two of the FIFA 11 plus. And this is really important because I actually don't think isolated neck exercises is probably going to give you the best bang for buck either. I think we need to integrate it into, you know, other strength and conditioning programs. And again, this is sometimes where you see in the literature that they're just adding neck neck exercises without thinking about, or what is that neuromuscular control to the trunk as well. And how are we stimulating that?   17:31 Yeah, that makes so much sense to not just do things in isolation. I mean, gosh, especially when you're talking about athletes who rare? There's not many athletes that do things in isolation?   17:45 No, no. And and I think that that's just really important to get that adherence as well. Because if they think it's an add on program, and it's going to take ages and 10 minutes to an athlete is actually quite a long time when they're doing so many other areas of the body, that if we could integrate it into existing programs, or integrating into multi joint movements, then it makes sense to them. And it and it's, it's it's integrated. It's not an add on.   18:09 Right? Because of course, as we all know, as physio therapist, one of the hardest things through a rehab process is the patient that doing the rehab. Right, so the best exercise is the one they're going to do. So if you explain it well. And you integrate it, you're more likely to have that patient do the exercise. Have you found that? Have you found difficulty patients adhering to the program?   18:38 So, so we didn't, we did, we did look at the evaluation of feasibility. So my PhD is actually on adherence to exercise. So it was something that was really at the forefront of my mind when setting any exercise intervention, that we need to have some sort of process to evaluate it and see whether the, you know, the players and the coaches found it feasible, and did it take too long could they see the benefits of it, and it's generally scored really, really highly. And I think that is the fact that we tried to just minimize the time that it took that it was complex. So you know, the youngest athletes were sort of 12 years of age, and you know, they all understood what they needed to do, but also to make it you know, applicable to their sport. I think that's really important.   19:21 And what are your thoughts on different kinds of strengthening you know, we see things on YouTube people will see things on YouTube and I don't mean to go down a rabbit hole on that, but you know, tying weights around their head bands around their head doing things with bands and weights with movement of the neck. What are your thoughts on that?   19:44 So there's certainly some crazy stuff on on YouTube or Tik Tok and I think that's not necessarily specific to the neck. I just think that again, what you've got to try and do and, you know, I think exercise therapists, whether that's physios or exercise physiologist that do exercise really well, they understand the sport and they understand the mechanism of injury. And so if you're going to add a weight to your neck, you've got to think, Okay, well, how am I adding the weight? And how is it replicating, you know, the risk of injury, or what I need to do within my sport. And so if you're in a crouch position, which I've seen in lots of videos, where they've got a head harness, touch the neck, and then there's really, really heavy weight at the end. And I kind of think, why you're doing that, what's that for? And maybe in the scram, maybe that's applicable, but you know, I can think of very few reasons why you would need to do that. And when they hang weights off the top of their heads, you know, you think of that, you know, that axial loading that they're doing. Again, why would you want to do that?   20:51 Yeah, I don't know. That's why I asked, and so we got an answer. I don't know, I really do not know why you'd want to do that. But now now listening to you talk about your research, it just makes so much more sense to integrate it in a neuromuscular based exercise, you know, integrating it with other muscles within the body and making sure that it makes sense for the position and the sport of the person. Yeah, absolutely.   21:21 And I think this is about knowing, knowing your patients, knowing your athletes, and, and if you apply that sort of methodology for any exercise, you know, whenever you see someone, so I've been invited to do some work with the RW F here, so the Air Force, and I don't know a lot about PILOTs, but you just go in here, talk to the pilots, and you say, okay, so what do you do? And you know, when does your neck hurt? And? And how long are you in that sustained position? And how much G force are you being exposed to when you're in a fighter jet? And you just kind of start to understand, you know, what, what's happening to this person? And how is that potentially, you know, making them at risk of injury? And then how do we need to train those muscles in a way that stimulates, you know, what they're exposed to as part of their job or part of their sport? I mean, you do that with every other joint of the body? You know, I think we routinely do that. But we just need to do it at the neck as well.   22:19 Yeah, and great advice. And now is there anything as you know, throughout our conversation today that we didn't touch upon, about your research, maybe about your PhD work that you think would be audience would really love to hear more about?   22:37 Um, I think that it's important. I think it's important than I think I sort of said this a bit earlier on that, we really need to make sure that the research in this space is really high quality research, and that we understand, you know, the mechanism of injury, particularly things like concussion, that we don't think that neck strength is going to solve everything. But you know, when we're reading papers, it's understanding, you know, what method did they use, you know, are the results actually believable, or didn't the way that they measured neck strength have given you such an unusual profile that actually shouldn't read any further in the paper, or it's just not applicable to your athletes, for example. And so I think that we need to be much more critical in the way that we apply research in neck strengthening. And I think that, although I'm very passionate about next trend thing as an intervention, you know, I don't think we should overplay what we can potentially do in this space, either. It's just part of our toolbox, but it's not going to be everything.   23:38 Yeah, there. It's not the panacea for all ills having to do with head and neck injuries.   23:44 That's right. And I think that if you don't understand about how to integrate a neck strengthening program, I mean, I'm very happy for people to reach out to me, but, you know, talk to people and, you know, as I say, critically appraise what's going on. And I think, you know, if you're really good at designing exercise programs, get creative, you know, have a little bit of a play of what you're trying to do. And I think that's often how we get really innovative in the way that we approach exercise programming as well.   24:11 Yeah, and it also sounds to me like there's not a one size fits all. Approach, exercise or program. No,   24:21 I mean, I think there's things you don't do. And then everything else is kind of open to Yeah, depending on your athlete. So yeah, don't hang away off your head.   24:29 Yes, that is fabulous advice. And now as we start to wrap things up, I'm going to ask you the question that I asked everyone, and that's knowing where you are now in your life and career. What advice would you give to yourself as a new grad right out of physio school, your younger self?   24:50 I think that's a great question. And I don't regret anything that I've done in my career, but I would say that I've probably come to really specializing in neck strength is a bit too late. So we started in the early 2000s. So my first paper was published in 2005. And as I say, I got distracted doing other things. And I wish I'd continued with it. And I didn't partly because I was having children, and I'd moved to Australia and just life got in the way. And when I came back to it in the probably about 2015 16. So 10 years later, and nothing had moved forward, really. And I just thought that was a really missed opportunity. And so I if I could go back in time, I would probably, yeah, I would probably want to squash those 10 years into maybe 18 months.   25:40 Well, that would be pretty amazing time traveling. So where can people find you? If they have questions, they want to follow you on social media, where can they go.   25:51 So the best place to find me is on Twitter. So I'm at peak underscore Carey, I don't tweet about anything other than my research. So that's the best place to find me. And then you can always drop me a message through there. Otherwise, you can probably find me via Google, at my email address at the University of Sydney.   26:09 Perfect. And just so everyone knows, we will have a link to the papers that we've mentioned today. So if you want to read up on those that don't worry, they will be in the show notes at podcast at healthy, wealthy, smart, calm. And Carrie, I want to thank you for coming on. Like I said, I really loved your presentation in Monaco, which was just a short snippet of kind of the amount of things that we talked about in the podcast today. So thank you so much for taking the time out and coming on.   26:36 No, thank you actually went to your presentation in Monaco as well. And you've informed a lot of what I do as well about, you know, I think that most research is quite ego driven. And I'm not an exception to that. And we think that if we publish a paper that somebody is going to read it and we're going to change the world. And that rarely happens because players and coaches don't read research. And so your presentation was about you know, engaging with the media and doing a lot more in the social media space. And that really hit home to me that we have to try and bridge that gap if we can to translate research to practice. So no, thank you.   27:10 Oh, well, that's nice. I'm glad to hear that I will pass that along to my partner Osman, as well. So thank you for that. And again, thank you for coming on. I really appreciate it. And all of you listening. Thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, Owner amd Founder of Goldsmith Therapy Solutions, Dr. Philip Goldsmith, talks about value based purchasing in home health. Today, Dr. Phil talks about the pros and cons of value based purchasing, and prioritising results over productivity. How will value based purchasing in home health turn out? Hear about OASIS assessments, the difficulties of working with insurances, and get Dr. Phil’s valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “It looks like value based purchasing in home health is going to be a good thing.” “Home health therapists are probably, unfortunately, some of the worst offenders at underdosing strength training.” “Professional communication is where the good are going to be separated from the bad.” “Most of the private insurances base their policies on payment on what Medicare does.” “You’ve got to be involved with advocacy if you want to see change.”   More about Dr. Philip Goldsmith Philip Goldsmith, PT, MSPT, EMT, DScPT, COS-C, is the owner and founder of Goldsmith Therapy Solutions, a provider of high-quality management, consulting, and clinical solutions for home health providers. Dr. Goldsmith has been a practicing physical therapist for more than twenty years, with experience in home health, skilled nursing, and outpatient orthopedic environments. Dr. Goldsmith received his BS in Health Studies from Boston University in 1996, his MSPT from Boston University in 1998, and his DScPT from University of Maryland School of Medicine in 2011. Additionally, Dr. Goldsmith has extensive experience in leadership and financial management of small and mid-sized not-for-profit corporations and has won more than $200,000 in grants for public safety organizations with which he is affiliated. Dr. Goldsmith lives in Hanover, PA, with his wife and son.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Results, APTA, Home Health, Value Based Purchasing, Insurances, Advocacy,   To learn more, follow Dr. Phil at: Email:              pgoldpt@gmail.com LinkedIn:         https://www.linkedin.com/in/philip-goldsmith-a81a692 Twitter:            @pgoldpt APTA Home Health: https://www.homehealthsection.org/leadership   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  Alright, let's go. Hello, healthy, wealthy and smart. I am Jenna canter here with the Dr. Philip Goldsmith, who we're going to refer to as Dr. Phil, don't you love it? I'm so grateful to have Phil here, because he has a small business owner who runs a business in which he provides Oh, I'm gonna mess this up. And I'm so excited to where he brings stuff to the home health people and they're happy and they smile and say thank you. Without it and I get it.   04:05 That's pretty close.   04:08 Would you mind summarizing in that perfect sentence you just said a second ago of what it is you're more details on your business, like   04:14 elevator speech. It's called Goldsmith Therapy Solutions. And I provide high quality clinical consulting and management services to the home health industry.   04:26 I love it. And that's an elevator speech we all need to have you know for each of our own individual businesses, anybody who interviews with me knows I don't spend too much time going into the bio stuff because that will just be in the people can read it and then Wounaan go oh my gosh, I love Dr. Phil, you know, look at this. Wow, incredible. We are going to dive right into the topic which I know nothing about. I'm a cash pay cash based out of network PT working with performers. So I'm going to ask all the base questions to fully understanding the situation so everyone can better get on the on the same page with this apparently, and I I'm, I'm not saying it's not but just for me, it's new, apparently topic that's like a hot topic, and that is value based purchasing in home health. I know nothing about it. So let's talk about what is that? What is the value? What is that   05:21 value based purchasing is Medicare's new payment model for certified home health services provided to Medicare party beneficiaries.   05:33 Why is that important right now,   05:36 because it's different, how Medicare is moving away from the you go do a visit or provide a service and we pay you for a service to a model where they pay you based more on your outcomes, and how good a job you do at taking care of those Medicare beneficiaries that have chosen to avail themselves of your services.   06:05 That sounds great to me from a physical therapy standpoint, because that's what we care about. So how was this? Let's start with how this is good. And then we can go how this is potentially something that could get in the way of providing care to people fully. So how is this good?   06:20 This is good, because it removes a lot of the artificial drivers that were skewing utilization. Meaning, excuse me until about three years ago. The more visits you the more therapy visits you made, the more money you got. And that was unfortunately driving practice patterns and everybody Medicare, not Medicare kind of agreed. This isn't working. Yeah, yeah. And   06:55 because that's about productivity, not about results. Yeah.   06:59 Right. And it was it was too much widget counting, and a lot of home health agencies were making a lot of money on providing therapy visits that weren't necessarily necessary. Hmm, Mm hmm. So, you know, the the interim step on the way was this thing called pdgm that we're in now where it's all based on functional states and diagnoses? And that's about it.   07:28 Yeah, it's not nothing to push getting them to where we need to get them or to protect them from getting worse. If we're talking about home health. Yes, yes. Okay. Okay. So then let's talk about where this could potentially be problematic.   07:45 So the, the concern is, are you comparing apples to apples, meaning they're dividing the agencies up by state by geography and buy large versus small volume, to try to make apples to apples. But the big issue is, this system works literally by robbing Peter to pay Paul, somebody is going to make money. And somebody is going to lose money. So the other people at the other end of the scale can make money.   08:25 Where could you go and give some details on this? Because I'm not really following on on how this could be? Yeah,   08:31 Medicare is gonna say, Okay, we're gonna take all of the large volume agencies in the state of Pennsylvania. And we're gonna line them up by the outcomes we've chosen, they haven't told us the outcomes yet.   08:46 Deciding what the outcome what outcomes matter,   08:49 they are in the process of that now, who are the consulting   08:52 with doctors?   08:57 So there is what's called a technical expert panel, and we could do that alone. The concept of technical expert panels could be its own podcast, where basically they bring in people in the industry and ask them, What do you think is important? Um, do they pay them? They cover their expenses, do they? Do   09:25 they start to get a financial interest to sway certain ways and their responses? Okay, okay.   09:32 They're representing their industries. So, you know, they can, I could volunteer to be on a technical expert panel. And my job is to bring the perspective of the physical therapy industry. Hmm. They also do us, you know, these big beltway consulting firms that you hear so much about, and they have policy wonks that work at CMS that do this stuff. A lot of its actuaries accountants and lawyers? Because one of the big rules is this is supposed to be budget neutral, meaning the pot of money doesn't change. It's who gets how much of that pot changes, specifically, the agencies that are the bottom performers, they're going to lose it as much as 5% of their reimbursement, so that the top performing agencies gain 5%. See,   10:25 there we go. That's where I think a financial interest could sway what people say, because this could be less money towards their industry. Well, it's problematic,   10:37 home health in general. I mean, this is, it's already, you know, you're already getting paid a lump sum for the care of each individual. And that varies based on those clinical and diagnostic factors that that I talked about before. Right. The scuttlebutt is,   10:55 I don't, but I just need to highlight that. I know I love that you said scandal, but this is great. That means rumors, love it scuttlebutt, I'm going to start using that every day.   11:06 One of the big outcomes they're going to look at is readmission to the hospital, did you keep your patient out of the hospital? Because that costs Medicare more money. And they're gonna look at functional outcomes, like transfers and ambulation. And there may even be a patient satisfaction component because did you know that Medicare mandates patient satisfaction surveys in most settings, you get those annoying Press Ganey surveys? Because Medicare says Thou shalt, and they track those, and those are actually publicly reported data.   11:41 That's actually great. I think the patient what their happiness is everything. Yeah, I think that's great. That's, yeah. Okay. Okay.   11:52 So it's your secrets here.   11:54 So it's it sounds though, like it's a bit of a gamble on where things are going to lie. And what's going to be decided on what these outcome measures are? That sounds like the biggest concern, what are these outcome measures that we're going to be using? Because if we're talking about movement stuff, you   12:15 aren't talking about movement stuff. But, you know, they've already established that all of the measures, the outcomes that are going to be looked at are either Oasis based Oasis being the clinical assessment that's done in homecare at a minimum every 60 days. Okay, Mission recertification discharge, hospitalization, return from hospitalization. That standardized assessment gets done. I have   12:47 a question about that, actually. And this is just from my own experience, it's a completely different audience that I work with. So when I'm working with my performers, I'm reassessing every single time I work with them. I'm a niche practice, though. I'm, I'm small and keeping it small. And so therefore, they get like real top, you know, I know them inside out what's going on in their lives and stuff, so I can best help them. So that is very, very specific. And and I'm lucky to be in that position. So when you're saying 90 days, that sounds like a long time for like a formal reassessment. I believe in oh, gosh, PT, school, it was it was a matter of like two months. So is it because of the the age where things may take longer to see results? Why it's a 90 day spot? Like, why is that? I'm honestly asking, it's not for judgment, I'm trying to be very transparent on my own bias. So I can learn   13:37 that every 60 days, well, every 60 days, that OASIS assessment gets done. However, that doesn't change, that your state Practice Act still applies that you may have to reassess every 30 days or every 10 visits or every 14 days, whatever your state Practice Act says, and Medicare still has the every 10th Visit reassessment requirement in home health, where they expect you to be using objective functional measures, and looking at your plan of care and your goals and saying, Are we getting where we need to be,   14:16 which is what we do in physical therapy. That is we're always asking ourselves that question.   14:19 Okay. This is more of a you know, it's more of a big picture thing. Yeah. Okay. For example, the emulation question. There's independent, there's independent but needs a one handed device independent but uses a two handed device can walk but need supervision at all times. And then there's a couple of answers for wheelchair bound, or bed bound.   14:46 Yeah, I'm not familiar with this, but I'm learning as you're talking about, is there anything about risk of falls because that's like the big a big one.   14:53 They look at that from a process measure standpoint, meaning they ask you, did you assess for fall risk, and there's criteria given a multifactorial objective. So really, it's got to be a two pronged thing. They're not looking at the results. They're looking at. Did you do it? Yeah.   15:17 Yeah. Is there room for? And this may be you don't know, because this is a bit of mind reading. As far as you know, right now, is there room for measurements for neurological disorders where we know that things may they're going to decline over time? You know, are immune immune? Am I saying the wrong thing? I think he's doing the wrong thing. But is there room for that where they have a health situation where things are going to decline? We know that but we're trying to keep them functioning their best as they're going through their process?   15:50 The answer is yes and no. Okay, the questions and answers don't change. What changes is, they can tease out by diagnostic grouping and by what they call risk adjustment, where if your agency has a high population of clients with progressive neurologic disorders, that's the the term in favor now. Okay, thank you, they're going to risk adjust your statistics to reflect that, meaning, we see that you have a larger population of people who probably aren't going to get better. And we're going to do some statistical mumbo jumbo in the background to adjust for that. But that doesn't change the answers that the clinician is using. Okay. There's no, I have to pull a different document because I have a different diagnostic group. There's no, I answer these questions for this diagnosis. And that questions for that diagnosis? Yeah. Yeah, the people who very much a big picture of   17:03 the people behind the scenes, I think I know the answer this question, but I'm still going to ask it, the people behind the scenes who will be assessing the the progress progress, and, you know, if it's fitting, looking at the outcome measures and what we need for that patients, are they medical professionals? Are these just people who are trained to work for this company? Who are the Who are these people?   17:28 So field clinicians who work with clients answer the oasis for each client, the agency, then submits it electronically to CMS. And the risk adjustment is baked in to the computers at CMS that process all this information.   17:50 Also, it's a computer thing. It's all very,   17:53 and that's part of the reason the assessment is somewhat limited in big picture. Yes, it's a it's a computer thing. Ah, it's a i. i, maybe maybe not. But it's a lot of higher level statistics. That's way above my head.   18:11 Right, right. Yeah. Oh, wow. That's what this is so negative for me to say, but what an easy way as a person in CMS to point away and go, Oh, no, it's the system's. That's what they computed. Like, I can't. I'm like, Who created it? Who designed the code? Fine. We'll look at the code person I need to understand. Okay. Okay. So, I mean, it just sounds a little bit like a trip to Las Vegas, where you studied a little bit. So you know, a bit about gambling, you say, let's say you're very educated about that, and you but it's still gambling? You don't really know. I don't know, I just I,   18:53 you know, it's, it's pretty well known how they do the risk adjustment. You know, it's just the statistics of how it's done is pretty high level, but we have a good feel for what they're risk adjusting for and what questions they used to do the risk adjusting.   19:15 I mean, do you think the physical and physical therapy industry home health for this, because that's what we're focusing on? Do you think what the way we have things set up now, the way I mean, that's the whole point is to be measuring their outcomes? That is literally what we're doing all the time. Do you think we're pretty safe with this adjustment? If anything, it'll probably be for the better if you're just overall? I mean, because we did the good versus the bad. Where do you think it's, it's gonna turn out for us?   19:46 It looks like value based purchasing a home health is going to be a good thing. It is going to reward you for doing your job well, and being aware of your outcomes and delivering good health. Quality physical therapy that drives the outcomes? Yeah, there's going to be, it's going to challenge the physical therapist and the PTA to work at the top of their license and to collaborate with the other professionals. Because some of these measures don't happen in a vacuum for lack of a better term, they don't happen unless you're working as a team, and everybody's on the same page. Yeah. And that's really that interprofessional communication is where the good are gonna be separated from the bad.   20:40 Yeah. This isn't my world. Oh, continue,   20:44 there's, you know, definitely the agency is going to have to be very aware of their outcomes and their data. And the understanding of that data is going to be huge. Yeah. And I can tell you, that there are consulting firms and companies, and that can look at those outcomes at a clinician level. And they're going to tease out high performing clinicians and low performing clinicians.   21:16 Yeah, yeah. Yeah. And I'm assuming that's where the concern is, what is, oh, I'm gonna backtrack to actually what I was originally thinking of asking. What is the hot talk on the streets regarding this? What are the big things that other physical therapists and people in the industry are going like, hey, about it? Or do we already cover those things?   21:41 We've covered a lot of it. I think there's a lot of optimism around this. Because the more recent changes over the past couple of years, starting in October 2019 really pulled back on the number of visits. We were seeing clients. And some of that is real. And some of that is artificial. Yeah. And it's gotten me up on my soapbox a number of times, because home health therapists are probably, unfortunately, some of the worst offenders at underdosing strength training. Oh, yeah, you want to get me started? Don't get me started.   22:34 Yeah, yeah. So it's, it would force that that push, I would love. It   22:39 forces us to understand how to deliver strength training, how to deliver the most the best outcomes we can in in fewer treatments.   22:52 Yeah, how to get trust, motivation.   22:55 really gotta understand you've got to be a high performing clinician, yeah. To survive in this market. Yeah, because a home health agency literally cannot afford to have lower performing clinicians that can't deliver the outcomes. Yeah. And a lower number of visits.   23:16 Yeah. Yeah. Absolutely. Absolutely. I definitely get that. So I I mean, I'm all about the outcomes. I've had people a different dance physical therapists asked me about how I do my outcomes and it really does depend on my patient and everything but I have a very I have a special circumstance you know, like I'm very lucky to have this niche that I have. i There are from an outpatient not out push out. Yeah. Out not outpatient. Wait, I'm getting so confused. Ortho. From an ortho standpoint, I'm calling because I'm not, I'm not home health. So I'm just like trying to get back to my my world. There are definitely I'm gonna choose my words specifically. So if you are a person who does own a clinic, that sees a lot of patience, you are a mill, there is no way to paint that there is a reason why there is a name for that. That's like saying, I, you know, I was you know, born from two Jewish parents and I grew up I have my Bar Mitzvah and then and like, I still observe Passover, and then be saying, I don't I'm not Jewish. Like what? Like, no, I'm Jewish, you know. It's very weird comparison. But whatever. That's what I chose. And I'll go with it. We   24:41 get to the point of mills.   24:44 I've always thought that the it was because of the problem with insurance and reimbursement and it's one of those like chicken or the egg kind of thing. What happened first, which I use in defense for any clinic. I'm like, hey, they're trying to figure out how to get reimbursed but at the same time, does in this horrible circle of terrible reimbursement trying to communicate what you did and everything, and people are trying to make money, which is fine, it's okay to want to make money Hello. Is   25:15 we as a profession do wrong to allow an industry to devalue our services like that?   25:24 It's because when trying to guess this is me, because I'm not a network. So, but from what I've seen, it's it's clinics trying, they're doing their best to report what they're doing. They outcomes with the patients, while at the same time speaking the language that the insurances say, they will reimburse. And then also these insurances saying they're going to reimburse, but they're not actually reimbursing, then there are administrative staff calling over and over again, fighting to get those reimbursements, you know, getting better at that. So that's why you have certain people working on the at the front desk, and then and so then they increase the number of patients during that time, because while they're gambling per patient on honestly, this is how I look at it for a patient on getting that reimbursement. Through, you know, the paperwork we've we've been trained to do to report outcome measures and everything. They're not they're not getting paid for it. They're fighting to get paid even on the basic level. So I think, but I don't know what happened first if insurance happened first, or, and, or the, you know, provision of the services, and they decided for it to be a lot of people that's the chicken or the egg thing. I mean, I'm sure somebody could look up the history, but I think that's where people just say, Oh, the healthcare system is messed up needs to be fixed. I, that's where I kind of lean back on to kind of be fair to everyone. Not that there has to be a middle ground. But I mean, that is kind of the truth. If I owned a big business, you're constantly you're like, Okay, I've hired this, these EMR systems, you know, we're we're gonna track and write down things. I hope this is the right system. Okay, this one's not working. Let's do a new one. And then you have your clinicians going, Ah, dang it, we have a new one, I have to readjust. But it's because we're trying to do it. Honestly, we're trying to do it legally. And then insurances just go, now, we're just not gonna reimburse you, we're not gonna explain why. And we're gonna be difficult to get in contact with to discuss and figure things out. So I don't know it's a random tangent, I'm sure people will go be like, Jenna said something wrong. I'm not the person to attack here. I'm just speaking. If you have problems, go talk to the insurance companies and figure it out if you already know how it works. But that's kind of how I look at it being problematic in the Ortho world specifically, because there is a lot of measuring of my brain out there. There's a lot of measuring of what was the word that we use, the more patients you see.   27:56 Counting widgets, counting widgets.   27:58 It happens, it does happen at the larger clinics. But yeah, can you I mean, I'm not saying I'm not saying I'm not saying I agree with it. But also, can you blame on? You know, like,   28:12 you started this to make money. I get that, you   28:17 know, but, but I mean, what I am in the business to hear, I mean, that's what I'm doing my own thing, is it easy to do what I'm doing, is it easy to get the patient Oh, my God. But that's I that's where I put my energy where I put my energy. But I feel like what is happening in the home house, like, Oh, my God, this is hilarious, full circle, but I'm going to connect it, it's going to be amazing. Feel like the Home Health what you're doing with pushing that pushing forth. The outcomes, I would love that I would, but I would love to actually be that not than just saying that. We love their beat. Let's make it all about the outcomes. And honestly, I feel like that's what we've been trying to do the whole time. It's just people aren't. insurances aren't saying there aren't following through with it, what they say they're going to reimburse, they say, We can reimburse up to this amount. It doesn't mean anything. It's horrible. So I would love there to be fixing in that way.   29:13 And I think someday Medicare will come around to a value driven system for outpatient therapies. And until Medicare does, nobody else will mean, Medicare very much still drives that bus.   29:31 Yeah. Wow. I never realized that. That's yeah. How do you know how do you I mean, honestly, asking, How do you know that they're the ones driving the bus?   29:43 Because most of the private insurance is based their policies on payment on what Medicare does,   29:53 because they're so huge. Yes. Mm hmm. Oh, gosh. Not saying it. It's easy to say there's no easy road.   30:02 That's where all the that's the root of all the CPT codes and everything else. Medicare needed a common terminology to wash claims through a computer to pay people. Let's boil everything down to a five character code.   30:21 Right, right, right. Wow. Huh? She's What a hot mess. It just gives me a headache thinking about all of it. I don't like it. It makes I need cake. Or pizza. Oh, not chocolate though. My dad loves chocolate cake. Are you a chocolate cake person?   30:43 I am a chocolate person head on.   30:46 We only put like chocolate cake is so different from chocolate bars come on.   30:51 Yes. But they both have their merits   30:54 F No. Disagree? Absolutely not. All right, if you are a person that if you would handle your stress from chocolate cake, just as much as chocolate bars. Okay, your team Dr. Phil. If you're like No, chocolate, just chocolate actual chocolate, your team? Jenna. I'm interested to see if there's going to be any written debate on this or discussions I'm sure there already has, which is why you were meeting Dr. Phil was like, let's do this topic. And like, I don't know anything about this, which is good. I think it's good because then I get to learn everybody else who listens gets to learn. And oh, I'm going to just say this just because I am not a fan of meanness. Don't attack either of us in this discussion. If that's in your if that's in, if that's in your intention in in hearing this and your response, oh, just at this as a message just for you get out of here. Well, we got to be better together, we need to be able to have these discussions, talk about it, totally fine to speak on your concerns about it or all that stuff. But we're just attacking each other that is not helping out the patients at large. This is about the people we serve. So we're discussing this to see what's going on to better understand what's going on. If you are in an estate, you are close to somebody who is in legislature, the then do talk to them, or see if there's a pre written letter from a PTA right now regarding this through their app, if you're in a PTA member or see if you can get a hold of that letter through a friend or something or I'm sure it's honestly on their webpage for you to easily access to advocate sending a letter to fight this or fight for it, whatever it is, because there's there's positives and negatives and everything. I mean, sometimes there's you know, it's leaning one way, obviously, but we got to just take action. If you want to see something you got it don't just reply on here take action. Well, I just gave so many different messages and one thing at the end, but that's okay, I'm fine with it. Any last words you want to say on this matter that you that we haven't covered? Dr. Phil?   33:15 I think the take homes are twofold. You just said the first one. You've got to be involved in advocacy if you want to see change. Second, value based purchasing, like we're talking about it today is just in the home health arena right now. It is what Medicare wants to bring across the board across all settings. And, you know, they don't they want to get away from fee for service. They want to get away from ID to units. If they're x and a unit. If they're X, a unit of East M and A unit of manual therapy and you need to pay me for it. They want to know a client walked in your clinic with this problem. They had these issues that we're able to quantify. And at the end of it, the client left our clinic and the issues were gone and here's how we've quantified it. That's what they want to be able to pay you for. And if you can't be excellent with that. You're not going to have a successful practice 510 years from now.   34:34 Thank you. Thank you so much. Where can people they wanted to get in contact with you Where can they connect with you on either social media or email?   34:44 I am P gold PT on Twitter. I do have a personal Facebook. I am not fancy or cool enough to have Instagram or Tik Tok or any of those. I have LinkedIn. My email is Easy it's P gold pt@gmail.com. The other place that's really easy to find me is if you go to a PTA home health.org on the leadership page, you'll find my name. Currently the treasurer of APGA Home Health formerly known as the Home Health section. And in two weeks in two days I become the President   35:29 didn't say that at the beginning. I was like, I wonder if you want me to and you didn't say bring it and bring it out? So yes, this is a person. This is a person who's very involved with fighting and spin keeping on top of what's going on for home health. So thank you so much, Dr. Phil, for coming on for your name. I love just saying Dr. Phil over and over again. And just sending you the biggest hug from afar. We got a meet at a conference recently and you are a gem. Thank you so much, and everyone send love to Dr. Phil for for his time.

In this episode, Sports Physiotherapist and Researcher, Loïc Bel, talks about his experience as an up-and-coming sports physiotherapist and researcher in the industry. Today, Loïc talks about complexity and uncertainty, clinical work and mental health, and the importance of having a team around the patient. How does Loïc deal with imposter syndrome? Hear about Loïc’s experience in Monaco, why he decided to keep getting more degrees, his thoughts on Physiotherapy Associations, and get Loïc’s valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “You can’t just use one factor to influence the whole situation. You have to accept the complexity. You can’t control everything.” “Nobody puts the bad stuff up on social media. It’s only all the successes.” “To be successful, we have to fail.” “Sports and physical activity as a whole is one of, if not the best, tool for health.” “As health professionals, we have to think about what we do, because it has a cost on society.” “Knowledge a collective thing.” “Don’t give up and don’t blame yourself.” “If you believe in your profession, try to get involved.” “Communication is everything.” “Try to ask yourself more questions. Don’t think that everything you learn is true, even at school. Question things a lot more.”   More about Loïc Bel Loïc Bel is a physiotherapist since 2.5 years ago. He graduated with a Bachelor degree in physiotherapy in Switzerland and is now in the last semester of his Master Degree in sports physiotherapy, also in Switzerland. He currently works in an outpatient clinic in a small city in Switzerland for 3 days a week, and during the other 2 days, he studies in Bern towards his Masters degree. He is currently involved in the ‘Commission for the Promotion of Physiotherapy’, that is a branch of his regional physiotherapy association. He is also a board member of ‘Le Réseau’ – which can be translated as ‘The Network’, which is an association that aims to connect health professionals working in sports and other professions that promote health through physical activity. On an international level, he currently is a board member of ‘Long COVID Physio’ as an education co-director. A recently big achievement was the publication of his first paper with his friends and colleagues, Vincent Ducrest, Nicolas Mathieu, and Mario Bizzini. The paper was about injury prevention in sports related to performance. Injury prevention is a subject that he tries to develop an expertise in, and he really fell down the rabbit-hole during his Bachelor graduation work that developed into that paper. His professional goals are to end his Master Degree in the first place. An ongoing project right now is to find funding to start a PhD on the subject of injury prevention.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Injury Prevention, Sports, Exercise, Research, Knowledge, Education, Mental Health,   Read the paper: Lower Limb Exercise-Based Injury Prevention Programs Are Effective in Improving Sprint Speed, Jumping, Agility and Balance: an Umbrella Review   To learn more, follow Loïc at: LinkedIn:         Loïc Bel Twitter:            @bel_loic   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.   00:35 Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and increasing referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a new offer. If you sign up complete a marketing audit to learn how digital marketing solutions can help the clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net help.com forward slash li T z y to sign up for your complimentary marketing audit today. Alright, so a big thanks to Net Health now on to today's podcast. So my guest today is like Bell. He's a physio therapist since two and a half years ago, he graduated with a Bachelor degree in physiotherapy in Switzerland and is now in his last semester of his master's degree in sports physiotherapy, also in Switzerland. He currently works in an outpatient clinic in a small city in Switzerland for three days a week. And during the other two days he studies in Bern towards his master's degree. He is currently involved in the commission for their promotion of physiotherapy, that is a branch of his regional physiotherapy Association. He is also a board member of labor. So and I'm sure I butchered that, which can be translated as the network which is an association that aims to connect health professionals working in sports and other professions that promote health through physical activity. on an international level. He is currently a board member of long COVID physio as an education co director. Our recently big achievement was the publication of his first paper with his friends and colleagues, Vincent Newcrest, Nicholas Matho, and Mario Barzini. We talked about that paper in this interview, and it was about injury prevention in sports related to performance. Injury Prevention is a subject that he tries to develop an expertise in and he really fell down the rabbit hole during his bachelor graduation work that developed into that paper. His professional goals are to end his master degree in the first place. An ongoing project right now is to find funding to start a PhD on the subject of injury prevention. And in today's episode, we talk about a little bit more about the IOC conference that was back in November. And also we talk about clinical uncertainty, mental health of new graduate physio therapists dealing with imposter syndrome, and the importance of our physiotherapy association. So a big thank you to Luke for coming onto the podcast and being so open and honest and sharing his experience as a newer graduate in the physiotherapy field.   03:23 Hey, Lloyd, welcome to the podcast. I'm so happy to have you on and it's so nice seeing you again after it's been a couple of months since we met in Monaco. So welcome. Yeah, thanks for having me. I'm really happy to be to be here enough time to. Yeah, and I'm, I'm so excited to have you on to talk about.   03:43 We'll talk a little bit about your experience in Monaco and your big takeaways from that and tell me your what what you thought and what your takeaways were. Yeah, it was it was a last minute chose to go to Monaco. And, and don't forget that actually.   03:58 It was the second big Congress for me. So it was a bit of euphoria. I went to Geneva when there was the World Congress to So second bit Congress on sports physios. So kind of specialization I'm doing right now. And it was it was bigger than I thought it would be actually. And it was really hard to do some take home, because there was so many things to, to take with so many new ideas, maybe so many new ideas about all ideas that were totally deconstructed. So that was a goal of mine to go in. And be like, Yeah, I want to unlearn what I what I had learned during school and during my students. And I know we discussed it together quite quite some time about the takeaway. So there was one word that came a lot during the Congress. I think it was the context, context matters. So you can have   05:00 The best exercise you can have the best the best plan you can have the best program you want. If people don't do it on buying it's, it won't matter much, actually.   05:12 I think one big thing is that maybe we don't know, as much as we think we did. It discussed it with a smart non on a recent Muscats podcast to   05:25 lots of talk, discussed some things that we thought we knew. And maybe they don't work as planned, or they don't work   05:35 in the nation an efficient way, like we started did. And it was a great, great symposium on the complexity, like everything interacts, you can't just use one factor to to influence the whole situation you have to you have you have to accept the complexity, you can't control everything. And, and yeah, you go home and you don't really know what to do anymore. You don't really know if if you did things right, you don't really know if you will do things, right. So that's kind of the takeaway I took from like for me.   06:13 Yeah, and I would agree, I left like God, I feel like I don't know anything and stuff that I didn't know, I had now have to sort of deprogram myself to   06:25 reprogram with new information and new research, which, I mean, if you asked me that's a sign of a good conference. Yeah, I said the same. If I, I'd be pretty, pretty sad to go to a conference and go with only a big confirmation bias, you know, like, Okay, I did everything right. That's fine. So it's a good thing. Yeah. Like you learn something, if you unlearned things. So yeah, it was great.   06:55 Yeah, I agree. And let's, let's kind of dive into this idea of complexity in practice. Right. So like you said, there's so much more to an injury than just the injury, right? So if someone has an ACL injury, it's more than just the physical rupture of an ACL and then knee. So can you talk a little bit more about complexity in practice, whether it be your personal experience?   07:25 And and how you tolerate that uncertainty in the clinic? I mean, if if we speak about Monaco, the big thing was when when you come home is Watson, how do I apply the things I learned? And what I feel like when I when I go to Congress is or to any symposium that speak about research, I'm always like, Yeah, but in research, we control so many things. We want to control the most things we can to better understand the mechanism. And then you arrive in practice, and it's the chaos. You can't control everything you've gone through in research.   08:03 I have a pretty young conditions, I ended school like two and a half years ago. And every time I discussed the topic with some more experienced clinicians, they always answer with the Yeah, experience helps.   08:20 Yeah, but what do you do when you don't have, you don't have that much experience, you have to build some. So you try to rely on research, you tried to, to you try your things, basically, you have some tools, try to use your tools.   08:37 That gives you some idea when you try what should be best practice in research. But sometimes it doesn't work as planned, and you have to deal with it. So you try to adapt. You try to modify things a bit. And you have to go with intuition sometimes. And   08:54 yeah, it can be a hard feeling to deal with. I mean,   08:58 I tweeted like, a few weeks ago about that, because I had a rough day, I really have a rough day. Like I had three patients, it didn't go as planned. We had to go back to the search, and we had to discuss things. And it's really exhausting. I feel like to come home and nothing worked as planned. You go like with 1214 patients a day. And this tree will stay on your mind like the whole evening the whole evening. You don't know you're just thinking about how could I help? What's next try to plan for you and for them.   09:35 Yeah, I don't know we can you can deal with it. You have to acknowledge that it can happen. And you have to. Sometimes you have to take a step back and be like, yeah, what did I do? Did I do something wrong? Or not? Because maybe you did nothing wrong actually. And how could I figure out a new strategy to to advance and do better? Yeah,   10:00 It sounds to me, like what you do when you have those days, and we all have them where you're like, I'm a loser, like, I can't help anyone, no one's getting better, what am I doing? But that instead of going back and sort of wallowing in it for the whole night, I think you can wallow for a little. But it sounds to me like what you do is you kind of reflect on that re reassess how you did things, and really look at what can I do differently? I don't want to say better, but what can I do differently. And if it's something, then you always have another time to try. And if it's, you know, I think that I did what was appropriate, then maybe it's let's go in and have a deeper conversation with this patient, you know, let's see what other part of this complex person in their ecosystem will allow us to move forward. So that's what I got from what you just said that you really take that time to kind of reflect, reassess, and then move in the next day, or the next time you see them. So they agree, and complexities are also about how it works with the with the other colleagues to other professions around the patient. So you have to reach out for other people, you have to discuss things with them. And you have to you have to explain what you did you have to, to also be confident about what you did. And and that's that can be quite confronting to, to do. So. Yeah.   11:39 Many things to deal with. But in the end, you have to go forward and keep on keep going.   11:45 Absolutely. And you know, as a newer ish grad,   11:49 you know, you kind of   11:52 knowing what you don't know. And maybe knowing what you do know, how do you sort of keep putting one foot in front of the other because I'm assuming imposter syndrome may come up   12:05 every once in a while. So what do you do to keep moving forward? And maybe what advice can you give to let's say, a new graduate that's graduating tomorrow, given the experience that you have over the past couple years?   12:21 You're right, it happens from time to time. And and I mean, social media don't don't help with that. I think, as a whole, yes. Because there are lots of success story. There are not much stories about failure. Well, I mean, here's the thing. No, nobody, nobody puts the bad stuff up on social media. It's only All successes, right? So you have to take that step back and be like, yeah, maybe maybe they fail to. And to come back to Monaco, there was a great great one. That was about the biggest mistakes. So did a motor compress was something about learn from our biggest mistakes. So it was with Yvette for Heigen Carolyn, a bullying Caroline Emery to.   13:09 And I think it was great to have like to be in a Congress with what you can call like, a camera like her from speakers in the world about injury prevention, and, and, and hear them like, we failed. But we kept on moving. We kept on trying. And we did really, really better and we try every day to do better. So it was one good thing is that for once there was there were people that acknowledge that they failed, but they kept on going in and it was it was yeah, they deal with things with the tools they had at that moment and that you can't have everyday data you you want at every moment. So you have to try. And another thing I'd say is that personally, I try to really reflect and reflect on on on what I don't know I try to Yeah, we can speak a lot about metacognition and and identify your knowledge identify your lack of knowledge in some in some topics, so I try to identify my weaknesses. And then I try to read because I can't just be with patients 24/7 So I have to read about them and and and try   14:29 that said so I said I see the things   14:32 there's a quote I like that that say what I believe is a process rather than a finality. I don't know who Who is this this from but I like it a lot like you have it never stops you have to keep on moving don't stay like in a stone try to tie traveled. Yeah, and that's how I said things. Yeah, and I I missed that talk at Monaco. Now, I really wish I went to it on the   15:00 You know, yes, we failed at these things, learn from our mistakes. And I would argue that the most successful people in the world have failed more times than they've been successful. Right? Because they're taking chances. They're putting themselves out there and, and they're making mistakes, learning from them and then pushing forward, which can be your stepping stone to success. Yeah, I'm a pretty firm believer that to, to be successful, you have to fail. Because if you just have success, I mean, first of all, it's not realistic. But I feel like if there was only on the success, and you couldn't fail,   15:42 you'd stop working. You don't anything to do anymore. You. You're not on this planet. So yeah, I think that's you. But every, every failure you have is a small break towards the Big House of success. Basically.   15:59 I couldn't agree more. And you know, in talking about all of this, you know, we're talking about failures and imposter syndrome and not knowing, and you're in a clinical setting, you're working with people. With all of that on your mind, it can certainly take a toll on your on mental health as a clinician. So what what do you do? Or what advice do you have when it comes to that clinical work? And mental health? Your own mental health?   16:28 Yeah, so I feel like we have a really demanding job, from a psychological perspective, because like I said, sometimes you fail, you have that bad day, and you come home, and you're like, Yeah, rethink, everything is worthless. So you have to do to overcome that. And with that, you have to, to add all the pressure about knowing things, because patients want answer answers. So you have to know things, you're the professional they want, they want to know, as sometimes you don't.   17:02 Now to, to put less pressure on me, I am honest with the patient, when I don't know, at the beginning, during my internships, I was always trying to find the right answer. And sometimes I didn't have it. And I try to find the thing to say. And now I feel like yeah, it was really unethical. First of all, and   17:27 no idea, say, I don't know, but we'll try to figure it out, basically. And one phrase I do, I do say a lot, when situations are complicated is that we'll try to improve the best we can. But I don't know until when we can, until what level we can improve, we'll figure it out. But maybe it will be only only a small portion and, and you'll have to try other things and physiotherapy.   17:58 And basically, you have to take care of your mental health and health professional for that. So I'm not ashamed to say that I wanted to psychologist and I discussed this topic, too. I didn't go for that. But I discussed it because it was really taking a toll sometimes my on my health. And now I learned to take a step back to be honest with the situation and discuss   18:24 discussing with patients and be open to criticism from patients to isolate them, you can tell me if if something isn't right, will change what we do. Finding yourself and being confident enough in yourself to say I don't know, is very, very beneficial for everyone involved, because you don't want to make something up.   18:47 Right. So if you don't know, I think what you said, you know, I don't know, but let's figure this out together. I'll look up some research, we'll figure this out. And if we can't figure it out, then I think it goes into another topic that you wanted to cover. And that's having this sort of entourage around the patient. Right? Because it's not your the two of you aren't on an island together, and there's no one else around, hopefully.   19:14 So can you talk a little bit about the importance of that, that team or that entourage around the patient? Yeah. So I think that I'm really lucky because   19:26 I met some awesome people in Switzerland during my studies and when I went to congresses,   19:33 I can mention someone It's Susan God that was in Monaco too.   19:38 She she's she's helping me on a daily basis. Basically. I'm often writing to her and and some other colleagues, some of the friends and colleagues that are my age we try to we try to figure out stuff together too.   19:55 I think   19:57 we are in a profession where   20:00 You can't have all the knowledge and some people already belt, some strong knowledge on some specific topic. So when I have a situation, for example, with Suzanne from with the shoulders, I write to her, because she's the experts in my, in my network, she's the expert on shoulder, so I don't hesitate to, to to write her to ask the patient if I can take, for example a video of or picture of the problematic I have. And I asked, I tried this, I tried that I have this situation right now. It's not have evolving, it's yeah, it's it's staying the same. We don't find a way to, to overcome the situation. What do you think about it, and then we discuss it and, and sometimes she she has some really great things that I never would have thought about. And I do the same with with friends.   20:56 I have some friends with my part time studies. They have the same problem as me. Sometimes they write to me and I try to help sometimes they do say I do thing with them. And sometimes nothing comes out from it. But at least we tried. And   21:15 and yeah, I try to do the best with the tools I have right now. And I feel like they are getting sharper every month, every year. But right now, yeah, it's not the best strain to get the tree with the knife the moment sometimes so. So yeah, it's gonna get better.   21:33 So what made motivates you to kind of to keep going and keep learning and keep sharpening those tools?   21:40 Right now, I think that's the first thing is that I want to help the people I work with, I don't I don't often tell the term patient. I think I work with people not with patient, they're productive. So yeah, I want to help them. So that's, that's one of the reason. And the other reason is that I don't like not know, to not know. So big. So I'm really curious. And I want to know, and yeah, again, you have to cope with not knowing but but I try to dig it always a little deeper and try to understand the mechanism of what I do have of I don't know, special battleship or stuff like that.   22:24 These are the two things, I'd say, drives me the most. And then I fell into sports physio. And I was like, yeah, it can be fun because I, I always liked sports. And I always did some. But it was also because I believe that sports and physical activity as a whole is one of the if not the best tool for health. And you have to understand what you do. I mean, we speak a lot about sickness size, about active therapy, you have to understand what you do. If you just give some exercises and you don't know what consequences can be.   23:05 Again, it's not the best gear you can provide. I feel like so I don't I don't like and it happens sometimes. But I don't like when people go home and they and they come I don't know, two days, three days after the treatment. And they tell me Yeah, I was feeling horrible for for two days. Because we because I did something that was too much volume or too intense. I don't know. But yeah, basically, that's it. And I feel like you have to be a Swiss knife, you have to add some tools to your toolbox. You have to add communication, for example. That's that's one that's the most important tool in in relationship   23:47 with these people and, and personal experience, I feel like is a is a big driver, too. I feel I felt right when I went to the psychologist and I could discuss and I could communicate. So   24:01 understanding what it feels like yourself, drives me to do better for the people that come to. I think it's it's important.   24:12 Yeah, and I'm so happy that you said communication is I would say the communication is most important any relationship period. That's true, whether that be personal professional, client patient, it is number one, and that that is a skill that can be learned. You know, there are books, there are classes that you can take on how to be a better communicator.   24:35 But I think it starts with knowing what you know, and being able to admit what you don't know and learning more. So kind of everything that you said throughout this podcast, I think really comes down to that piece on communication and it's huge. I'm so happy that you brought that up. And on that note, we're going to take a quick break to hear from our sponsor and be right back with more   24:58 when it comes to boosting your   25:00 Next online visibility, reputation and increasing referrals. Net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit.   25:35 Why move on to higher and higher degrees? Right? So for you, why do a master's degree in Switzerland when a bachelor degree is enough here in the US? We had started with a bachelor's, I went to a master's. Now we're at a doctorate level clinical doctorate. So why move forward through all of that when Hey, maybe if a bachelor's is enough or a master's was enough, why why keep pushing forward on the degrees? I think it's a big topic in Switzerland too, because we have the other countries around us that all go to the master degree level, we are maybe one of the only country left in Europe that doesn't ask for a master's degree to be in the clinic, maybe I don't know not the last bit. We're not like in the best situation right now. And that's that's me. That's me, critics from our colleagues and other students in PT school actually, to to that I wanted to go further. And some some told me that I wanted to prove that I was better than them, or that I wanted to be paid more, so I can be paid more. I can't ask for more money, because I got a master's degree. So these are not the reasons. But the main reasons from me with were like when I went into my internships, during my degree, I was really feeling clueless. And I felt like I didn't have the tools to do anything.   27:06 I was a big, big, big manual therapy for years. For three years at school until the I was lucky in the last year there was the Geneva Congress, the World Congress in Geneva, and I went to the to the conference from Peter Sullivan and Jeremy Lewis. And it really blew my mind. And I was like, that's what I want to do. And it really changed my perspective on things. And I was like, Yeah, I want to upgrade my skills, I want to get a better understanding of everything. And, and that's, that's what drives me, it drove me in the first place.   27:44 provide the best care.   27:47 And I think you have to, like I said, to better understand that. And I feel like, as health professionals, we have to, we have to think about what we do, because it has a custom sort of site society, basically. And I was happy to go to that conference, because I realized what I what I participated in, when I was only providing passive, passive treatments. And now I think it's like I have to participate in reducing the costs. I have, it can be by by encouraging people to move more it can be by maybe avoiding a surgery, you can you can have ACL conservative treatments, more and more, it becomes a big bigger trend than before. And that's how I see things right now. And   28:43 one other things with the master degrees, that I like to research and you have to have a master degree to do research in Switzerland. So you I mean, you don't have to, but it's way easier with a master's degree. And I always wanted to add my break to the brick house because I really liked doing my beach law, graduation work. And I think that knowledge is a collective thing I published with the with the colleagues of mine, Mario pizzini, the kilometer in France and UK recently the my first paper and I don't feel like it's only my paper. It's like we did this. We did it us for and it's only for people that come and add just a break to injury prevention and non subject so   29:38 that's what I want to do. Basically I want to I want to add Matt, just my break. I don't want to be remembered for it. But I want to help things move on and go further. And domestically. We can help me understand the research better and help me to understand how to conduct it's basically so that was one of the reasons and   30:00 As, as a young clinician   30:03 research I rely a lot on.   30:09 And if we speak about the funnel model from   30:14 evidence based practice, you have best evidence on the top. You know, it's better than me with the conference at that spot physio. So I think that's that's an agreement.   30:26 Research is at the top. Great. But if you can't read research, you can't use it. So that's that's one of the reasons.   30:35 Yeah, well, I think that's a fabulous reason. And just so people know, we'll have a link to the paper that you just mentioned in the show notes at podcast at healthy, wealthy, smart, calm. So we'll have a link to that. Do you want to talk briefly about what give give the abstract, if you will, of that paper? That's exciting. By the way, congratulations. Thank you. It was I worked on it during my master's degree during two years, I didn't think it would last this long to publish it. But we finally made it. But the idea was, was that   31:12 was that we thought that injury prevention programs for the for the lower limbs could improve performance. And the we evaluated that through a numpy review. And the logic behind it is that   31:29 we have a big utterance problem with these programs. So how could we improve the utterance and there was a talk, we can come back to Monaco, again, about never mentioned prevention, we only speak about performance, you know,   31:42 it's it's the main driver of sports, affiliate sports. And I'd say even off amateur sports, you want to you want to win. So how do you sell it to these guys and women's? So elite athletes, athletes wanna want to be the best. So performance is a key things.   32:02 So it was the logic behind it. We want to we wanted to explore that. Does it affect performance, just by doing these programs? And we can say it has, it has an effect, it doesn't have the best effect. I think   32:17 you better trend for performance than doing these warm ups, for example, if you want to improve performance,   32:23 but it's, you can you can say that it could help. But I think more on on not much level, not knowledge level, it won't be strong enough stimulus for them.   32:39 Excellent. Well, thank you for that quick, abstract, or quick synopsis of that paper. And again, it'll be in the show notes for this podcast. Now.   32:49 As we start to kind of wrap things up, I'd love to talk a little bit more about physiotherapy association. So we have in the United States, the American Physical Therapy Association, we have world   33:04 confederation of physical therapy, which was that was hosted in Geneva a couple of years ago, I was there as well. Do you think they're important? Do you think they serve a purpose? Or no,   33:17 I think they are a big key to, to promoting our profession. Actually, I don't know how it is in other countries actually, with the with the contact with the public with maybe the politics too.   33:34 But they out. I mean, you can you can go and ask the politics and the public everything that you want. If you only one, it won't work. If you come as a group, and with tons of people, maybe it will change things. And that can come back to to the master degree. Step. Two, we need people with an expertise to push the job. And that can be made through associations. We have to actually make the knowledge and then we have to do a diffusion of knowledge. And that's a great way to help people we see so many things that are   34:14 pseudoscience on I don't know a low back pain for example, that goes to the public maybe that's if we could promote what we think is best care and what would help people it would it would be great and I think we have to do it as a group as an association, our gateway for that. And I'm on the I'm a board member of the local zoo that can be translated as the network   34:41 I'm one of our I'm one of the if not the youngest, and with the less experienced in the group but   34:49 we want to promote like physical activity for for health. We want to regroup every everyone you don't have to be a physio but everyone working in sports in   35:00 In movements, and oh, by now and go and promote that for everyone. And   35:09 and I'm also on the commission for the promotion of physiotherapy,   35:14 in my region, Switzerland, so we do, we do some, some really versatile stuff. So we are going to public conferences for everyone to attend. So we want to disseminate knowledge in an understandable way for everyone. So we invite speakers, and they tried to keep it short and simple for everybody to understand. And we have some more professional conferences.   35:43 For example, we did one a year ago, a small workshop with Darren brown on long COVID. It was not really discussed at that moment. So I wanted to have people in Switzerland health professional,   35:58 better understand they had the occasion to discuss with Iran for like, nearly an hour. And   36:06 he answered every question, and I Big shout out to them. Because he He's He's amazing. Everything he does seem to push. Yeah. Everything it does. Yeah. I don't have any words to describe him. Yeah, I don't have amazing, but yeah, that's the thing I think we have to do. And again, it's about accumulating, and if diffusion, you have to accumulate the knowledge, you have to defer to big diffusion to concern people. And I couldn't have done it without an association. And it's rich, it's stretched, maybe, I don't know, 120 feet do   36:49 that could treat lung COVID patients better. And that wouldn't just use exercise.   36:59 To try to to improve things, skirted codes, wasn't everything. So it's important to have that and it's it offers a big platform to reach public your wants. So that's why I think that you have you have to go in this association. You don't have to agree with everything. I don't agree with lots of things in the Swiss physical physiotherapy Association, and quite vocal about it. In my regional Association, I say that I don't like lots of stuff. And I tried to make things move from the inside. Not always easy. But you have to try. But yeah, the problem with that is that I'm on the board with the Huizhou. I'm on the board with the promotion of physio, I'm I don't do much to be honest. I'm on the board from long COVID physio to. And that's can be tons of projects, actually.   38:03 With all the side projects with the clinic,   38:07 with my students who have to write my thesis, I only have a few months left, and I'm crawling compare workloads right now. But yeah, you have to deal with it. And that's, that's kind of the situation right now.   38:21 Yeah, I mean, I agree with you on Darren Brown. He's outstanding. I interviewed him for the podcast about lawn COVID. And it was a wonderful interview. We're going back and forth. And I finished I said, Do you have notes in front of you? He's like, no, yeah. He's like, That's, like, yeah, I met him in Geneva, at the Indaba. Part was where everyone can come and just speak, and there were topics, didn't have a clue on the topic. And it was like you everything.   38:54 And at the end, I discussed with him and I was like, yeah, do you know something on the topic? And he was like, no, no, I was just going with the flow and okay.   39:04 But   39:05 he's just like that. He's, he's, he's an awesome speaker is a wonderful person, and I can't, I can say, Yeah, and it's more about him. That's only praises for him. I agree. I'm with you. I have 100% only praise for that man. And I think he's, he is pretty remarkable. And what a great asset to the profession of physiotherapy. And he has that ability to disseminate information to the public very well. So he knows how to simplify things, not dumb them down, but simplify them to make the average person understand and that's a very special skill. And I think he has it inherently so that he can sleep good. Yeah, it. Yeah, it's a great skill to have. Okay, so now that we're really wrapping things up here, what would you like for let's say two or three times   40:00 takeaways of our conversation to be for, let's say, younger physical physio therapists or even physiotherapy students that you can impart to them after being out in the world for the last two and a half years or so. Yeah, the first one I think would be   40:24 don't give up. Could it be an advice? I don't know. But don't give up and don't blame yourself could be a good one, I think   40:32 you have, I think that you have to deal with the situation with the tool you have at the moment you live it.   40:42 Sure, that's now some situations I had like two and a half years ago, I would deal with them better right now. And some that I have right now, I will deal better with them in a few years. But you only have these tools in your toolbox right now. And try to do your best and don't blame yourself you fit doesn't go like you planned it would go if it doesn't go like you would have liked to go.   41:12 You can you can fail then like we said it will help you change the way you do it the next times. And you'll do better. Basically, that would be the first I think   41:26 with that with the mental health. So don't blame yourself because don't take a toll on it.   41:33 I think it's important.   41:36 But to be a second ones.   41:40 Get involved. I think if you believe in your profession, if you believe in physiotherapy, if you believe in health movement communication, tried tried to get involved. You don't have to do every project like like, I think I do, or like I think many people that came on that podcast do, I think you you should choose. Just quick on that. I think that maybe we have culture and physiotherapy where we think we have to accept everything. Don't do it.   42:13 Better, choose the projects, better choose to and do it, do them greatly. And then choose eight and fed them. Choose your projects, but try to get involved. If you if you believe in it, try it, try it, it will be worth it, you will meet some awesome people, you will make some connections and it will be worth it in the end. Anyways. So I think there's that and I think that's that maybe   42:41 maybe to come back on that we should find a way to to propose these projects to young clinicians as at least into a salon. We don't have anything to anything to get them involved. Maybe we should find a better way to propose the projects to to ask them. I think they have an I have a fresh vision on lots of things. And I think that's one of the reasons why we should we should have younger clinicians come in and express themselves. Because we live in an era where things go really fast. And if we only have the same old people that do it for 50 years, maybe that won't make it.   43:26 And let think I don't know, actually, what would be the last thing? Do you have an idea?   43:34 I mean, I think what you said was great, the only thing I would just like to reiterate from this conversation. So the big thing that I took away is that communication is everything. And that really finding a mentor finding, like you said an entourage of people to help you sharpen those tools. Those are my big two takeaways from, from our discussion today. And finally, I always ask, but you probably just answered this, but I'll ask it anyway, since I asked everybody is knowing where you are now, what advice would you give to yourself as a new grad? So not random? New Grad, but you yourself going back in time? What would you say to yourself? So as a new grad?   44:26 I'd say accept, say, say no to lots more things. I say that because sometimes I get really overwhelmed, overwhelmed with the things I do.   44:39 I think I would say that. And if I go back in time even more, maybe like in my first year of PT school, I'd say try to   44:50 try to ask yourself more questions.   44:54 Don't think that everything you learn is true even at school.   45:00 Question things, lots more, even even if it's teachers, even if it's school, a question things, it's not always the best, the best that you learn our school question lots of things.   45:14 Excellent advice. And now where can people find you if they want to follow you? They want to ask you questions they want to get in touch where's the best place for them to reach you? It could be kind of on like on social media, where wherever is best for you. I think that Twitter is the best for everything physio related. You can go on what is it like Bell B, L underscore like, Oh, I see.   45:38 I think it's the best way. Oh, by all by email, if you text me on Twitter, it's my DMs are open. I think I can give you my email if you perfect problem. I think I don't think we need to give give your email.   45:54 Yeah, well, we'll we'll stick we'll stick to the Twitter app for now. So people can find you on Twitter, we'll have a link to that. Well, I want to thank you so much for coming on the podcast and you know, as a newer ish grad, if you are indicative of others in the field. And I think the future of physical therapy is looking really bright. So I want to thank you for coming on and for sharing all this great information with us and your takeaways from Monaco and everything else in between. So thank you for the invitation. It was really great. It was fun. I had lots of fun, at least it's got my pleasure. Good. That's all I liked to hear my pleasure. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Lloyd for being so honest and open with us about his experiences as a newer grad physio therapist and of course, thanks to Net Health. So again, they have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit today to get your clinics online visibility, reputation and referrals boosted   47:10 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, AAPT President, Rob Tillman, talks about leadership and diversity in physical therapy. Today, Rob talks about being a leader, effective delegating, and the problem of bad advice by industry leaders. How Does Rob balance his life? Hear about Rob’s journey to where he is today, advocating for diversity, and the shortfalls of the industry, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “You can’t get anybody stronger by giving them opioids. You can’t correct biomechanics by having somebody on muscle relaxers.” “Change doesn’t happen overnight. Attitudes can happen overnight. Mindsets take a little bit longer to change.” “Competency burns down barriers.” “The key thing in business is to manage as many variables as you possibly can.” “Not only do we not have diversity when we’re looking at the body types we have to work with, we’re not having systemic diversity at all in medicine.” “You can treat everybody fair, but it’s impossible to treat everybody the same.” “The outcome is when you get them back to doing what they want to do in their lives.” “The best leader shows people how to do it.” “There’s a difference between believing in something and living something.”   More about Rob Tillman Rob Tillman is the president of Ortho Rehab & Specialty Centers. In 1986, he received his degree in physical therapy from the University of Missouri. Rob immediately saw the need to attain a level of clinical competence that would allow him to effectively address the complex needs of his patient population. With this in mind, he enrolled in a post graduate residency training program with the Sorlandets Institute which later became known as the Ola Grimsby Institute. He is a Fellow of the American Academy of Orthopedic Manual Physical Therapy and American Academy of Physical Therapy. Rob attained the highest level of clinical certification available in the field of orthopedic rehabilitation. Since then, he has received international recognition for his research on the lumbo pelvic system and has written benchmark works on the thoracic and cervical regions, as well. Rob has presented at several national and international conferences on a wide range of healthcare-related topics. He is also a recognized authority in the arena of sports medicine, having been credited with the rehabilitation design and training programs for many professional athletes and organizations including professional baseball, a Superbowl MVP quarterback, an NBA championship-winning power forward and a four-time golf world long drive champion.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Rehabilitation, AAPT, APTA, Priorities, Education, Diversity, Leadership, Advocacy,   To learn more, follow Rob at: Call the office: 501-975-4040 Website:          https://www.pt-orthorehab.com AAPT:             https://www.aaptnet.org LinkedIn:         Rob Tillman Facebook:       Rob Tillman   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:  00:00 Hello, this is Jenna cantor. I am here with the ROB Tillman who is currently the president of a PT and also is in charge of the ortho rehab and specialty centers. He is just a top physical therapist in the profession. We got I had the major pleasure of meeting him in person for the first time at the APTA 100 years Gala. Was it 100 years? It was, yeah, yeah, we were all dressed up, I got to freak him out with my excited energy, because I was so excited to be meeting you, Rob. And I, by luck convinced you to come on this fun ride and do this interview with me on healthy, wealthy and smart. Thank you so much for agreeing to come on. My pleasure. It same. It absolutely is just wonderful. So um, I would love to just start with if people could learn more about how you got to these leadership positions, start from wherever you feel comfortable. But I would love to hear how you got to now. I mean, you're heading these things. Of course, I mean, so many things. So please share.   01:10 Well, to be honest with you, I I didn't really seek to be president or leader of anything. I just really wanted to I went to physical therapy school and I wanted to do sports medicine. So I learned that while I was trying to do sports medicine and orthopedics most patients have that come to an outpatient physical therapy clinic have neck or back pain. So I decided to go ahead and learn something about how to deal with neck and back pain. So I did a residency with a group called Restore Landis Institute, which is now the older Grimsby Institute for four years and did a residency and passed by competencies and became what's called a level two manual therapist by the Norwegian standards. And I think it's still the highest level of competency, internationally recognized in orthopedic manual therapy, started teaching courses, and orthopedic manual therapy after I gained my level of competency and start working with the group was held South back then it was the world's largest healthcare Corporation geographically. And I started troubleshooting clinical operations, and learned how to do the administrative things. And then next thing you know, I'm a vice president. And then I'm a senior vice president, and then they have their accounting scandal. And then, so I started my own company about 18 years ago. And all the while while I'm doing my, my, my core competencies and working, you know, to make a living and moving up in the in the company I was with. I'm at a group called the American Academy of physical therapy that was established about 30 years ago. And   02:54 it was in 1989. Yeah,   02:57 it was it was a black folks that had concerns about access to physical therapy, school and quality care in the black community. And I learned about them through who is now my best friend, Leon Anderson, the third, his dad, Leon Anderson, Jr. is the founding president of the American Academy of physical therapy. And I just really started teaching what I had learned to the group and expose them to the specialty of manual therapy, and I just kind of hung around and enjoyed myself with them because that's the first time I really experienced unconditional love, professionally, in physical therapy, because they just made me feel welcome. A lady who's deceased now named Diane Ellsbury. I call her my PT mom. She'd says, Hey, Rob, baby, how you doing? And just hug me and just what do you need anything? Are you taking care of yourself? You're not working too hard. Are you just like an auntie type thing. And then I became more involved in the operations and joined a committee called the innovative services committee. And innovative services was that's exactly what it does. It does cool and innovative things like create programs, we established a navigation program for mentorship for for our young folks coming through an advocacy wing that was concerned about practice acts and access to care and licensure issues and things like that. In the process, I somehow got appointed to the Arkansas State Board of physical therapy. So that's how I ended up wearing these hats. And while I'm on the board and Arkansas State Board of physical therapy beginning about 1617 years ago, I'm currently still on the board. And it's it's rewarding. It's rewarding. It's a lot of work, but it's rewarding, and I'd rather be at the table than not be at the table for a lot of the things that are going on because our profession continues to evolve. The physical therapy profession continues to evolve. And as an E involves then we have to be able to apply the clinical concepts that we are. In general learning in physical therapy school. State practice acts can hinder your ability to perform the things that you've learned if you're not careful. So we really have to make sure that all of the practice extra current and access to physical therapy is available because we are the most green profession. In healthcare. It's all hands on care and exercise. You can't get anybody stronger by giving them opioids. Okay, you can't correct biomechanics by, you know, having somebody on muscle relaxers, you know, it's kind of hard to strengthen somebody while on muscle relaxers also, by the way, but as we're looking at all these things that I'm doing at the same time, it's just when people ask me to do something, I don't want to be the person that's complaining about things not being done appropriately. I want to be the person that's kind of like a catalyst, or at least an advocate or participant in moving things forward and making things better. And sometimes you don't get paid for. Okay, but but, but that's why I love the Academy because it's the service academy. It's, you know, it's a place to come and serve and love the people that you're with and be loved, have a positive attitude and move some things forward.   06:21 I think sometimes people get caught up into looking at the AAPT or the APTA as something that needs to serve them. The APTA is also a giant service group. If we look at it appropriately, and as we come together, and share concepts and ideas, the current leadership of the APTA has done a lot better on sitting down and really trying hard to understand the challenges of the black community, just so my my hat's off to past president, Sharon Dunn, and also the current president, Roger Ver, and, and Justin Moore, the CEO, and Carmen Elliott, who's vice president over Dei, I think that they're really putting their best foot forward on working towards things. I think that we all have to be patient, and monitoring the progress as we do blend initiatives and work together on things. Because change doesn't happen overnight. attitudes can happen overnight, mindsets take a little bit longer to change as far as our train of thought. But behavior patterns take a lot longer than that, and coordinating behavior with other groups and other people take even longer. So I've learned to be a bit more patients in my practice, and my working with folks. And I've also learned that not everybody that doesn't understand the EI or the hardships that other groups are having. They're not all necessarily opposed to other folks doing well, or what somebody would call a racist or something like that. They just don't get it. And sometimes people want to get it. And those are the ones that we have to engage in conversation with and share ideas and have our thick skin on, to work together on things and not be so easily offended because we've all got pasts. I try not to be so easily offended and angered by things. But also, I have still pretty good intolerance of people that are in denial about other people's hardships. That's a little bit tough to be in full denial about other people's hardships. And there's current legislation that's going through several states that actually don't want America to tell America's full story. Because some people aren't comfortable with hearing about America's past and some of the impressive things that have taken place in this nation. But while we're deleting some truths that need to be spoken about America's past, we're deleting the chance for especially when in this case, black people to tell our kids and society in general, the challenges that we've had, and the reality of how we got to where we are and what we need to do collectively about. So that's another thing that's happening in today's society, but I do believe in general things are moving forward. As far as being president of the Academy, I never wanted to be president of the Academy. I wanted to be the guy that shared the cool clinical stuff. And just got to hang out with people that were just loving folks. I became chair of the innovative service committee. When BV Clemens retired, one of our founding presidents. He was later President second president of the Academy. And when he retired and took a step back, I took over the innovative services committee. And then I was asked to run for the director position, which the innovative services committee reported reports through the director director's position. It's now under the director, our current director, Renee crater Dr. Crater, great lady. Man few years ago, they asked me if I would consider being president of the Academy. Are you sure you want to do that? But my skill set on big A former officer in a large company and my background and all the things that I've been working on and still doing, including being on boards and things like that fit the skill set that was needed for the president at that time. And again, I'm humbled and honored to serve as the president of the Academy. I've done it for the last three and a half years, I can't wait to get the next crew of people trained up and ready to take over as we're pushing forward on things. But right now, it still currently fits my skill set and and and I hope that the academy is satisfied with my leadership and innovation and my quirky ways of dealing with things but it certainly has been my pleasure still serve as president of the Academy.   10:46 I'm so everything you shared, i Nobody sees me. But I have this very excited smile, listening and everything. And I love hearing things. In your own words, you are a very, very humble individual and the amount of service you have provided to the physical therapy profession at large. Thank you.   11:06 So it's my pleasure. It's my pleasure. It really is. It doesn't even seem like work.   11:12 Right? And and that shows anyone who works with you, like I've known you for a blink of an eye. I mean, it's been, gosh, half a year now. Yeah. But like it from for you are so kind you know how to like enter a room, whether it's on email, or text or whatever, in the friendliest way. You are. So I find you to be so approachable. And very, as a leader, it's still no denying what your position is. I just really think you are really, you said, I love what you bring to the table. Love it, just enjoy very much. Yeah, from the from the amount of time I've known you. How do you handle things with being what doing what you're doing? And I've never asked you this before. And that life balance, you know, people talk about work life balance. How do you do that? From what I've seen, you have specific times, you're like, I am not replying back, which is great. Could you talk about that a little bit more where you kind of set boundaries and stuff. So that way, you're able to handle everything and not overwhelm yourself.   12:20 Sometimes I My wife's a surgeon, she's a breast cancer surgeon, the Chief Chief of breast cancer at the University Hospital here. She's comfortable multitasking and doing a bunch of stuff. I really want to make sure I'm a perfectionist and whatever I put my hands on. So if my attention is split, if my attention is split, I know that I'm not going to do the thing that I'm working on, as well as I could. So I do one thing at a time. I do one thing at a time. When I'm in clinical notes. Sometimes I can reply to a text sometimes I can't. But I want to make sure when I fix a problem, that problem that has my undivided attention, my total undivided attention and I'm giving it my best that I possibly can. As I'm trying to resolve the issues that I have in front of me. I love that I feel   13:15 like it's a very attainable way to approach life rather than just going just one thing at a time. Do that. Good. All right. I love that. I've actually even been doing that this week. Not even purposely because you said but now I'm going to be like Rob said this I'm inspired. I've been doing that this week where I I had it upon me to finish up the project we're working on together and I was like nope, let's hone in and now like it's at a really good spot you know now and then I moved on to it. I've already moved on to other things because again,   13:47 that's it's because even in relationships if I know I'm doing the best I can with that relationship even if it goes awry. At least I know for sure I did the best I could with it. Oh I love that. I love that so much that way you don't have any regrets. Yeah, yeah, yeah, it   14:03 makes me think of what that tattoo that that tattoo where it says no regrets but regrets is spelled in properly regards because I love that I kind of want I'm not into tattoos but if I got one it'd be either Disney or that. I love that so much. So now as when you are a leader of a as a leader of a PT how is that different from being a leader at a clinic? Like a clinic owner? How is that different?   14:38 I'll say it's the same it's just the objectives are different. Objectives are different. Okay. Now when when you're dealing with a clinical situation it to me if you're doing it the right way you're focused on your outcomes. Yeah. I'm not in a silo to where you know the orthopedic surgeons are upstairs and they own my my practice you They're gonna send me patients regardless of company, you know, so we're outcome oriented. And we get the things that are a little bit tougher than the guys that have the automatic referral that own their own PT practice. I've learned that competency, burns down barriers. You know, people don't care if your margin, if you know what you're doing and they got back pain, they're going to come and see you. That's true, that's true. But key thing in the key thing in business is to manage as many variables as you possibly can. Because they're variables that you can't manage. So being timely looking professional, okay, incompetent, having the tools that you need to get people better. I mean, how many PTSD see that, that work for a group that owns the practice that doesn't even have the tools to get the outcomes that they need, and they're working with the only resistive equipment they have is exercise to me. You know, you have to have what you need. And I'm our chief proponent of physical therapists independent practice, but I'm also a huge proponent of us owning our own businesses. And not working for groups that own you.   16:14 Yeah, we do. Uh, you know, I really see and feel what you're saying there, I have my own practice. And there's a lot to be said, because we all shine in a different way. We're all doing evidence based, but when we're able to come through as a as the autonomous decision maker that we've been trained to be, we can really help those patients, we can be a best service. I truly do believe that.   16:40 Yeah, I think so. But, you know, by the same token, we have to go the next step, and do what's defined by the way that the APTA is going, and the different academies and specialization. Oh, yeah, I've heard somebody give the worst advice at a three state meeting once and I'm not going to get the states because it might tip it off, it will. But this guy stood up and said, to the students, when you graduate, don't worry about training anymore. You already know enough, you know, you know, everything you need to know, to really make it. And I sit there. And then I asked the question, I said, Well, I think that the APTA is going towards specialization. So how does this fit in with that, but I know darn good. And well, after serving a four year residency in orthopedic manual therapy, that I'm a far better and more competent clinician. Also, you know, even being a co author and co author in some textbooks and defending my my thesis internationally at the First and Second World Congress on low back pain. It helped me to learn more, always active clinician, because I've learned more. And I have a more diverse patient population, because I'm a specialist in orthopedic manual therapy that's paid his dues. And and I believe we get superior outcomes when you go through residency training. Of any comment. Yeah, of any kind. So that was the absolute worst advice I've ever heard anybody give some young kids right out of school.   18:10 I think there's been a lot of advice out there that can be off, but I definitely think that's really, it's off. I'm thinking you got me thinking of I grew up as a ballerina. And ballet is impossible to perfect, however, that every ballerina is trying to perfect it what we're doing with our lines or bodies, you know, it's definitely out of the anatomical positions. And when you first start out like that, you learn all the dance steps, you learn all that, does that mean? I'm done? No. I'm always taking class, I'm always working to get better. And I learned so much from my life as a ballerina, I was pretty intensively in it at one point for a good portion of my life. And I learned the importance of always learning, always practicing and having to be passionate about it. Because if I wasn't passionate about it, I wouldn't be showing up and putting in my best. So having that background and then going into physical therapy as my new profession. Definitely was in line the idea of, of course, I'm always going to be learning Absolutely. What Why would that would make me the worst person to work with if I was start in one year of Tottenham?   19:22 No, I'm haunted by what he said. But it motivated me to teach something different to people in that. Yeah. With me, because I hear somebody saying something in full. He said it in full sincerity. He really didn't think anybody need to learn anymore. Yeah, but that's terrible. So let me go and teach people why they need to learn more. Yeah. Because especially when you're minority or a woman, you had better have it together. If you're out there on your own, you have better have a superior product because you're not in that good old boy network. Well, you're an outsider, also, if you better do it better.   19:56 Yeah, it's yes. And also If we're going off that you're going off with the research at the time that you learned it, we did not do diverse bodies, we do not have diverse bodies in research, we are massively lacking that, you know. So we need to be open and ready and seeking and creating more of that information to learn from to better serve.   20:20 I'm glad you're saying that because not only do we not have diversity, when we're looking at the body types that we have to work with, we're not having systemic diversity at all in medicine, because different people, the guy named D'Amato wrote a book a long time ago called Eat right for your blood type. And he talked about how different types of blood types have different types of foods that they can metabolize, and using their systems and have it not function in a fashion that's detrimental to the person. And lo and behold, different people can eat different things and perform differently. I'm gonna type O blood time, I need dense protein. Some people that are more of a type A blood type may not need as much dense protein, they may be able to make it by carb loading and eating pastas and things like that. If I eat a bunch of pasta before I go into an athletic endeavor, I'm going to suffer versus somebody else may be able to metabolize that and move forward with it. So everybody's different. And I think we're just now getting to the point to where we're paying respect to the difference in the different physiologic physiologies that different people have. And it just so happens that certain physiologies are grouped together in different ethnicities. Yeah, and because of because of that, because of that, then we have we have an evolving ability to specialize care to specific individuals. Yes. When When, when it's all mainly designed for just one certain group, or one certain physiology. Mm hmm. Body Type one certain athletic performance level?   21:59 Yeah, no different different, different, different, different levels of stress and anxiety, depending on what your background is. The stress and anxiety, someone gets the food, the blood type, that all affects healing. Yes. And it can definitely take away from the exercises they're doing.   22:18 Or give you a specific example of that, I'll give you some with COVID. With COVID. They're finding the people that get most sick from COVID have low vitamin D levels. Okay? Now, black people can't synthesize vitamin D, vitamin D is actually more of a hormone than it is a vitamin. Okay. And when you're exposed to sunlight, your body synthesizes its own vitamin D, which is a vital hormone for the basic function of your system, in your in your body. Okay? Well, black people can't synthesize as well, because we have more melanin in our skin. And the melanin reflects the sunlight. And so we have to have an increased exposure to sunlight to have the appropriate vitamin D level. Well, everybody was told to stay home for first three or four months during COVID. And lo and behold, black folks died at a higher rate than everybody else did. Okay, sky like, wet, your black folks have a more problem with high blood pressure, isn't it, and we eat the same thing that everybody else eats. But just so happens that affects us differently. And it may be because certain ethnic groups can't metabolize that metabolize the same foods the same way that other folks can. And so I think as we look at those things, and be more specific with it, we can teach through the whys. We're talking about, you know, masking up and what to do to not get COVID. But we're not telling people in specific you need to have this number of these nutrition nutrients every day. Okay, to where your system is more healthy. And your hydration level needs to be exactly this. I think that we could have done a far better job and still can have telling people what they need to have in their systems to be healthy.   24:07 And on that note, we'll take a quick break to hear from our sponsor and be right back. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration. Head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit.   24:50 I agree. I absolutely agree. And for me, I I haven't even gone into the nutrition stuff in massive detail with my patients and now you're opening up another door I've actually been getting into cognitive behavioral therapy, right now learning about that not to become a therapist, not at all. But to better compliment how I communicate with people who could do well with it or watch out for trigger words, all that kind of sensitivities. Because the individuals I find my patients really do open up to me a lot. They have been through or going through some of the most jaw dropping things in their lives. And yes, that affects their healing. So I need to make sure I'm not triggering them. By my, the way I speak, if anything, complimenting a journey of healing, as we are working towards a healthier, healthier movement, decrease pain in their life. So yeah, yeah, I definitely get it from from where I've been with the anxiety stuff. Yeah,   25:51 you're dealing with people in their complexity. Journey, people that deal with people in the same with patient care. Now, let's go back to them. You know, zoom out zoom. And you've heard me say that, Oh,   26:01 I love that. Yeah.   26:02 So the deal is, okay, let the we've zoomed in so tightly, let's zoom out so that we can see everything again. And now let's zoom back in. Because, you know, you can teach a kid how to hit a baseball, and he can hit every type of baseball pitch at every speed. But what if he gets hit in the ribcage? Oh, you don't want to get hit the ribcage again? Right? So is that going to alter his ability to perform? Well, if he's so afraid of getting hitting and hurting, then it may be in the back of his mind that he's gonna have problems. So you know, it can alter his performance. So yeah, but the mental aspect of performance of any time. You know, my daughter suffers from anxiety disorder. And and it's hard. But we have to work through it. Because, you know, let's let's be sympathetic to us. But we need to be more patient with some folks and see what we can do to integrate them into a functional position in society. You can treat everybody fair. But it's impossible to treat everybody the same. Ah,   27:06 amen. Amen. All right, I'm going to switch completely into another because it just popped into my head. And I was like, oh, I want to ask regarding leadership. I was talking with another business owner, she's actually new to owning her own private practice. And, and then there's another person who's much more seasoned with his pride, like, yeah. And he said, I'm working on delegating more. And further, and I cringe, because we like to really Oh, that is that's it? How could you talk about your journey with delegation, because as you get, you know, the more of the leader, the higher leadership position, you do have to delegate more. How do you do you know, like,   27:51 Well, yeah, yeah, but here's what needs to happen is you've defined your clinical product, okay? You have to replicate that product, either you have to do it or somebody has to be able to produce the same clinical product that you produce. And it just so happens with mine. It's it's specific care in orthopedics with a high level of differential assessment of Neurophysiology histology and Arthur kinematics, and the appropriate prescription of hands on care and exercise from that. So if somebody comes to work for me, especially in the main office, they're not going to have their own patient load for six months. Until they go through the readings. And they they learn the basic clinical practice for dealing with an upper cervical problem, a lower cervical problem, ribcage issue. Problem with a hyper lordotic spine, a problem with a hyper mobile spine, problem with pelvic issue, be it internally, as far as pelvic floor issues, or biomechanically, when the sacred tubers and sick response ligaments are a little bit loose, and they can't withstand the normal loading. But they should be able to, they have to be able to do all those differentials in there to be a predictable application based upon that assessment and diagnosis, to where we're replicating the outcomes that we need to replicate with patients that present with those pathologies. And that takes time. So now let's go back to the guy that says that the students don't need to learn anymore. Well, they're going to get their lunch eat. All right. There are guys out there that then and ladies that have been doing this forever, that have the highest level of competencies, that'll run them out of business. If the playing field is indeed level, and there's access to the same level of referrals, and getting a good outcome doesn't mean that a person comes and says, Well, I hurt when I'm riding a bike for a long period of time. Well, why don't you take a walking instead? Now that's not an outcome. The outcome is when you get them back to doing what they want to do in their lives. Yes, that's it not modifying their life but getting them back to doing what they want to do so that they can maintain the quality of life that they desire, not telling them that well, if it hurts to bend forward, quit bending forward. No, that's not. That's not an outcome. Right? Right. modification.   30:09 Yeah, yeah. And it's so interesting you say that, because always learning, I have my practice where I'm 100% virtual. And that happened from the pandemic, I was not expecting that, and my performers love it for access everything. And it got me very into, you know, I'm not going to go into the details of what I do. But regarding outcome measures, I literally, that's what we very intensely focus on what they ultimately want to do not just like, oh, I have no shoulder pain, you know, they want to know if they can do this arm movement. And when they dance, you know, every time can they do that without having to worry about it. And then we get them there. And that is why I have a massive increase in satisfaction, because we are fully getting them to that to that their specific goals. I love them for   31:01 that. I'm very, very slow to accept praise for anything that I might do. Because the patient's the one that's got to do most of the work at the end. In the very end, and you're really is only as good as your last patient. You're only as good as your outcomes. Say that you are, yeah, doesn't matter how much you walk around talking about how great you are and how smart you are, if the patient didn't get better than you fail?   31:23 Well, because it's not about us. It's not about us,   31:26 it's about them, it's about getting them better, you know, and that is the most rewarding thing. You know, like, it's, it's,   31:35 I've built my company, we've got five facilities now. But it's one patient at a time, one outcome at a time. And most of the patients that we get come by word of mouth. Nice. Yeah. So you just get after it and handle your business and maintain and be a good steward of the opportunities that come to you. And take care of people the way that you'd want to be taking care of yourself. But back to the point of leadership. Yes. Your best, the best leader shows people how to do it, instead of trying to do   32:05 Yeah, and that's a skill. That is a skill. Oh, well,   32:11 the funny thing about it is I've always gone to church, and I've you know, I've always gone to church, and different people have different ideas of spirituality and religion. But there's a difference between believing in something. And living something. Yeah. Okay. There's a big difference in believing something and living something. And I go to church now, the preachers, my brother in law, and I was kind of skeptical because my sister in law married this guy, and he's preaching, I was like, you know, just because you got to church doesn't mean I'm gonna be hanging out at church on time. That's such a good guy. He's such a good guy, and he lives it. So now I went from saying that to actually being a part of the service every Sunday and doing devotion at the start of service. So you know, if somebody sees you living something sincerely, and not saying one thing, and then doing another and behaving in a way that's totally outside of what's your professing in a crowd, and I think that's a lot. That's, that's what a lot of people away from spiritual base. Community, is, people are observing what people are saying. And then they're observing that person's application of what they're saying. And seeing if it adds up. And a lot of times that, yeah, you know, a lot of times does, yeah, and I think that's led to a whole lot of skepticism and a lot of our religious organizations. Yeah,   33:35 yeah. Actions do speak louder than words they do. It's just like, exercises,   33:41 exercises. Think about it. Think about it, you know, you know, the only Torah or Qur'an or Bible that people see in public are the behaviors of those people that profess those religions a lot of times, hmm. So, you know, are we living testimony to the Torah, or the Quran or the Bible? Are we are we living testimony to because if we were as diverse as we are with religious beliefs, if it's obvious that we're living, right, you know, everybody, I think would get along a whole whole lot better if the Pharisees were zeroed out. Yeah,   34:19 yeah. But that's where that's where you you jump in for this leadership and for all this volunteer work, because you want to start being the change you want to see in the world and be rather than just being an outsider. Like, let's take action for this change, which I so appreciate that about you.   34:35 Well, I just I'm slow to accept it. But if I do, I'm all in. Yeah, yeah. If I do, I'm all in. Yeah. It's It's It's humbling to be asked to serve in a leadership role of any form of any form, to be called upon to serve because that means somebody thinks enough of you to ask you to think about doing something and being an agent of change or or a vessel of service. Yeah, and that's what I always think about my wife gets a lot of a lot of requests to serve as well. And so we're very understanding of one another's roles. When we're asked to do things that might eat away from our our family time.   35:16 Yeah. Yeah. Kind of hard. Yeah,   35:19 it's rewarding. It's rewarding. I love that.   35:23 Thank you so much for coming on. I know this can inspire so many people. Just when you speak if you ever are at an event and you see Do not be afraid to approach Him, He is the nicest human. Like, go say hi. Ask questions, everything like you're like, Oh, God, no, I'm gonna get   35:42 this better than others.   35:44 Well, yes, you are still human. Of course, of course. But you're very good at communicating that you're like, Hey, you said that with me. You're like, now's not the time. Let's connect another so we did, which was incredible. So yeah, it definitely just a great leader to know to learn from and just, you're just good people. So just thank you for being you.   36:05 Thank you. Thank you for having me. Yes. Turned out to be the way that you wanted it to be this time.   36:09 Oh, my gosh, this is all every time. I feel lucky.   36:13 We'll do it again, if we need to. Oh, my God, I   36:15 would love to. And then, um, how if people want to reach out and connect with you? What is the best way if somebody wants to reach uncle? Oh, I want to I want to ask them a question.   36:25 Well, they can call the main office here in Little Rock 501-975-4040 Or you can look us up on our website at ortho rehab comm and leave a message there, somebody will check it.   36:41 Wonderful.   36:42 Thank you so much. And also don't forget about the American Academy of physical therapy. If people are curious about that. It's a wonderful service based organization designed to deal with healthcare disparities in the face of black community, but we're trying to help everybody, but our leg laser focus for us is to work with the black community and then try to help everybody else as we can.   37:03 I love it. Thank you.