Healthy Wealthy & Smart

In this episode physical therapist and podcast cohost, Dr. Jenna Kantor talks about the highs, the lows, and everything in-between from the past year.  We talk about:  The effects of Covid-19 on life and the practice of physical therapy  Online bullying in the physical therapy world  Realizing the importance of friendship  The mental shifts we experienced over the past year  What we are looking forward to in 2022 And much more!    More about Dr. Jenna Kantor:  Jenna Kantor, PT, DPT, is a bubbly and energetic woman who was born and raised in Petaluma, California. She trained intensively at Petaluma City Ballet, Houston Ballet, BalletMet, Central Pennsylvania Youth Ballet, Regional Dance America Choreography Conference, and Regional Dance America. Over time, the injuries added up and she knew she would not have a lasting career in ballet. This lead her to the University of California, Irvine, where she discovered a passion for musical theatre.  Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia. During her education, she co-founded Fairytale Physical Therapy which brings musical theatre shows to children in hospitals, started a podcast titled Physiotherapy Performance Perspectives, was the NYPTA SSIG Advocacy Chair, was part of the NYC Conclave 2017 committee, and co-founded the NYPTA SSIG. In 2017, Jenna was the NYPTA Public Policy Student Liaison, a candidate for the APTASA Communications Chair, won the APTA PPS Business Concept Contest, and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media. ​Jenna Kantor currently holds the position of the NYPTA Social Media Committee, APTA PPS Key Contact, and NYPTA Legislative Task Force. She provides complimentary, regularly online content that advocates for the physical therapy profession. Jenna runs her own private practice, Jenna Kantor Physical Therapy, PLLC, and an online course for performing artists called Powerful Performer that will launch late 2019. To learn more, follow Jenna at:  Website: https://www.jennakantorpt.com/ Facebook Instagram Twitter Fairytale Physical Therapy   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:                https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here 00:00 Hey. Hey, Jenna, welcome back to the podcast for our annual year and Roundup, if you will. And I want to thank you for being a great addition to the podcast and for pumping out really amazing podcast episodes, you're great hosts, the energy is fantastic. And the podcast episodes are always great. So I want to thank you for that.   00:27 Oh, my God, you're so sweet. I like I was definitely not as much of a podcaster this year, I acknowledge that. But hey, listen, we've all been adjusting this year to pandemic and now pandemics still happening, but also recovery. And I'm just grateful to still be a part of this podcast in any manner to be in this interview right now. Because I really, you and I are very much on the same page regarding remaining evidence based and speaking to people that we respect in this industry, and also people that we want to see just rise and have great success. So I'm just grateful to be honestly, I am humbled to still be in the room here with you.   01:11 Thank you. That's so nice. So kind. Now, let's talk about this past year. So 2021, obviously dominated by the ups and downs of COVID, which is still going on as we speak. We're we're both in the northeast, so we're experiencing an incredibly high surge at the moment. So COVID is obviously a big story. And I think part of the COVID journey that isn't being talked about as much. But I think general public, certainly the mainstream media, are people now living with long COVID. It is just something that seems to be skimmed over. And we know that at least at least the bare minimum is 10% of people diagnosed with COVID will go on to have symptoms of long COVID. And instead of some of the studies that I have read recently, those percentages are much, much higher. So what I guess, what is your take on all of that? And what do you think we as physical therapists can do to keep this in the in the forefront of people's minds.   02:23 We discussed this before, but I think there's going to be bias within this. So I want to acknowledge that we all have our biases. That being said, I think we need to first acknowledge there was a phase where there was a part of the world that did not think COVID was real. So based on the research that is out there, and personal experience of a lot of people getting it, as well as personal friends very close personal friends working in hospitals in New York, specifically COVID is real. So I want to say that first. I'm not going to differ from that I really wish there I'm I think we're past that in the world. I think there was never a clear cut of like, Oh, I got it, I see that it's real. I was wrong. I would have liked that moment, because that hurt people in the process. But I just want to say that first. So COVID is real. Okay. Now, let's not belittle it. And I think in regards to the patient care. I think this, the reality of long COVID needs to be just as respected. Just like when you have a patient that comes in the door and says they're in pain, and you don't believe them. We need to stop that. So we need to believe them and their symptoms, and what they have and what it's from and treat it accordingly. Because if we go in the door to help out these individuals who are struggling with this, they're not going to get better. What are your thoughts?   03:59 No, I agree. I agree. And I've heard from people living with long COVID that people don't believe them even their own family members, people in who work in medicine, they don't believe them. So I think that's a huge takeaway that if as clinicians we can do one thing sit down Listen, believe because the symptoms that they're having are real. We did a couple of episodes on long COVID thing was back in August and spoke with three amazing therapists and they're all involved with long COVID physios so if anyone out there wants more information on living with long COVID I would definitely steer you to long COVID physio on Twitter and and their website as well. Because they're a wealth of knowledge. These are people living with long COVID their allies, they are researchers and I think they're putting out some amazing information that can help not just you as the clinician, but if you know someone that maybe you're not doing directly treating maybe it's a family member living with long COVID I think the more information you have, the more power you can kind of take back to yourself.   05:10 I love that. I love that. It's the biopsychosocial model. I mean to that I from working because I work specifically more with performers, the psychosocial component, my my patients, my people I call my people, my people would not be getting the results they're getting if I didn't have to deal with that, with them standing by their side, holding their hands helping them through and out of their pain. There's symptoms every day and this that goes for anything.   05:41 Yeah. And and we now know, speaking of performers that a lot of Broadway shows are being sort of cancelled, and then restarted and canceled and restarted because of COVID outbreaks within the cast. So this may be something people might think, Oh, I work with performers. I don't have to worry about long COVID Well, maybe you do.   06:01 Yeah. Yeah. And for them, it's the, from the performance that I'm in contact with on Broadway that, you know, it's I'm, I'm, I'm very connected. I've been in the musical theater industry for a very long time. So for the people who are on Broadway, the individuals I spoken to, they're doing okay, which I'm really, really grateful for. It is a requirement for the performers to be triple vaccinated, and now they're getting triple vaccinated. I know one performer on Broadway, who was about to get her booster shot, and then ended up getting COVID, which was quite unfortunate. She's doing okay, though. Grateful, no signs of long COVID Right now, but for the performers, you're talking about dance, there's endurance and breathing that is necessary. If the singers even if they're, they're not dancing, they still dance, they're still asked to do things, they still have out of breath, emotional moments, were breathing is challenged. So I'm just bringing up one component with long COVID. But that's, that's a big standout for performers specifically, that need, it needs to be kept out for them. I remember one time during, oh, goodness, during 2020. And it was the latter portion of the year. And I was doing virtual readings with performers. That's how I was staying connected with my my friends and people in the industry. And it was our way of being creative. In the meantime, while we're waiting for things to open back up. And one individual is she what I just cast her to read as the lead in the show, and she was so good. It was my first time hearing her perform first time meeting her. She was Outstanding, outstanding. And at the end of it, we were going around checking in with each other how we were doing and she started to cry and opened up about losses and her family due to COVID. And that she didn't think she would be able to sing like that again, because she had been dealing with her breathing problems for so long. And so then we all get emotional with her. I'm getting emotional just thinking about it. So yeah, it's it's a it's a real thing. We didn't have the vaccination then. So I'm interested to see statistically where we are at with long COVID with having the antibodies in our systems. Obviously, everybody is different, but I'm hoping that there's less of it because of the vaccine.   08:25 Yeah, time will tell right? Yeah, we have we need those data points. So aside from obviously COVID being, I think the biggest story of the year, certainly within healthcare and even within our field of physical therapy. What else have you seen over 2021? Or maybe it was in an interview you did or a paper you read that really stuck out for you as as a big part of the year you know, it made it's made it it made its mark for you.   08:58 Oh, I'm going to focus just on the PT community. And I want to emphasize with community I see our community at really, we've always butted heads there's always things that we butted heads on. But I'll just give the instance that really made me go whoa, I was in a room with a bunch of intelligent wonderful human beings and discussing something I said a term that I thought was really common especially because in the musical theatre industry. We are fighting for dei diversity, equity inclusion all the time. Like if this is a topic of conversation all the time. It is a huge thing in regards to casting what is visually out there the most at like the highest level and, and bipoc the phrase bipoc was unrecognized by a good portion of physical therapists in this room and I was disappointed Did I was it said so much it doesn't. It's not saying that a person is evil for not knowing no. And that is not my point. But it is a problem that it's not being discussed to the level where these common extremely common thing phrases are not just known. That just says a lot to me, because it's in regards to people getting in the door access and being reached, in lesser, lesser affluent areas, that to me, it shows that it's not being discussed, it's not being addressed. If it was, then bipoc would be, and this is just one instance. But I thought that was very eye opening. Because it's just like saying, I'm going to eat today, someone saying, I'm not going what you're not eating, I don't know. And that was a bad example. But just something that is or you wake up you breathe, that is how known the phrase bipoc. Same thing with LGBTQIA. Plus, in my community, like, for me to go into another room and for things to need to be defined. I know we all have different worlds. But I think as physical therapists, there, there's a disconnect, unfortunately, depending on wherever we are from, and we need to fix that. Because I can't live everywhere. I can't treat everyone in the world, I can't treat all the performers in the world, I don't want to I like having my niche practice and treating select individuals, and boom, my people do very well. And if it gets to a point that it starts to grow, I'm going to be passing them along because I don't want I don't want that I don't want it to be huge like that. And with that in mind, I need more people who know and therefore are our allies. To me, it's a lack of ally ship, of just not knowing the basic language. And I and I apologize to anyone who's listening on my intention is not to sound like a white savior at all. It's not. But with my limited knowledge at this point, I'm already seeing something that is really, really lacking amongst each other and we need to fix it. I don't know if it's books or I don't know, I don't I don't know the answer to that. But I'm just addressing that was that was the biggest standout thing for me this year.   12:27 And it for those of you who maybe are not familiar with the American Physical Therapy Association, they have what's called House of Delegates. So they had a meeting in September of this year during the APTA centennial celebration. And in that they did pass a resolution that the APTA would be an anti racist organization. Now, were you in the room when that passed? Jenna?   12:54 No, I was not in the room, I was actually there at the House of Delegates a bit discouraged this year, I know. i The fact that they were able to figure out any manner to put it on is is a feat to be had after 2020 20. However, the in person when you go and if you are not a delegate, which I was not this year, you can usually sit in the room, and just be in the back and listen, because the because of the space that they got in the way it was set up, there were chairs in the back of the room, but there weren't that many and it filled up. So they already preemptively set up another room where you could watch what was happening on a TV, which did not sit well with me. Because I could have stayed home instead of flying in for that. So I was definitely not in the room. I definitely was less present this year. Because of that I was I was bitter, I was bitter. I was bitter. I felt like I I already know you it's through elected and know who you know, to become a delegate, but I really felt disrespected and unimportant. Being in a separate room, watching from a TV rather than actually getting to be in the room because there are ways that they hold the meeting where you can stand up to say a point of order to speak on some points from the from the back of the room. And I just wasn't even going to wait to see how they figured that out. I just felt like not a not an important voice. So I wasn't present for that. But I do know about that. I think it's wonderful to get that on the docket. But the same thing when we voted in dei unanimously. How?   14:41 What comes next? You mean? Yeah, well, yeah.   14:45 What is the game plan? Because for me, I can say a sentence like that. But then what are the actual actions and that's where it's like, is that going to happen? Two years down the road three years. What are we at what are we actually doing? What are the measuring points and take action? and not meetings on it, not being hesitant on making mistakes. Let's make mistakes. Let's just go for it. That's the only way we're gonna learn. There's no such thing as a graceful change, no matter how hard you try,   15:11 right? Yeah, yeah, I agree. I think like you said, what comes next is? Well, I guess we'll have to wait and see what are the action steps they're going to take in order to create that and, and live up to the, the words of being an anti racist organization? Because it was passed overwhelmingly.   15:32 Right? And then I'm sure they applauded for it, you know, like, this is great. But to me, I think it's, I it's just like, okay, you know, like, what, but now what? Because from DJI and the I heard that they're trying in the battle in this behind the scenes, trying to move forward, but I have not seen action there. And maybe I'm missing something, you know, feel free to call me out Call me whatever. Like, I'm, I would love to be wrong.   16:07 Yeah, these big organizations are slow ships to steer. That's not any excuse whatsoever. But I understand there's a lot of layers that one has to go through to make things happen. As you know, you've been volunteering for the APTA for a long time. So you understand that, but I think a lot of people who don't don't, so that's why I just wanted to kind of bring that up and saying, like, yeah, it takes it takes a long effing time to get stuff done, you know?   16:33 Yeah. And I mean, you can hear it, I'm frustrated by I'm not, I'm not happy about it. And but it's, it's because of my friends, the conversations I have, and I, I'm, I'm lucky, I'm a sis white, stereotypical female. So like, the way the world has been made, and the way it caters to humans. It fits me, but it doesn't fit everyone and I'd like I can't imagine what it would be like to just be left out of a lot of things in everyday life. I think that's horrible.   17:05 Yeah, agreed. What else? What else do you think was a big something that you saw within the profession? Or even trends in health and fitness that might have really changed over this past year? For better or for worse? I can think of one I think and this is just my opinion that the the communication via social media has gotten a little too aggressive. Is that a nice way of saying it? Like I don't understand it, I don't get it. I took like a little break because I was Oh, can't say I was bullied because I feel like bullying. It's that sort of like you know someone is having like a sustained go at you. So I don't know   18:01 it's bullying is bullying. Yeah, bullying is bullying. That's the thing is that we have a lot of bullying that happens but then they gaslight you about their bullying. It's like Whoa, it's next. It's almost like a strategy. Like they're playing a game of Monopoly, and they have down how to win. Like, yeah, people barely there is a lot of bullying.   18:20 Yeah, a lot of bullying. A lot of threatening, like, I get like threatening DMS or people threatening me, you know, on their Instagram stories or whatever. For I can't imagine I look back at that interactions. And I'm like, I don't get it.   18:38 Yeah, I don't get it. Yeah.   18:41 So I and my first reaction was to like, when people will do this and be so aggressive as to send like a Taylor Swift GIF. Of her song, you need to calm down. And then I have to take a step back and be like, that's not gonna help the situation any. Right, right. Right. Don't do it. I just sort of back off. But I think because of that, bullying or threatening behavior, I've   19:05 really like I'll say it bullying continue. I've,   19:09 I've just like, for the past couple of months, I've really taken a backseat to any kind of social media just to like, give myself like a mental health break, you know, like meeting I don't comment on things. I might post some things here and there, but I don't really make any comments, unless it's to. And that's mainly and I'm going to say this because from what I can tell it's true, is it happens to be men in the profession who are a little more aggressive than the women, like women can seem to have a bit of a nicer conversation around whether it's a question or, you know, something, but when a lot of the men it's just become so like ego driven, that there's no resolution, and it's just mean. Mm hmm. And so I was like I need to take a break. So I saw a lot more of that this year. I don't know if it's because of lockdowns and because of a heightened sense of what's the word? Stress to begin with? And then yeah, or something else on top of it? I don't know. But I, I saw that this year, definitely for the worse, because I just think, gosh, if people outside the profession are looking in and watching these exchanges, what are they thinking?   20:28 Yeah, yeah, I've definitely seen it in sis males specifically.   20:33 Yeah, yeah.   20:34 I'm not it honestly. doesn't it's not a specific color of skin. But specifically sis males.   20:43 Yeah, I would I would agree with that. Yeah.   20:46 I have. I have experienced a little not not to the level, but I've definitely experienced that. And it's for 2021. And it's not okay. No, it's not okay. However, I ever look at it as a blessing. And this is where I get I love looking at it like this. Yes, please, please, thank you. Thank you for identifying that you have no space in my room, my shelf my space at all. I will not take advice from you in the future. And I will not heed any, any value to what you have to say, because of your willingness to chop me down. Thank you for identifying yourself. I'm now in the debate of blocking you from my mental health. And that's it. And that includes in person. That's it. That's it. And I really don't look as blocking as like, wow, for me, I'm going like, No, I don't want to know you. I don't want to know you. And my life is so much better because of it when I was at the PPS conference, because of just going No to the to the people I don't want to know and just saying like, just straight up like I like I don't need you, I don't need you. I want to be a service to people who need physical therapy period. So people are going to just, you know, find ways of you know, and spend their time writing some angry thing. Have that that's on them that's on them. Like I'm like, like, and if it and honestly I will likely block you.   22:18 I love that I love like you're you're it's not just that you're blocking the person. You're blocking the energy blocking the energy they're bringing into you and draining you down. So then you're not at your best well, or with your friends or loved ones patients, even with yourself. Yeah, you know, if you have to ruminate on these people. I love that. Yeah, it's not it's not just blocking you from social media, it's blocking the energy that you the the bad vibes, if you will, that you're Brown. And that affects you that affects your mental health that affects you emotionally. And it can carry through to a lot of other parts of your life and who needs that? Yeah,   22:59 and, and for anybody who's trying to saying like, I can a bully did it or like it. Okay, let's, let's look at it this way, when you're messaging an individual something, first of all, we all know this. When you write in text, everybody's going to interpret it with different tone. So as soon as you write in text, we all know this, and we're taking advantage of that fact. So that way, you can later go, oh, I said it in a nice tone, Bs when you're typing it, it can be in whatever freakin tone and you know what you're doing. Also, when you're not talking to a person, the only time you show up is to say something negative. Yeah, that's you're not your voice is not important. And you know, your voice isn't important.   23:39 It's so true. What I've actually seen is a lot of these, these kinds of people, they're not getting the attention they used to get. Mm hmm. Do you know cuz I think more people are of the mindset of like, I don't need this anymore. Like this was maybe this was funny. Maybe this was cute a couple years ago. Ah, not anymore.   24:01 And also I love I don't like having down moments, but we all have our down moments in our career and in our life. But I what I do love about the down moments in the career in life, the people who are around at that time, those are your friends, those are the people you want to know. So I love my moments in the PT world. When I'm in a down moment because the people who want to talk to me then those are the people I want to know. Whereas when I'm you know, can candidate for the private practice section, you know, which is awesome. And then people want to actually talk to me then. Oh, wait, I'm gonna wait and see when you know, I'm not that. Am I still someone you want to speak to? That is those are the people I want to invest time in. Those are the people I want to invest time in. I want to see you you do well and vice versa. I want to be able to get to know you as a human more and more and more. I just want the children Relationships, it doesn't mean I'm going to have time or you know, we're gonna have time to talk every day. But I want those true relationships. So for me, those downtimes, when I might not look the most graceful, I might be messing up or maybe not messing up. Maybe I'm actually making a change here speaking on something or getting people to think differently ever thought of that, you know? Awesome. Like, are you gonna be here to chop me down? Or just be here to have a conversation and having a conversation? Set up a phone call? If you really care? Like if you really could you don't? People don't care that Oh, reaching out, they don't care about you cannot be when they're reaching out to give feedback. Let's have a comfort. No, they just want to get into an attack mode. No, we No, no, don't try to decorate it. We know that's what's happening. And yeah, that were to town. There's enough going on.   25:52 Yeah, there's enough going on. And you know, this conversation really made me reflect on the past year, and I think what's been a good thing has been the deepening of good relationships. So like, nobody has time for that other, like bad stuff anymore. Like there's enough bad stuff happening. I don't have time for that. But what you do have time for is the relationships that are two sided, you know, a nice bilateral relationship that you're willing to invest in, and allow that relationship to come deeper and grow. And I feel like, you know, and like, you don't have to be friends with 1000 people, you know, you can be friends with a handful you can be friends with one person. And if that person, it's it's real and deep and meaningful, then isn't that wonderful? And I think years ago, I used to think, oh, the more   26:46 people you know, the better. Me too. Me too.   26:49 And now I think because of the upheaval of the last couple of years now, I'm really finding like, you know, I need like couple of good people that I can count on to have my back to, like you said, lift you up when you need to, and maybe to like, give you the honest truth when you need it as well. Right? Exactly. So I've been really, really happy that over the past year, I've made some really nice deeper connections with people than the physical therapy World Sports Medicine world. And I'm really, really happy about that. So I think that's been a real positive for me,   27:26 I totally agree with you, I mean, that our relationship is naturally growing over time, which I appreciate and, and I really do I completely on the same page completely on the same page. And and for me, when I go to conferences, like I'm really isolating more and more, who are the two are the people that like I must spend time with? And and then if other people want to join sure, you know, absolutely. But I I'm not overwhelming myself, oh, I need to be friends with that. No, I don't need to. And you know what, like, that became very apparent when I seen people speak, even at PPS, where the goodness, they were showing slideshows with their friends, and it was like, literally all people who are elected in the higher positions are all best friends with each other. It is it's true, you can't deny it. If you're up there. If you're one of those people. It's true. And you know what, I look at it like this, my friends may go up there to that, mate. That's not why I'm friends with you, though, you know, in friendship through because I like you as a person. So I'm gonna let that lay and not even explain and go into more depth and let people interpret that how they want and the right people will stay in   28:44 my life. Exactly. So what are they? What are they? Let's, let's sort of wrap this up on a positive note. What are their positive things came to you this year, whether it be professionally, personally,   28:59 oh, I think being more comfortable in my skin at conferences. So I had the I mean, absolute honor. Like I was really overwhelmed with happiness at the private practice conference this year. It was just so cool to be nominated. And I felt so much more comfortable in my own skin going up there. I you know, there there are a couple naysayers not realizing there'll be naysayers that, you know that I had to deal with but going up and it was a small moment. But we had you have this rehearsal. I don't know if it's done the same way. For the nominees where they go, you practice when your name is called going behind the podium and then walking down the stairs so you know what to do when you're asked to go out there and give your speech. And I went out there and I did a great vine to my spot. And I mean, I was so happy I did that because I was feeling it and that's what I would do. I did a great fine. And I know that silly, nobody else paid attention to me honestly probably knew that I was doing it. And some were probably like, Oh, but I didn't care. I was like I am on this freakin stage right now, this is the coolest thing. And to be at that place of like more self acceptance, because I know I don't have the stereotypical personality and energy, you know, that that is normally accepted amongst the vast community. So to be more me in that moment, I felt very proud. I felt very proud of myself. And that was really cool. I'm really, really happy about that. And then I like Dan, you know, sat down and ate some more bacon, it was great.   30:46 Well, and you know, being comfortable in your own skin that then comes across to the people who are in front of you. So when the speech actually came about, I'm sure people picked up on that picked up on the fact that you're now more comfortable in your skin that you're more comfortable, perhaps as a physical therapist, and because you found you're not that you've, you've already had this niche, but you sort of found your niche. You know, what, you what you're in the physical therapy world to do. Does that make sense? Yeah, yeah. Yeah.   31:19 Absolutely. Absolutely. And I got a little bit picked on for being too perfect with my speech and everything. And I was like, I you know, in reflection on that, I was like, they just haven't fully accepted my energy. That's okay. Don't get there. Okay. That's it. Don't get there. I'm like, I'm a performer. So it's gonna happen. You know, do you want to join a British company dialect? That's,   31:47 that's a weird comment. That's a weird criticism. Yeah, but yeah, you know,   31:53 but I felt I felt I felt like I had to reflect to go No, I actually felt really good, because I've definitely put it on before. No, I practiced it to be to deliver it. Me as me. And now it's so fun. So fun. Oh, my God. Yeah, I was just that that was a big, positive. Awesome, awesome feeling. I work with so many people who are in the PT industry, who want to be dance physical therapist or physical therapist assistants and imposter syndrome is super real. And so I like that I'm practicing what I preach and self love. And and it's awesome. How are you doing all that this year?   32:36 I'm better. I mean, imposter syndrome, I think, for me is always there, like always kind of underlying the surface, if you will. But I think that's pretty normal. You know, the more and more I listen, or I read about, like, these famous people who are up on stages and in movies, and you know, people who think oh, they have no, they must be like, amazing. And no, they it's the same thing. So I think for me, accepting that it's normal has actually helped decrease it a little bit. Instead of feeling like, oh, boy, everyone else here is like, amazing. And I'm like the loser trying to keep up. And then I think, no, that's pretty normal, because I think everyone else feels that way as well. Yes. And then once once I was able to accept that it makes going up on stage, like, I don't get as nervous as I used to, and it's been. It's been much, much better for me even speaking. Like I was joking, I could say I now I shared the stage with FLOTUS, because at the future physical therapy summit, I spoke for literally a minute and 45 seconds as a spokesperson for the brand Waterpik. So Waterpik has these wonderful showerheads. And they sponsored the future physical therapy Summit in Washington, DC back in September. And so the sponsors got to go up and say a little something. So you have literally less than two minutes, and I had to get all their talking points in. But I also like, decided to make it funny. So I was just saying things off the cuff. And afterwards, everyone's like, that was a great bit. I love that bit about your parents. I'm like, I didn't think of it as a bit. But okay. But then the good news was afterwards, people came up to the table, the Waterpik table, you know, in the, in the hall area, and like the one guy was like, I wasn't gonna come up, but then after that talk, I had to come up and see what you guys are all about. I needed to find out what you were doing and hey, can you do this? And so, for me, I felt as nervous as I was to go up and speak be mainly because it wasn't about me, it was about Waterpik. So I wanted to do them proud, you know, and afterwards, they got so much great feedback and possible partnerships selling through clinics with 700 locations? And can we do a study with Waterpik? On wound care? Can we do a study with Waterpik on people living with CRPS and using these, like, and that's exactly what they were looking for. So that made me feel like much better and gave me a little bit more confidence. And it was also fun to be able to do such things kind of off the cuff. You know,   35:25 that's so cool. Yeah, I love that. You should definitely be proud. That's so cool.   35:29 So that was really fun. And then the next speaker, it was it. The next speaker a two speakers after me was the First Lady of the United States Dr. Joe Biden. So yeah, there you go. No big deal. No big deal. Yeah. FLOTUS. So that was really fun. And was that yeah, for me, I think that was a big highlight of of the year for me, I guess professionally, which was really cool. is cool. That is so cool. It was it was cool. Anything else that for you? Did we miss anything that you wanted to get in?   36:02 Yes. For the Yes, yes. Yes. Okay. I now live in Pittsburgh and and was visiting New York had a great time. I got to see Karen at one of my favorite salad places, although I didn't get my normal favorite salad, which now I'm in regret until I go back again, to get my favorite salad from Sweet greens. It's the kale salad. It's so good. Caesar kale salad. I highly recommend it if you're going and you want to save some money because I love to be cheap in New York. Okay. said that. Now I'm not sponsored by sweet green. I just love sweet green. Okay,   36:31 I know we're dropping. We're dropping a lot of like,   36:33 I know. Like suede. And also get Levine's cookies. Okay, yeah. When you go, I never have gone to the tourist areas. I avoid it. But I spent a lot of time in Times Square because I was going to see Broadway shows. And it's also one of the few Disney Stores that still is open. So I had to go in there. I got a wreath I didn't need but I needed you know, and Okay. Rockefeller Center. So I go there to meet Stephanie. Why rock as you and I didn't have enough time with your Stephanie. But while we were waiting, there's a whole show of lights. A GG know that you knew this that like it's with music and everything like Disney. I had no idea. What's the store that darkness said yes Avenue, Saks Fifth Avenue. And it's like castle and lighting. It was I was just joking. If you don't know, I love Disney. I love Disney so much. And this was a Disney experience. And I just we weren't waiting in the cold. I'm like, all bitter. You know, I just I'm not happy in the cold. So I'm like, and then the light show on Japan?   37:45 Yeah, it's spectacular. It was   37:47 so great. I had no idea and it goes up like every few minutes. It's quite regular. So if you like oh, we miss it. You're fine. Just wait a few minutes. It'll start again. i Oh, go see it. Go see it. Don't stand in Time Square for New Year's. But go see that that was such a wonderful, positive, beautiful moment. And, and just great. It was great. Also, there are a lot of great photographers in New York. So if you're visiting New York, and you want to get stuff for social media, that is the spot to get it. There are so many talented photographers you can get reasonable prices and and build your social media real fast. All right, that's it.   38:26 Perfect. Well, before we wrap up the year, where can people find you if they want more information about you in any of your programs? And also let us know what you have coming up in 2022?   38:38 Okay, well, most immediately, you're going to find me at Disney Land in February this year in 2022. Because I'm going to be there my birthday. If you go there on the 16th of February. Just let me know. And we'll like meet up with you. But no, I'm going to be eating junk food all day. So if you're expecting me to be held a healthy influence, I will not be alright. For me, I'm going to be continuing with my private practice, working with performers and continuing with helping people live their lives as dance PTS helping you on the business and treatment side with my dance PT program. But most importantly, because I'm always like I'm a performer and physical therapist. I'm doing all this work right now. I am getting back into performing which I'm really happy about so I'll be submitting a lot more which I'm just super stoked. I feel like all my work stuff is is being is much more easier to handle now I've got it down. And the systems are in place if you will get to audition more than I'll be a movie star just like that because it's so easy. It'll be great, but I'm really excited about that. What about you Karen?   39:55 Oh, that's exciting. Gosh, I'm not gonna be a movie star. Anything So what do I have coming up? Let's see, um, this past year I finished the Goldman Sachs 10,000 small business program, highly recommend anyone to apply to because it's really amazing. How many more plugs can we drop in this episode? And so I'm going to this year, I'm looking to hire another PT for my practice, right? Mm hmm. Which is very fun. Exactly, it grows, but   40:31 you're like, I'm not going to take all the patients. It's gross,   40:34 but time to bring on someone else. Right. And then continuing to work with just a couple of people. With business coaching, I like take four people at a time for me that I get it handle, it's good enough for me, I'm happy to do it. So that will open back up again. Maybe end of January of 2022. Because like you said, when you know what you can handle and you know that you can help the people who want to be helped, then it becomes so much easier. So now I feel like I've got this under control. I know how to split up my time and manage my time. And so I'm really looking forward to that in 2022 and we'll see what happens.   41:24 I love that. That's awesome. Yeah. Yeah, are so cool. I love what you do.   41:30 Where can people find you? Oh,   41:33 yeah, so I have the dance physical therapists Facebook group. So that's one specifically for PT so you will find me in their active conversations once talking about performing arts research all that stuff. You can find me at CSM Oh yeah, social media, dance physical therapists on Instagram. I am also musical theater doc on there. But I really associate people more regarding musical theater, not other pts. So dance physical therapist, is that and then on Facebook, Jenna cantor. And yeah, pretty much Jenna Cantor from Twitter and Jenna cantor. Yeah, your website. Jenna cancer, PT, calm.   42:18 Perfect. Perfect. Excellent. Well, Jenna, thank you so much for coming on and wrapping up 2022. And for all of your help and friendship throughout the year. I really appreciate it. And appreciate so   42:31 much. I have to just say that joke that keeps coming to my head every time you keep saying wrapping up. I feel like I should be wrapping a present. I just it's a stupid joke. But I just need to put that in there. Thank you. I said it.   42:43 Tis the season when in Rome, right? Yes. All right. Well, thank you again, so much. And everyone. Thank you so much. On behalf of myself and Jenna, for listening to the podcast all year and for supporting it. And you know if anyone has any suggestions on anyone they'd like either one of us to interview please let us know. You can find us on social media. I'm on Twitter at Karen Litzy. NYC and Instagram at Karen Litzy. You can email me Karen at Karen Litzy. Calm it couldn't be any easier. Or you can find me at Karen Litzy calm. We're super easy over here. So let us let us know if there's any topics or people that you're like man, I really want to hear from this person. We'll be more than happy to see if we can get it done. So thanks again. Everyone have a very, very happy new year and a healthy 2022 And of course stay healthy, wealthy and smart.

In this episode, Specialist Sports Physiotherapist, Morten Hoegh, talks about pain and injury management and research. Today, Morten talks about his workshop on pain, the problems in the research around pain and injuries, and embracing the patient as the expert. What is nociplastic pain? Hear about the injury versus pain narrative, treating the perception of injury during pain, the problem of over-treating pain, and get Morten’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “There is a difference between having an injury and being in pain.” “You will have injury and pain on one end, but you will have pain without injury on the other end.” “Just because we know something doesn’t mean we know everything.” “Pain prevention is well-intentioned, sometimes unrealistic, and possibly unhelpful.” “All pain is real. It’s always experienced as pain.” “People who live their life with pain, they are experts.” “We have different aspects and different competences, and we should bring them together.” “We should definitely try and cure pain from the planet, but maybe not by opioids.” “Things take time to cope with.” “Make sure you stick to good ideas if you think they’re good, but also leave them if they’re not.”   More about Morten Hoegh After qualifying as a clinical physiotherapist (1999) and completing several clinical exams, Morten was granted the title of specialist physiotherapist in musculoskeletal physiotherapy (2005) and sports physiotherapy (2006). It was not until 2010-12 he made an entry to academia when he joined the multidisciplinary Master-of-Science in Pain: Science & Society at King's College London (UK). From 2015-19 Morten did his PhD in Medicine/pain at Center for Neuroplasticity and Pain (CNAP), Aalborg University. He is now an assistant professor. Having spent more than a decade as clinician, teacher, and business developer, he decided to focus on improving national and international pain education based on the International Association for the Study of Pain (IASP). Morten was vice-chair of the European Pain Federation’s Educational Committee from 2018-20 and has been involved in the development of the Diploma in Pain Physiotherapy and underlying curriculum, as well as the curricula in nursing and psychology. At a national level, Morten has been appointed to several chairs and committees, including the Danish Medicine and Health Authorities and the Danish Council of Ethics. He has co-authored a textbook on pain, and written several book chapters, clinical commentaries, and peer-reviewed basic science articles on pain and pain modulation. Morten’s first book on pain in layman’s terms will be published in January 2021. Morten is regarded as a skilled and inspiring speaker, and he has been invited to present in Europe and on the American continent. He is also a prolific debater and advocate of evidence-based and patient-centred approaches to treatment in general. Morten is motivated by his desire to improve management of chronic pain, reduce stigmatisation of people with ‘invisible diseases’, and to bridge the gap between clinical practice and neuroscience research in relation to pain.   Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Neuroscience, Pain, Injury, Rehabilitation, Research, Experience, Treatment, Management,   Resources: #IOCprev2021 on Twitter.   To learn more, follow Morten at: Website:          http://www.videnomsmerter.dk                         https://p4work.com Twitter:            @MH_DK Instagram:       @mhdk_drmortenhoegh LinkedIn:         Morten Hoegh   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:                https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hi, Morten, welcome to the podcast. I'm very excited to have you on. So thanks so much. Thank you for having me, Karen. It's a pleasure to be here. Yeah. And today, we're going to talk about your really wonderful, wonderful workshop at the IOC conference in Monaco. That was just a couple of weeks ago. And you did a great workshop on pain, which is one of my passions.   00:27 But I would, I think   00:30 the best thing for us to do here is to just throw it over to you. And let you give a little background on the talk. And then we'll dive into the talk itself. So go ahead.   00:43 Thank you. And, you know, I'm really happy that you liked it. It was a great pleasure to present that the IRC was my first time there as well. A lovely place to be and very lovely people. And he really well organized conference as well. Well, back to the background. So the tool was, the workshop, as it were, was actually originally something I planned with Dr. Kieran or Sullivan, who is now in Ireland. Unfortunately, he couldn't come due to turn restrictions and all of that for COVID. So we had to change it slightly. But over the period of the last sort of year or so I've been working with colleagues at all university where I'm affiliated and test Denton and Steven George of Adelaide and, and to university respectively. And together with them, we sort of have written up this idea that there is a difference between having an injury and being in pain. And the reason we came about that was because we wanted to try and look into what is actually the sort of narrative definition of a sports injury. And and some one of my colleagues are actually two of my colleagues Kosta, Luke, and Sabine Avista. We're looking into this and trying to sort of find out what the consensus what they came up with, when they were looking at the last 10 years of of sports related research is that the same articles could use injury and pain for the same thing. So it was being used almost as well, not almost, but as sentiment synonymously throughout the program, or the manuscript, and others will stick to pain and others will stick to injury. But if you then try to go down into the methods and find out what is an injury, really, some would have definitions, but there weren't really anything. And definitely, there wasn't a clear distinction between when is the tissue injured. And when is the athlete suffering from pain that is keeping them from not doing what they want to do.   02:50 So we came up with this idea to write an editorial for the BDSM. We couldn't get it accepted as an editorial, we were under the impression that maybe the topic was a bit too narrow. So it really wouldn't have any impact. But we had a we had some some help from from   03:12 sorry, you can cut that bit out. I was just losing her name. Let me just get it here.   03:21 Oh, that's she was such a great help. I'm really sorry for not being able to I definitely think we should put her name in there.   03:32 Oh, here we go.   03:35 So we wanted to do the editorial first. But we were under the impression that we couldn't get the editorial through because the topic, you know, is probably a bit too narrow. But fortunately, Madeline Thorpe, who is working with TAs in Adelaide, she helped us create this infographic that sort of conveyed the message of the difference between what we call a sports related injury and a sports related pain. So after a few revisions, the BJs took it in as an infographic with a short text to describe what we mean. And and it's been. It's been, you know, quite well cited afterwards. So we're very happy with the the attention that this idea has got. And then of course, what we really are trying to do here is to create two new semantic entities as we say, Where where it's clear when we do research, but also when we talk to athletes, are you really injured? Is the tissue injury that needs healing and where you might need you know, specific treatment for that injury versus Are you having pain as a consequence of an injury or even without an injury, which is what we call sports related pain. So that's sort of the broader concept and and I hope I've I've done right with my co authors.   05:00 because they've Of course, been been a huge part of both the development and the writing of these, these, this infographic.   05:09 Yeah. And can we now sort of dive in a little bit deeper? So, injury versus pain? Right. I think a lot of people will think that every time you have an injury, there's pain. So used a really nice example in your talk. So does tendon tissue damage lead to pain? Yeah. But is the pain in the area of the tendon equal to damage to the tendon?   05:38 Maybe not. Yeah. Right. Oh, so yeah. So let's, let's have you kind of dive into this injury versus pain narrative. And if you want to go into those pain mechanisms that you spoke about, we can dive into that as well, because I know that that people had some questions on that on social media. So let's first talk injury versus pain. Yeah, again, my my perspective on this with my background, being a physio and, and sort of a neuroscientist is that I come from it, I would say from a pain, scientist pain mechanistic approach. And what I try to do is to understand what goes on in the human that could explain why they feel pain. And in some instances, and for instance, in low back pain, we we think, in about maybe 80 to 95% of the cases, we don't know what's going on. So we're pretty sure that the risks are mechanism, perhaps are quite complicated. One there has multiple factors that are interrelated, but there's probably something. So that's really difficult to study. Again, consider consider, you know, if you were tasked to, to come up with a, you know, a model where you could study this model would be, for instance, an animal model. So not that I would encourage people to go out and, you know, do bad things to other animals. But just, you know, for the sake of the example, let's imagine that you wanted to do an animal model of low back pain, or even a herniated sorry, a groin injury, you could say, in sports.   07:20 If you know, the most basic thing to do would be to create an injury. If you don't want to create an injury injury, what you could do is induce inflammation, you know, inject capsaicin, or put something under the skin or down into the tissues, and that makes your immune system go, you know, make inflammation. And that inflammation makes your nervous system respond more powerful. We call it sensitization, I think many people have heard of that word by now.   07:49 And that's a really good way to create that sensation of pain in humans as well. So we can inject capsaicin again, and people will usually feel pain.   08:00 In that case, that's what happens or that's how we understand what happens in the case of a tissue injury. So when there's a tissue injury, there's inflammation, and we understand that pain. So when the tissue hit healing period, is sort of crossing from what you could say, the inflammatory phase, into the prolific face, pain should go down. And in most cases, that's what happened. But what when the pain persists after the inflammatory phase. You know, from the science perspective, we don't know that. But we still know that this person is in pain. So whether that be an athlete or non athletes, they're still in pain. And in this in sort of the pain research world, we have a definition of pain that doesn't necessitate any type of injury, not even any activation of those, we call them nociceptors. But nociceptive system you could say.   08:53 So we acknowledge that people can have pain and not be Do not be damaged, not be injured, not have pathology. And that's sort of the idea that we are trying to bring into sports medicine as well, which has been over the you know, many last decades I've you know, I've been in in sports medicine or as a sports physio, for 20 odd years and sort of dominating belief. And also perhaps, trajectory has always been sort of the orthopedic sports related and to some extent, also pharmacological approach, combined with and that's important, combined with a non pharmacological physio, perhaps approach. So there's been this interrelationship collaboration between doctors and physios and other health professionals, which is quite unique. As I see it in the musculoskeletal system. We don't see that to the same extent, for instance, for low back pain or neck pain, but sports has done that. But maybe there has also kept people within the realms of sort of orthopedic approaches trying to understand what goes on. It's   10:00 tissues, and why did they hurt, and then when you couldn't find out why they hurt, we've just looked deeper into the tissues, which is, of course, a good idea from a scientistic or scientists perspective, because there are definitely things in the tissues that we don't know today, which will, you know, make us become more aware of what goes on, you know, as, as late as in the beginning of October, wasn't it where the Nobel Prizes were given out, there was given a Nobel Prize out for the person, I might do violence to his name, but it's part of Putin, I think he's last name it.   10:36 I didn't, I suppose a Putin or something like that. I do apologize for not being able to pronounce it. But he got the Nobel Prize was shared the Nobel Prize for his work on a peer to two receptors, which is a quite new phenomenon and sort of the longer perspective, but it might learn us over time, why could movement hurt? Which is something we don't know today? So if there's no sensitization, why does it hurt to be moving? And that's really interesting. But again, coming out in the clinic, we don't know enough. So we will have patients in the clinic where we simply do not know why they hurt.   11:14 And you could say that doesn't matter. We can call it anything. But then if you take a clinical look at what goes on what happens again, if you look at the signs, what does it mean, when people are hurting, and they think they're injured? They This is what a percentage again, they seem to be thinking that they're being in pain is the same as being weak. If you're weak, you're not, you know, you're not allowed to be in on the team, you might lose your position. So it has a lot of negative connotations. And I mean, that in itself is wrong. But what if it's based on a misconception that just because you're hurting, you are also injured? And couldn't we help people who are hurting with their pain,   11:59 just as well as we could if they are injured with a tissue injury. So what we are saying is that the two are different. They're both real, they should both be addressed. And they're not, they're not opposite ends of a dichotomy, you will have injury and pain in one end, but you will have pain without injury on the other end. So we need to pay attention to both of them separately. Yeah, it's because sometimes a person has a pain problem   12:29 may not be a specific tissue problem, but they have a pain problem. And so this pain problem may, like you said, cause certainly a an athlete to catastrophize. And to really play out to the point where maybe now they're fearful to get on the pitch or the court or the field. And so where does that leave us as physio therapists when it comes to their care? How do we help manage someone, or I should say, help someone manage their pain in order to play their sport, knowing that their every time they go out and play, they're not compounding, quote, unquote, tissue damage?   13:14 Yeah, and interesting, let's say someone has the perception that their tissues are injured, and every time they move, that's a sign of their tissue injury, or even when they hurt more, the injury is bigger, then that person, I mean, if that's a person like me, I would think that I should do something about that injury so that I don't hurt. But pain is always a symptom of something underlying it. Whereas we know from pain research in for instance, low back pain, that pain can in itself, be the disease, what the ICD 11 is now describing as chronic primary pain. So you can have that in your body, you can have it in your tendons, you can have it all way where your tendons are, you can have it where you know, where the bones are, where the where you feel the muscles are. And it's the pain itself is the problem. So rather than looking specifically at a tissue, which needs strengthening or some sort of treatment, then we can look at the person and say, What is it really that you need? A very, very simple example here, which is unlikely to be, you know, the case for everyone. But let's imagine we have someone with knee pain. And the thing that happens is that when they start running, their knee pain gets worse. But if they've been running for a kilometer, or two kilometer or miles, whatever, you know, whatever metric you use,   14:40 then the pain might be the same. So it sort of comes from nothing to let's say, five in the first mile, and then it stays at five, maybe six, and that person wants to run two miles perhaps. But what's the problem in that? I mean, the problem of course, is if pain in this case is a sign of an injury   15:00 that we should attend to. So we need to understand that it's not an injury.   15:06 Once we've done that, why not help this person, deal with the pain and maybe deal with it when they run, just like we would say to someone, if they have, again, back pain, for instance, and they have pain when they work, but their pain is not necessarily worse when they work, should they not be working? I mean, of course, if, if your pain can go away by two days of rest, and graded exposure, that's fine. But in some cases, and they're not as rare as I think most people believe they are, that we just need to work with that person and help them do what they need or want to do with that pain. And why is that, you know, of course, it's not the optimal it would be much nicer is if we would just kill the pain. Or if they could kill their own pain. But we're not there yet, we are still working to get it. And we're not giving up, there's a lot to do. But currently today, and tomorrow, we need to help people work with their pain, that's the best thing we can do now, and and, you know, giving people that agency to actually manage their pain. So in the case of the runner before, maybe the best thing we can help them do is share with them ideas and make them take agency over their pain by you know, using perhaps a cold pack or heat pack or a rest regime or watching you know, something that takes off their mind of their pain for a minute look at you know, watching dope sick on Disney, whatever they need to do to get their mind off, you know, the pain that they have, so that they can recharge, and they can be as you know, their normal again, before they go out for another run. So all of these things would make absolutely no sense if we didn't acknowledge that pain in itself is the problem, because it's not helping anyone's tissue injury, if there was a such to become better. So again, that's the infographic in its essence is that on one end, you use those inspiration to how to manage pain, what that means and how pain is influenced. And on the other side, you will have tissue injuries, and how to manage that, for instance, loading. In sports medicine loading is a big issue. It's probably the one thing that you know, everyone is doing when you're rehabilitating some someone after an injury or pain. But pain doesn't necessarily necessarily sorry, pain doesn't necessarily respond to loading. So you can have the same pain, whether or not you're loading. But there could be tons of other things such as the way you think about your pain, the way you respond to your pain experiences you've had before the context your work in. So you can run in one context without too many pains or problems. But in a completely different context. For instance, when you do a competition, or if you know, if you need to do something, because that's the bar to get onto the competition you want to do, then pain can be a much, much bigger problem. So we need to understand that context of beliefs and experience really influences pain, whereas loading may not. But it could have caused, but it doesn't have to. So pain is a much larger, much more complex topic of which we still don't know too much. We do know quite a lot. And as long as there's an injury, we understand the pain that goes with it. But when it comes to these pains that are there by themselves, the ICD 11 type chronic primary pain, then that's the type of pain that we you know, we've really, we don't have the sort of blueprints on that. So we can't help everyone. And we can't say this is right for you or wrong for you. We need to do individualized care for all of these people and help them find the best tools to support themselves. Yeah, and I think that was something that people who weren't at the conference and kind of reading through tweets,   19:08 that certainly brought up some questions, one of which was the pay mechanism, no sub plastic pain, where we can't fully explain it. And so then there was a question of, we can't fully explain it, why even bring it up? So I'll throw it over? Yeah. It's, again, it's a good question. And especially if you're a clinician, why would you use it, though, they're basically what they are. They're ways that scientists understand the pain. So again, imagine you're standing at one end of the road and you're looking at the other end by the end of that road, a very long road, you have pain. And then the way the place you're standing at is how you explain how to get to that end point. And if you're standing at a place and you know there's a tissue injury, there's inflammation. We understand that as   20:00 Part of the normal normal nociceptive system. So we would call it nociceptive pain.   20:05 Underneath that there is a range of different changes and modulator modulators of the system that leads to, for instance, peripheral and central sensitization. So they're not unique to anything that is there also in nociceptive pain, but it's induced by, for instance, a tissue injury.   20:24 If you have a different tissue injury, the one that hits your nervous system, we call it a neuropathic pain, so you have a nerve damage, along with pain, we call that a neuropathic pain. So again, you're standing on this long road, but in this case, the road itself is sort of gone wrong. But we still know what's going on. Again, if you want to use the study metaphor, you can, you can design a study, you can just take an animal, and you can compress or do something to the neurons, and you can create this similar pain experience, or at least the behavior that it assimilates this pain experience in animals, other than humans. And then finally, we have this new, we call it a mechanistic descriptor knows a plastic pain, which is much much blurrier. And perhaps it's more like a waste bin. As it is now it's, it's where you would say we acknowledge that people have pain.   21:24 And a lot of things goes into it. So just like in nociceptive, and neuropathic pain, sensitization is definitely part of it. It could also be part of the note of plastic pain. But unlike the other two, you don't have the inflammatory response that could explain it. And you don't have the neuron damage that could explain it. But the person experiencing the pain could have a similar experience. So what is it really? How do we a scientist tried to understand that pain, and that's what most plastic is at the moment. And there is a little bit of debate that whether or not you can actually use algorithms to diagnose or, you know,   22:09 maybe   22:11 justify at least that you yet the person in front of you are experiencing this type of pain mechanism or pain related to this mechanism, we definitely have a very, very, you know, widely embraced algorithm used for neuropathic pain. And some very, you know, high profile researchers has just recently come up with a paper suggesting that the same can be done for noisy plastic, sorry, for noisy plastic pain. But personally, I don't think we should, because unlike so nociceptive and neuropathic pain, they're both well understood by signs and we can separate them, they are different. So you can have both, but you would have different qualities to it, there'll be a nerve damage in one and there wouldn't in the other, for instance.   23:02 But we don't know about most plastic pain. So it could be changes in your nervous system, it could actually be, you know, increased responsiveness of your immune system in interaction with your nervous system. It could all be all of that. So it could be sensitization, but it could be tons of other things as well. So how can we start when we don't know what the mechanism is? How can we start to clinically differentiate? So I don't personally think we're quite there yet. Although I like the idea that maybe we can at some point, what I'm afraid of, if we start to use these clinical descriptors, sorry, these mechanistic descriptors, as clinical guidelines, is that what happens to the people who are now embraced and validated in their pain experience by scientists saying, Well, we know what you have, it's mostly plastic pain. But what if we made up an algorithm? And we used it for people? What about the people who fall out? Do they need, you know, a fourth descriptor? Are they just weird? Do they have unknown pain? Are they back to the psychogenic pain? So we've come quite a lot of way, embracing the clinical aspects of pain into the pain research world. And I think using you know, these three mechanistic describers, as you know, trying to really differentiate them and create perhaps treatments that is directed at either one. At this point, or especially anatomy is specifically directed at most aplastic point pain. Just because we know something doesn't mean we know everything.   24:34 So yeah, that's that's the issue. There was a bit of off topic. I'm sorry. But it's such an interesting topic. And I think that the most important thing about no plastic pain is that it is a construct that researchers use. It's embraced by the IRS, the world pain Association, the pay Research Association, and it validates that all pain is real. And there's, you know, it's still real even though we can   25:00 not understand it from a science perspective. I think that's important. And I would hate to see that we misuse it. To say that some really has it. And some don't. Because that's just, you know, that'll be I'll be sad. Yeah. And and can't one's pain experience?   25:20 Everybody's pain experiences individualized. But one person's nociceptive pain experience may be exactly like someone's neuropathic pain experience or someone's no support plastic pain experience, because it's in so then to categorize the persons Oh, well, my pain is like this. So it means this, so I can't have this. And I think it can get people a little confused. And when you have more long term or chronic pain, it's like, the the pain is there. Pain is pain. Some people need the the label or categorization, but like you said, Is it is it really helpful? And it kind of leads me to the one of the last slides in your presentation, and it was like pain prevention is well intentioned, yay, thumbs up, sometimes unrealistic, and possibly unhelpful? Yeah. So do you want to expand on that a little bit? And what you meant by that slide?   26:23 Yeah, that's slide was. That was actually the whole idea when, when I started to talk with Dr. Kieran Sullivan about workshop is that we see a lot of people, athletes. So both of us are still clinicians. And we see and we hear stories of a lot of athletes who have been treated and treated and treated again, or assessed and assessed and assessed again. And again, because they have a pain that we cannot objective eyes. So we can't find anything on scans or blood samples or clinical tests. So rather than acknowledging that pain can be there, so let's say nosey plastic pain, those are, there's something going on in your nervous system that gives you this pain, and we don't know what it is, we can't see it, that will be the, I would say the proper thing to do. So rather than doing that, we tend to keep sending people off. And it ends up with too many scans and too many assessments and too much worry. And in that process, we know the athlete is unlikely to be performing optimal during that period of time. Partly, of course, due to the pain, but also due to the insecurity to you know, if nothing is found on the first scan and a second scan that at some point, they probably start to wonder whether or not they're completely broken, or if it's a really rare disease or even if it's gonna kill them. And these are things that we might feed into by overtreating. So, of course, we should try and prevent pain. Statistics suggest that that's quite tricky. And we, you know, it would be great if we could or even perhaps what we can do is give people tools so they can take agency over their pain when it flares up. But having this idea that when you are in pain, you are damaged is very unhelpful. We think. So we really wanted to highlight the fact that sometimes pain is is that it is pain is still disabling. It's that feeling of pain, and nobody can feel whether or not their pain is due to an injury or not, it feels just like pain. But we identify all pain as if there was an injury, when in fact, it's it's quite unlikely that the majority of cases would have an injury attached to it. And just coming back to one thing you said before that it was quite subtle, but I think it's a really important point you made there, which is that all pain is real, it's always experienced as pain, whether that be of any of the descriptors or for any reason, it always feels like pain, and the quality that we attached to it, it's a muscle pain, or it's whatever is something we do it's our perception is our belief about what the pain is. And maybe that's what we need to also address in sports medicine is that disbelief about what your pain is caused by is a potential target for treatment, we call it psychotherapy or psychoeducation. Or, you know, and that doesn't have to be paying neurobiology education that's unlikely to be better than any other good education and listening and embracing. So there's a range of different interventions that are combining or embracing the fact that you need to talk to your athlete or your patient and help them make sense of their pain in a way that gives them empowerment will give them agency over their pain.   29:51 And something that came to my mind as you were saying, oh the pain it's it's in the muscles, the tendons, the bone, it's the joint and can't that all   30:00 So be a coping mechanism of the athlete. So they may say, oh, it's, you know, this is just a muscle strain. It's so it's their way of coping of saying it's nothing I can continue to to move forward. Do you know what I mean?   30:16 Yeah, absolutely and, and I think as long as it empowers them, if you know if you have the pain that you again, think about Dom's, or delete onset onset muscle soreness. That's an empowering pain, isn't it? I mean, I have Dom's, I was doing exercise yesterday. And if you really want to, you know, be good at something, then perhaps Dom's is your sort of reward even, even though it's painful, it should be awful, it might actually feel like a reward. So in that case, you interpret the pain that you are experiencing, as a reward or something you want it to happen. And I definitely think that some would say that this is just a minor thing, again, think about general health and male, you know, older men, like myself, tend to not go into, you know, the GP for what we consider to be minor things, but in fact, that might be killing us. Because we say, no, no, that's nothing, no, that little spot, that's not cancer. And I would say I don't, I don't think it's a lump, it's probably just something that's here this week. So we should be much better at listening to it, and giving it you know, you know, the quality or the, you know, the meaning that it should have. So it's on both ends of the spectrum, sometimes we neglect that pain is there for a reason, and we should listen to it. And sometimes we should understand that the pain is there without anyone really knowing what it is. But it doesn't mean just because we don't have a universal tool that can treat all pain, which is what we say when we say there's no treatment for chronic pain. In fact, there's quite a, you know, a variety of well established evidence based treatments, that can reduce pain, but they need to be targeted, and individualized so that each one find their, you know, their way through their pain. And of course, one way to do it is to go to everyone you know, who has a, you know, any background in health and ask them what to do, probably the best thing to do is to talk to someone who knows about pain, and then get advice about what seems to be working for you. Embracing that the one in this case, the athlete with pain, they have perhaps one or two years experience with their pain, they know much more about their pain than I do. But I can act as a consultant, I can listen to them, I can help them structure, I know what you know, patterns out there. So I can listen for that. And then together, we can try a few things. But over a period of maybe weeks, they should know as much as I do about pain generally, but with their focus on it. And and that should give them you know, with a bit of practice the ability to find out what works and what doesn't. And rather than thinking of pain management, in the case of a sports related pain, as an on off thing, so either it works and the pain is not there, or it doesn't work, it only reduces the pain a bit, we probably should be realistic and say that most people can have reductions in their pain, perhaps 2030, perhaps more percent. But the majority of people will experience from some sort of management of pain reduction. But it doesn't mean that the pain is going to go away. And it doesn't mean that thought is going to be absolutely pain free. But we need to find a balance between the two so that we understand when pain is actually a sign of either injury or possible injury. But also understand when pain is something that might just be part of life. And the best way we can do the most evidence based approach to that would be to find your way through it, you know, in perhaps, together with a   33:56 clinician of some sort? Yeah. And my gosh, I was just gonna say as we wrap things up, would you like to put a bow on it on your talk and at at the IOC conference and to this talk today, and I think you've just done it? I think you'd beat me to the punch. But is there anything else that you'd like to add?   34:18 That, that you want the listeners to take away?   34:22 I think the most the thing that I always want to stress is that people who meet or live their life with pain, they're experts. And we as clinicians, and researchers should embrace that much more. So the patient as an expert, is something I feel deeply about.   34:44 And I think we should be able to understand that as you know, as a scientist, you might know, you know a lot about groups.   34:51 As a clinician, you might know a lot about people who come to you with a similar symptoms, but as a person who have pain, you have two or three years   35:00 perhaps have experience with your own pain. And I think the best way to you know to get all of these together is by everyone being aware that we have different aspects and different competencies, and we should bring them together. And I think that's the best we can do right now. But still, don't give up hope we should definitely try and cure all pain from the planet, but maybe not by opioids. Yes, I would agree with that. And now more and where can people find you if they want to learn more about what you do? Read your research, where can they find you?   35:39 I think the easiest way would probably be to either find me on on Facebook, or go on Twitter. My handle is at MH underscore DK. And I'm also on Instagram. It's at MH DK underscore Dr. Moulton. Whoa.   35:57 Excellent. And one last question. It's a question I asked everyone is what advice would you give to your younger self, knowing where you are now in your life and in your career?   36:09 Remember, things take time to cope with sometimes you have a good idea. And you can't imagine, however, too, you know, you hear something and everyone else knows it. And you're like the only one who doesn't get it. But give it a bit of time. And, you know, I we have a saying that Rome wasn't built in one day. I think it goes in English as well. So give things time and and make sure you stick to good ideas if you think they're good, but also leave them if they're not.   36:37 Excellent advice. So Morton, thank you so much. This was a great conversation. And like I said, your talk at IOC was really wonderful. There's if people want to see his slides, there are tons of tons of tweets with all of his slides and great descriptors. You could go to IOC p r e v 2021. That was the hashtag for the conference. And as you look through, you'll see a lot of tweets from his from Morton's workshops. So thank you so much for coming on and expanding on that for us. I appreciate it.   37:13 Amazing. Thank you. It is a huge pleasure and privilege to be here. Thank you, Karen. Thanks so much. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.

In this episode, Bryan Guzski, Director of the Orthopaedic Residency Program at the University of Rochester Medical Center, and Tim Reynolds, Clinical Assistant Professor of Anatomy & Physiology at Ithaca College, talk about their work on Movers & Mentors. Today, Bryan and Tim talk about their book, Movers & Mentors, and they get the opportunity to be the interviewers for a portion of the episode. Why is it important to have mentors? Hear about the motivation behind the book, some surprising interviews they’ve done, the value of having a team, finding your ‘why’, and choosing when you say ‘yes’, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “From an entrepreneurial standpoint, from a business standpoint, your partner is everything.” “Invest in [yourself] and take care of [yourself], physically and mentally, so that you can take care of your patients better.” “Challenge yourself to step beyond your comfort zone, because the benefits of that can be significant if you’re willing to try.” “Find a mentor and don’t fear or stray away from the imposter syndrome. Use that as fuel.” “If you never ask the question, the answer is always no.” “Trying to do it all will keep you small.” “You have to really only say yes to things that align to your values.” “Take a step back, know who you are, know your values, know what your individual mission statement is.” “He who knows others is wise. He who knows himself is enlightened.” - Lao Tzu “If you don’t have the capacity for it, then don’t do it.” “Stay curious.” “Continue to search for the ‘why’. It’s okay not to know.”   More about Bryan Guzski Bryan Guzski PT, DPT, OCS, MBA, CSCS, is an outpatient orthopaedic physical therapist practicing in Rochester, NY working primarily with patients with spine related issues and persistent pain. Bryan earned his Doctor of Physical Therapy degree from Ithaca College in 2014, completed an orthopaedic residency program through Cayuga Medical Center and received his Orthopaedic Clinical Specialist certification in 2015, and earned a Master of Business Administration degree from Simon Business School at the University of Rochester in 2021.   More about Tim Reynolds Tim Reynolds PT, DPT, OCS, CSCS, is a Clinical Assistant Professor of Anatomy & Physiology at Ithaca College and a part-time physical therapist practicing at Cayuga Medical Center in Ithaca, NY, where he predominately treats patients with spine or lower extremity impairments. Tim earned his Doctor of Physical Therapy degree from Ithaca College in 2014 and completed both his orthopaedic residency and spine fellowship through Cayuga Medical Center, and currently helps mentor and teach in both of these programs as well.    Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Academia, Movers, Shakers, Mentors, Prioritizing, Self-care, Self-improvement, Values, Motivation,   To learn more, follow Bryan & Tim at: Website:          https://www.moversandmentors.com Twitter:            @moversmentors                         @timreynoldsdpt                    Facebook:       Movers and Mentors Instagram:       @moversandmentors                         @bryguzski                         @timreynolds10 LinkedIn:         Bryan Guzski                         Tim Reynolds                         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 Hey, Brian and Tim, welcome to the podcast. I'm happy to have you guys on to talk about movers and mentors. So welcome.   00:11 Thank you, Karen, thank you for having us today. We're sharing this sit down chat with you.   00:15 This is great, Karen, thank you so much.   00:17 Well, thank you guys for including me in your book with over 70 Other pretty illustrious folks in the Movement Science physical therapy world. So let's start with the basic question that I'm sure a lot of listeners want to know. What is the why behind the book?   00:40 Yeah. So Karen, Tim and I were going through residency orthopedic residency together. Back in 2015. We both graduated from Ithaca College in 2014. And we both entered into a residency program at ethika are in Ethica, in 2015. And as we were going through the coursework there, and kind of taking different classes and really kind of immersed in the PT literature and physical therapy, space and various different content. We started noticing a lot of reoccurring names and reoccurring themes. And so, you know, different names like Tim Flynn, Josh Cleveland, surely sermon, Stuart McGill, you know, all these all these names that, you know, names in our rehab space that I've done a lot of really cool things and have put out a lot of different research that that, you know, we follow to this day. So we started noticing those names. And Tim and I were also reading a book by Timothy Ferriss called Tools of Titans at the time. And we really liked that book. And we enjoyed it. We got a lot out of it. He interviews people like, you know, Arnold Schwarzenegger, and Oprah Winfrey. So various different industries and various different spaces. But we like the model that book and we started to ask ourselves, well, I wonder how, you know, individuals and movers and shakers within our industry would answer questions that we have. So fast forward two years. That was 2017 2018 at that point, and Tim and I started putting together a list of questions and a list of names. And at that point, you know, we kind of we kind of took it from there. And Tim has a little bit more info on how we how we came up with the names.   02:29 Yeah, so it's one of those things that we could have written a 5000 page book in regards to the movers and shakers within the physical therapy industry. And I think one of the most important things that Brian I have tried to stress is that this is a living project. This is not a one and done situation where there are movers and shakers that are currently developing and changing the practice. And so I think that's one of those things that, yes, there are people within the pages that I'm that are, we're happy to have there. But at the same time, there's so many other people would want to reach out to, and we look forward to have the opportunity to potentially talk to those individuals in the future, and are excited to see how does the profession change in the next five to 10 years and who are going to come up and literally shake the industry that we have the opportunity to be part of. And so as we started to go about this, like Brian said, we're diving into this literature, I had the opportunity to do spine fellowship after doing my orthopedic residency. And so the amount of Tim Flynn articles that I've read over the past three years was obnoxious. And so we started to make this almost like PT Dream Team, if you would, where we said okay, from, from a literature standpoint, who do we do we invest ourselves into a lot of, and like Brian mentioned, John John Childs, and we have Josh Cleveland. And then we have Tim Flynn, and the surely SARM and Gwendolyn Joel, there's these names that we have read multiple articles from and so kind of selfishly, we put together this list of people that we would really appreciate reaching out to, because we've been so invested in their in their literature over the past several years. And then from there, we kind of spread our net a little wider, because we had to see who's moving the industry from a clinical practice standpoint, right. So not necessarily from an academic or research standpoint, but from clinical practice. And who's moving it in regards to social media influencers? Because as someone who works in academia and works with the up and coming physical therapy generation, those are the people that they're following on Instagram and on Twitter, and so they're moving and shaking the industry in that format. And we looked at who's been guest speakers at recent conferences and who's putting out podcasts and how He was really trying to have the opportunity to get our profession to move in a positive direction. And so from there, we created this sort of master list, we reached out to all of them, and some have the opportunity to participate, which we're super thankful for. Some respectfully declined based on the fact that they had other stuff going on. But I think one of the things to remember, Brian is sort of given us timeframe, this was right pre pandemic, that we started to reach out to all these individuals. And what's been such a blessing is that we've been able to cast a wide net across multiple different countries across multiple different professions. But at the same time, we reach out to people in Australia, and there's Australian wildfires. And so we're trying to really respect individual's personal physical well being while navigating global pandemic while trying to also conduct interviews. And so it took us a little over two and a half years to be able to accumulate everything and be able to put everything out into a book format. But I'm super thankful to have those people within the pages. And like I said, I'm excited to have the opportunity to reach out to more in the future.   06:14 And so it takes, you know, a couple of years to get all this together. How did the two of you kind of keep the momentum going? Number one, because that's hard. And then number two, how did you kind of kind of temper your excitement and your expectations? Because I know, I'm the kind of person who's like, let's just get it done. Let's go, go go. But here, you know, you've really taken your time, over two plus years. So can you talk a little bit about that?   06:52 Yeah, I think from the outset, Tim and I both thought, I will send out some emails, you know, we'll get a handful of responses. It'll be a cool book, maybe we'll sell to maybe, you know, five, including our siblings, and parents, that sort of thing. And it really from the first batch of emails that we sent out, you know, Tim and I were really, every time we got a response, we would text each other, shoot each other an email immediately, Hey, Peter O'Sullivan responded, or David Butler responded, or Karen Litzy responded, you know, this is awesome. Like, we're actually doing this thing. So I think it you know, you spoke to momentum, Karen. And that's one thing that Tim and I, you know, we've never really hit a point where we were at a lack of that, or hit a dull moment, if you will. Because every time we got we did another interview, or we got another email, or we set up a, you know, maybe a podcast, it was definitely adding fuel to the fire. And, you know, they kept us pretty engaged and pretty excited throughout the whole thing. So, yeah, I mean, to I think if you asked us when we first sent out our emails in 2018, hey, you know, this is you're going to publish this in 2021, we'd say, No, it's going to be next year. And then life happens and pandemics happen and several other things. And, you know, it turned into a two and a half year project. But you know, it's been a lot of fun the whole time. And Tim and I still are still excited about it and excited about about the future, too.   08:16 And I think that's one of the things. There's kind of like Christmas every single time we had a response because it was super cool. You send out these, these emails, or you give a phone call to people that you've literally have had as your mentor from afar for years. And it's like, oh, my gosh, I cannot wait to have the opportunity to sit down. Like Peter, I saw that I've watched a lot of Peter softened videos from pain science standpoint, from spine fellowship work. And having the opportunity to sit down with Peter resolve them for an hour and 15 minutes was like, amazing. I was super stoked. And so so all those opportunities to talk to these people definitely continue to keep flame burning. And at the same time you talk about how do we sort of balance that, that excitement and try not to do too much too quickly. Brian and I have known each other for years, this has been such an amazing project to be able to find a partner that you want appreciate and to after two and a half years don't hate. So I think that's like a really good thing. And I think we balance each other out very well, where we're both skilled in a variety different formats. And then at the same time, after reading your draft manuscript, probably like five times through and through, you really do not want to read one more time. And there's points where we're like, I think it's good. I think we just just push it out, call it a day. And then Brian could probably agree that I'd say well, let's just read through it one more time, and then you catch one or two small mistakes. And so I think it's one of those things that just finding the right person that's willing to invest and stay motivated to push you and challenge you From an entrepreneurial standpoint, from a business standpoint, your partner is is everything. And so I think that's been one of the blessings that we've had this for this project.   10:11 Yeah, I love it, I think that's great advice is to have that person who complements you. Right and because you don't want to have just like a yes person, but instead you want something that's going to complement you and push you in, in a positive direction. And, and I will second the Peter O'Sullivan, he is just what a nice person and giving and charitable and gosh, I had an interview with him at CSM a number of years ago. And I had to ticket it. Because it was live at CSM. And we actually had to ticket it so that only 25 people could go and I it was only for students. And by the end of the interview, he was laying on the ground, you know, students and stuff. It was just so it was such a great experience, because he's just one of those very kind of electric personalities.   11:08 Definitely. very warm, very electric.   11:10 Yeah. Were there any interviews that you did that surprised you?   11:20 Um, in   11:21 a, in any way that doesn't have to be good or bad. Just surprise you because perhaps the persona that this person has, whether it be their research, social media clinical that you thought they had, and then when you interviewed them? It it surprised you?   11:46 Yeah, I would say. Obviously, when you when you interview over 75 individuals, you get a variety of different responses, you talk to a variety of different personas, devided different characteristics. And I think going into it, knowing the background of someone's, I use the metaphor of like the front cover of a book, we all have like front cover worthy attributes or accomplishments. And then it's like, well, what's on the inside of those pages. And so we see everybody's bio, and I've been on X, Y, and Z shows or published this many papers and, and so we see all that stuff. But we never really hear some of those people talk or talk personally about some of their successes and some of their failures. And so I think everybody had the opportunity to have some elements of surprise. But I think what was also cool as Brian, I made up this master list, and it was basically just based off of accomplishments and achievements, or their influence on the profession. And so, for instance, I was looking through and like talking to Michael Radcliffe, who is who is a researcher that I've read your research, but I, I never really pictured what you would look like. And I never really perceived that you would have such amazing responses within this book. So I think it was those individuals that I might not have been so invested from like falling on social media, or have watched your YouTube videos, and really getting a chance to know them in an hour, hour and a half. Those were the interviewers that really caught me by surprise, but at the same time, I think I walked away with so much more, because there is so much unknown that they're willing to offer me. Um, and so I think I think that was the most exciting part or the most surprising part for me.   13:42 Yeah, I think kind of, because of the types of questions that we asked, we really intimidate joke about this, if we want to know, you know, surely Simon's recommendations for motor control. We can find that online. We can we can Google that. Right? If we want to know, you know how David Butler opens his pain talks, we can probably find that somewhere and explain pain or explain pain Supercharged. But you know, how Heidi genetica who's the CEO of versio Excuse me? Why pte how she structures her day. And what her favourite failure is it those are things that you can't find you can't find that in textbook you can't find that online. So the types of questions that we asked really opened, opened it up to knowing these people from a different perspective, which we thought was pretty cool. I'd say that one of the individuals that really stands out in my mind, Tim actually did this interview, but I transcribe it so I got to listen to everything, literally word for word was Stanley Paris, who's one of the founding fathers of orthopaedic manual physical therapy and then the United States and North America for that matter. And I mean, this guy is is just incredible from sailing around the world to swimming the English Channel to founding St. Augustine to being, you know, a founder and president of various organizations like the guy has done it all to owning a winery or several wineries. I believe he's just, you know, a jack of all trades. And I think listening to that interview, I was like, you know, he's, I think 83 Now, and my jaw was dropped to some of the some of his answers and some of his experiences. So that was, that was really cool. But, I mean, we had so many so many great interviews, Jeff Moore was a terrific interviewer. Peter O'Sullivan, like we talked about Kelly star it gave, you know, exceptional answers. So we were really, really lucky. And, you know, positively surprised, I should say, surprise, in a positive way with with all of our guests.   15:55 Yeah. And it it, it does kind of, like an education for you. Right,   16:02 definitely. Yeah. 110% Yeah, I mean, it was one of those things. I had the opportunity to speak with Michael shacklock. Um, and such a well spoken. Such a thoughtful, mindful person. And back in residency, Brian Knight did some research with neurodynamics and your mobilizations. As I was like, Oh, my gosh, like, you're the Dude, that was like, given us all this information. And now we have the opportunity to actually speak to the source. So I think back to being like eight or nine years old, and have all these posters of Major League Baseball players up on the walls, and just like, thinking about how cool it was to have their pictures, and to think about what it would be like to play baseball with them. And now to be able to communicate with some of these movers and shakers within the industry, and have them be peers, and be able to carry out a conversation with them learn from us as much as we're learning from them in that conversation is just such a rewarding opportunity.   17:08 And do you feel like it has changed your clinical practice at all? How you are with patients? Did any of the answers or just even the interactions with some of these folks change the change the way you practice? Um,   17:24 I think yes. I would say I've slowed down, and I'm more intentional. Just based on a few, I guess, specific responses, but one that comes to mind is oh, shoot, pause. This might be a Karen, you might have to take this this out. And then wait,   17:48 wait, wait a mess up. Or 25? I   17:50 know. We were crushing it. Dude. Millet mark. I don't know. I want to say more. Mark Milligan. So we'll jump back in. Yes, I would say more mindful and intentional. And I've slowed down in my practice, one response, or several responses from Mark Milligan definitely kind of changed the way I think and operate within the clinic. And I've definitely tried to be more intentional and kind of think about my thinking a little bit more in the clinic from a specific, you know, tactical exercise prescription perspective, not so much. Because that wasn't really the focus of our book. But just, you know, Mark's mindset, and kind of his, his recommendation to all young professionals to really kind of invest in themselves and to take care of themselves mentally and physically so that you can take care of your patients better, I thought was really powerful. So yeah, I'd say, a little bit more intentional, focused, and I've slowed down.   19:00 Yeah. And I think sort of piggybacking off of what Brian was saying, less so about the actual clinical approach to what sort of treatments are you providing? And I think that was one of the the most exciting things about the book was we were not talking about what's your favorite three exercises for X y&z Because there's so much saturation, I'd say from a social media standpoint, which is great. I think that's one of the things that's challenging the profession, that anybody has the opportunity to put out content, and it's one of the curses of the profession that anybody has the opportunity to put out content. And so I think the opportunity for young graduates and PT students, and individuals interested in the Movement Science field that is sift through a lot of information to be able to find out what is truly valuable for them. And like Brian was saying, These are the answers questions that aren't necessarily within a textbook, but also probably not necessarily on people's social media channels also, right? No one really steps up to the plate and says, you know that one time when it took me three tries again to PT, school, Dad was really a good important point in time, my life, or, yeah, I remember when I failed the boards. Those are things that I think can really influence and the sort of career life changing for these individuals, who, as a current college professor, writing final exams, getting ready to watch by an influx of tears in my office in the next bout 48 hours, who perceive a failure as such a detriment to their potential growth, and well being as a person, I got a B plus on this test, all my friends got A's, I cannot necessarily navigate that situation. That's like conversation that I hear all the time. And so talking about how has things changed in my practice, I'm currently part time in the clinic, more time from an academia standpoint. So I think it's changed my communication opportunities, with the next generation, being able to literally use this book as an encyclopedia. And knowing the responses that people have given flipping to their name, and saying, I need you to read this chapter from Mike Reinhold, where he talks about becoming an expert, because you're not there yet. Because you shouldn't be there yet. Because you haven't gained clinical judgment and clinical experience. And it's going to be okay. But go read this come back in five minutes. And so I think that's how I've been able to sort of benefit from this, from this experience and how I've taken it influenced my own practice.   21:51 Excellent. And, and as a side note, Tim, the, my podcast episode coming out tomorrow, my podcast is with Silvia Zubaan. And she's a clinician 50% clinician 50% academia at St. Louis University in Washington, Washington University in St. Louis. Sure. And surely, sermons. Yeah. And it was a really nice conversation on how to navigate. She's been doing it for 15 years now. clinician and academia and academia. So it was a really nice, really wonderful conversation on how to navigate that those two worlds successfully and how to be vulnerable when you need to be and with whom, and because it can't always be great and perfect, like you just said. So if you have a chance, I would come out tomorrow, I would listen, I'm excited. Currently to edit this part out. I don't need to plug my own podcast within a podcast. He was a little self indulgent. But because you, you're kind of in a similar position. She's just been doing it for a lot longer.   23:10 That's awesome. I appreciate that. So   23:11 check it out tomorrow. It was really, like, such a good conversation. She's super cool. She should be in your next book. There. Yeah, like it. She's super cool. Yes, Silvia it's CZ you PP o n. Yeah. And she does some research and and she's written some papers and things like that, but she's super cool. Okay. So, um, is there anything? Before we sort of flipped this a little bit? Because I know you guys were like, Hey, would you like to expand on some of your answers, which, you know, is fine. So we'll flip this in, in a bit. And I'll have you guys host and I'll be your guest. But before we do that, is there anything else kind of about the process of of compiling and publishing the book, that you would love people to know, because it made such a big difference in your lives?   24:23 I think one of the blessings of our profession is the lat orality component to your growth as an entrepreneur, but also as a professional. We graduate with a clinical doctorate, or and this can be transcribed across multiple professions, but you go to school to be able to learn how to learn right and in our profession where you sit for a board certification, which gives us the opportunity to practice as a clinician within that. You can wear multiple different hats and I think what was nice with this is That title allowed for us to speak to a variety of different people and have this mutual commonality, which was physical therapy, or Movement Science or the treatment of individuals with certain pathologies. And I think this would never have happened if we didn't make ourselves vulnerable and uncomfortable. Because who are Brian and I? And why should we have the opportunity to talk to Karen Litzy? Or why should we have the opportunity to talk to David Butler? Or why should in so we had this idea, and it all stemmed from the courage to be able to reach out and ask because you never know, unless you try. And so I think sharing one of these thoughts with your listeners is, I think we all have dreams and aspirations that are slightly beyond our scope of practice. And sometimes we can limit that opportunity for us to navigate those ideas, because we are either potentially afraid of failure, or just don't know what the outcome is going to be. And so since that's an unfamiliar territory, we just assume, and therefore we never attempt. And so I think the one of the best things that I've learned from this is accepting failure for what it is, what's the worst that they're going to say? No, I do not want to be part of this, thank you for the opportunity. And the best thing that we could do is create a relationship, create a mentorship opportunity, and have sort of this professional friendship that stemmed from a cold call email. And so I would, I would recommend, at least my thoughts would be challenged, challenge yourself to step beyond your comfort zone, because the benefits of that can be significant if you're if you're willing to try.   27:02 Yeah, Brian, right. Yeah.   27:04 Yeah, I think there's some level of kind of normalization of failure and imposter syndrome within this book. And I think when you dive into it, and you dive into the responses, everyone has been there, everyone, I'm speaking to, you know, students, new graduates, young professionals here, but guess the message kind of spans anyone in any part of the PT space or industry with however many years of experience, you know, everyone's felt that level of imposter syndrome, or, or fear of failure, and the kind of ability to, to kind of push through that, overcome that and almost use that and leverage it to, to push further or overcome obstacles is really powerful. So I think of it like if you're ever kind of at the top of a mountain, in terms of, you know, imposter syndrome, if we look at it, like, like a curve or like a mountain, if you're at the top of it, then you know, what's really driving you and what's what's pushing you forward, if you're kind of somewhere along along the line on the slope, then you have some level of uncertainty, some level of fear, or some level level of imposter syndrome, and that's actually going to feel fuel you to learn more and be better be more effective. And again, one of the main themes of this book was finding a mentor and the importance of that and how valuable that can be in any, any track or any, you know, facet of our profession. So kind of find that person that's doing something similar or doing exactly what you want to be doing. And, you know, don't hesitate to reach out to them. Because we're in the, we're in the business of helping people and thankfully, we have a lot of professionals around us that that want to help other people but also want to help you know, students, young professionals, so don't hesitate to reach out. I think you'll be surprised with with, you know, the the feedback or the the return on that. So, definitely, definitely find a mentor and, you know, don't don't fear stray, stray away from the imposter syndrome use that as fuel.   29:20 Yes. And I will say I got a piece of advice several years ago from a fellow physical therapist, son. So her name's Cecily de Stefano. She's a physical therapist outside of DC. And we were in Chicago for a one night q&a With Lorimer Moseley. And the next day, we were walking around, she had her five year old six year old somewhere around there, young son with her, and she was sort of walking up ahead and he was walking Next to me, and he said this, Karen, would you like to have a play date? And I said, Well, I don't. I don't have any children. And he was like, no, just you. And I said, Oh, um, okay, well, I think we should probably ask your mom first. And then he gave me a great piece of advice. He said, Yeah, because if you never asked the question, the answer is always no. And I was like, and I said, that's the best piece of advice I've gotten in years, and you're like, five. So just to begin with what you guys said, If you never ask the question, the answer is always no. And I've never forgotten that, since he said that. And so now I just always add, ask the question, because the worst that can happen is it's no and so okay, you move on. But you never know. Unless you try. Okay, so true. So let's, uh, we'll start wrapping things up here. But now I, again, thank you for including me in this book. It's a real honor. So if you want if you guys have any questions to I guess I can expand upon or, you know, anything else that that may be? I don't know, you go ahead. Talk about being out of your comfort zone. Go ahead. And you asked me, I'll hand the mic over to you guys. And I'll see, we'll see what we can do here.   31:21 Sure. Karen, thank you, again, for being a part of this. I really liked your response. We were speaking about failure a little bit before. And I really liked your response on failure in the last comment, here you have, I'll read it right from the book, it says, failure has taught me to be more introspective to have an open mind to trust in others more. And to know that in the end, it will all work out the way it is supposed to. I was wondering if you could expand on the to trust in others more? Do you have a specific example that you're thinking of, or examples, or just, you know, have other people come in at really important times to help you out when you're, you know, in a in a, you know, event of a failure?   32:07 Well, I can't think of one person or one incident in particular, but what I will say is, I am personality type a driver. So someone who likes to get things done, who likes to be in the driver's seat who I don't need help, I don't need help, I can do it on my own, I can do it on my own. And as a result, I think that yeah, I've had failures, because I tried to do it all by myself. And it just doesn't work. You know. And so there's a great team building exercise called lost at sea. Google it, I won't go into detail as to what exactly it is. But you have to you fill out. They give you a list of things that maybe you need when you're lost at sea, and you fill them out what you think you would need from one to 15 or 16 or something like that. So you do it on your own. And then you you do it as a group? And then you find out, like, did you do better on your own? Or did you do better when you had someone helping you? And better meaning like, did you survive? lost at sea? Or were you eaten by sharks? Right? And time and time again, and the group that I did it with? Everybody did better with the group. Right? And so for me, and I learned that I took the Goldman Sachs 10,000 small business program, and it was part of that program. And the big part of that program is learning how to be part of a team and learning how to have people around you that make you better. And so I think my biggest failures came because I didn't ask for help. Because I always thought no, no, I can do this on my own, or I can handle this and quite frankly, I couldn't. And so it resulted in a failure resulted in a less than optimal outcome. It resulted in stress on me and and perhaps some mental and emotional anguish, when in fact, I could have just had a team around me ask for help. And that task probably would have been done better than if it's just me and so yeah, I always so when I said that line, I didn't have one particular person or event in mind, but rather that like sometimes you have to like suck it up, you know, and admit that you can't do things and it's okay. It's just part of life. Like I had interviewed a woman Her name's Stephanie Nikolaj and she said you know trying to do it all will keep you small and she's right. You know, you can it's hard to grow as a person as an entrepreneur as a clinician, my God if you just did everything I Your Own I mean, you'd be like, I don't know you'd stop growing from the day you graduated from college right from your PT program. So you you need the these people around you need people around you, who can lift you up and and make you a better person, a better clinician, a better entrepreneur, whatever it is. But you'll never be that evolved person if you're on your own, it's just impossible.   35:26 Yeah, I think, Karen, like the number of hats that you wear as a business owner, a podcast as a volunteer and advocate, right? You, you kind of need people like that in your ecosystem, and it for so many projects, and especially the bigger the project, it really does take a village, and you need people that specialize in certain aspects to come together as a team. You know, Tim and I have talked about this kind of checking, checking your ego at the door sometimes and just kind of leaving that, as you said, Karen, you know, kind of admit that you can't, you can't accomplish it all by yourself. So I that was a that was a really great answer. And, you know, I think you spoke to some of the points about being more introspective and having having an open mind as well.   36:09 Yeah, and being able to trust people, clearly, I have trust issues. But you know, I think finding like, like you guys said, like you found each other, you knew each other for many years, you have this really nice trust and bond. And I don't know, maybe it's like 20 years in New York has made me a cynical New Yorker or something. You know, but really finding those people that you can connect and trust that they have your back and you'll have theirs. I think it's really important.   36:37 I think, another question that I would have just to sort of elaborate on, obviously, we have a variety of individuals that are listening, right now clinicians, non clinicians, entrepreneurs, and one of the questions that we asked within the book is, what advice would you give to a smart driven college student or a young professional entering the quote unquote, real world? And I think one of the things that you mentioned, that was really valuable was that it is easy to say yes to everything, when you believe it will further your career, I would advise you to only say yes, the opportunities that align with your values and goals, as the saying goes, saying yes to one thing is saying no to something that might be a better fit. I think that's really powerful. Because I think we're in a society of more is better, or the perception that doing more is better. So knowing knowing who is listening to this and having the microphone if you would, for for a minute baseline question. Can you elaborate on that? Or if you had to give that sort of monumentous speech regarding that topic? I think that can be really valuable for a variety different people this?   37:48 Yeah. And I think that saying that saying yes to everything, or only saying yes to things that align with your values? I mean, yes, you have to really only say yes to things that align to your values. But I think that speaks to speak to that 30,000 foot view of society in general, and of social media and what we're seeing everyone else do, right, so you may scroll through your Instagram or Twitter, Facebook, Tik Tok, whatever it is, you're on. And you may say, Well, gosh, this person just, they wrote another article, or Gosh, this person speaking here, and they're doing this and they're starting an app, and they're, they've got a podcast, and how come I'm not doing all that? Should I be doing all of that, so I should be set? Why, you know, I need to be doing XY and Z and, and, you know, you've got that, that FOMO disease, you know, your fear of missing out, and then you bombard yourself with things that you think you should be doing because other people are doing them. But it's not even something you believe in, but you think you should believe in it? Because Because other people in the profession are doing it and look at how many followers they have, or, or look at all the success and I use that in quotation marks because we don't really know someone's true success out on social media, right? Because we only put the good stuff on social media, you're not going to put the shitty stuff on social media, right? And so I think this saying yes to everything. I think a lot of it is based on societal pressures, what you're seeing on social media, maybe what a colleague or someone that graduated with you like, oh my gosh, they already started their own practice. And I didn't do that yet. So I guess I have to do that. And I have to say yes to this, that the other thing and it's, I think you really have to especially now like take a step back. Know who you are, know your values know, know your what your individual mission statement is, right? I know you guys said you have a mission statement for your book, but I would challenge everyone like you have your own mission statement as whether it's a clinician or you're in academia. But really you have to know deep down what your values are, what you're willing to take and what you're not willing to take, and, and really know yourself in a very deep, meaningful way. And I'm not saying I know myself in a deep meaningful way yet, but I'm trying, right? It doesn't mean and again, it doesn't mean you have to know that. So again, that's another thing people think, Oh, I have to do this now. But you know, in researching a talk for CSM that I'm actually doing with how do you Janemba my, the part of my talk is increasing your self awareness as an entrepreneur, and how do you do that, and I came across a really great quote, he who knows others, as wise, He who knows himself as enlightened by louts Lao Tzu, la Otz, you I hope I'm pronouncing that correctly. And I saw that quote, and I thought, Oh, that's so perfect, right. Because as, as clinicians, and as physical therapists, our job is to get to know the patient in front of us or the student in front of us or whoever it is in front of you that oftentimes, I think we give away big parts of ourselves without taking it back and looking inward.   41:16 And so you kind of get this like, drain on your empathy, and your energy goes on as the day goes on. And I think that happens a lot. And in these kind of giving professions that we are in, whether you're a professor or a clinician, or even a researcher, right, you're going to give all of your energy to that. And then you see you're always looking outwardly all day. And do you take the time to come back at the end of the day and look at yourself inward? And say, Well, what, what am I doing? Like, why am I doing this? Am I doing it for the likes? Or to get more followers? Or like, what is your goal? Right? And so I think that's kind of where that saying no to things comes in, if you know, your why behind what why you're doing things. It will make it easier for you to say yes, and to say no, because it's going to align with with who you are. But that takes time, you know, so as a new as a student, or a new professional, maybe you do have that all figured out. And if you do awesome, come on the podcast, let's talk about it. How did you do it, but you know, if it takes time, and you have to kind of find your groove and, and really know, where you want your career to be headed. And some people do know that right off the bat, I didn't. But it doesn't mean that other people don't have a very clear path of where they want their career in life to go. You know. And, and there's obviously that changes here and there. But I think that's what I meant by that, quote is looking for those opportunities is to really know yourself, and what your How much are you willing to take? How much capacity do you have for XYZ? And if you don't have the capacity for it, then don't do it? Because it's going to be done like half assed, you know, and nobody wants   43:19 nothing. That's great. Yeah, great advice. Yeah, finding, finding your why and staying true to your why and finding things that that sort of line up with that to allow for you to not have that emotional, physiological draining. If you would find things that fill your cup not not dump your cup out.   43:37 Yeah, exactly. Exactly. Yeah. It's a nice way to put it.   43:42 Um, yeah. So Karen, thank you so much for, you know, kind of expanding and elaborating on some of those. You know, as Tim and I mentioned in the, in the beginning, I think when we were chatting probably before we were recording, Tim, and I want to probably get a podcast started at some point in the future. And, you know, we'd love for you to come on and be one of our guests, so we can talk more about this stuff.   44:06 Yeah, I'd be happy to. And now before we wrap things up here, where can people find you guys? Where can they get the book? Let's go. Go ahead. The floor is yours.   44:18 So we have a website. The website is movers and mentors calm on there is all of our social media information and links directly to Amazon where you can find both our Kindle version and paperback version. If you have questions, comments, please tag us send us stuff on social media. Tim and I love that we you know, we've been very fortunate we've had really engaged you know, an engaged audience up until this point and so you know, we're looking or looking for more of that and shoot us an email if you want and with with comments or feedback. We love to hear that as well.   45:00 Great. And how about where can people find you on social media? Oh, yeah. Yeah,   45:08 it's in those that thing tendons got our handles there.   45:11 Yeah. So my, you can message me on Instagram. But Tim Reynolds DPP would be my thing. That's my Twitter routes, and would be my Instagram. And we'll send you that Karen. So you can sort of tag along for the podcast. But I like Brian was saying, I think the opportunity to interact with our, with our audience is one of the most exciting things, getting somebody that reading the book from South America and is so excited to receive the book is one of the highlights of our day. And I think having the opportunity to have our our audience also send us Who do they think should be the movers and shakers in our potential upcoming volumes of this would be something that we'd really appreciate. There's so many people within the profession that we do not know of yet. And so obviously, appreciate having their insight and input in that as well.   46:08 So I'm at at Bryan, Bryan, Gaskey, and Instagram and then we're at movers and mentors, both on Instagram and Twitter.   46:16 Perfect. And all of that will be in the show notes at podcasts at healthy, wealthy, smart, calm. So before we wrap up, what is question I asked everyone, what advice would you give to your younger self? So let's say fresh out of PT school at Ithaca? What advice would you give yourself?   46:36 I would tell myself, stay curious. Because I find that when I'm curious and asking questions, that means I'm engaged. And I think engagement. If it aligns with your your purpose and your passion, then you have kind of all three things in alignment. And that, you know, lends itself to a happy, fruitful and hopefully, you know, effective career.   47:05 Excellent. Tim, go ahead.   47:08 And I would say sort of piggybacking off what we were talking about earlier, Aaron would be continue to search for the why. And it's okay not to know. And I think that's one of those things where finding your why and staying true to the values is one of those things I'll add to life journey, continue to search for that throughout the lifespan. But I think actively checking back to is this lining up with my Why would be one of the things that I would want to do, either from a journal reflecting standpoint, or just from like a quarterly check in. But then also, the acceptance of it's okay, not to know not necessarily not to know what your y is, but not to know certain things in part of your life. Um, and I think being 20 to 2324 and try to navigate your 20s. And I'm thinking that everybody in that sort of FOMO aspect is having the solutions and answers. And it is okay that you do not know yet you are enough, you will be enough, challenge yourself and have the opportunity to allow for that growth and expansion.   48:23 You guys, that is great advice. Thank you so much for coming on the podcast and sharing your book. Again. It's movers and mentors, and it's available on amazon.com. Go to their website, go to the social media. Everything again is that podcast out healthy, wealthy, smart, calm. One click, we'll take you to any thing you need for both Brian and Tim. So thank you so much, guys, for coming on.   48:49 Thanks for having us, Karen. Yeah, thank you, Karen.   48:53 Pleasure and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, Dr. Sylvia Czuppon, Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine, talks about balancing her role as an academic with her role as a clinician.   More about Sylvia Czuppon:  Dr. Sylvia Czuppon received her Bachelor of Arts in Psychology in 2000, Master of Science in Physical Therapy in 2002, and her clinical Doctorate in Physical Therapy in 2011, all from Washington University. She received her Certification as an Orthopaedic Clinical Specialist from the American Board of Physical Therapy Specialties in 2010. Her work has been published in British Journal of Sports Medicine, PM&R, Physical Therapy, and Journal of Orthopaedic & Sports Physical Therapy. Dr. Czuppon is currently an Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine in St. Louis, Missouri. She divides time between outpatient clinical practice treating musculoskeletal pain patients and teaching orthopaedic content in the professional DPT curriculum at Washington University. She has given local, state, and national presentations on lower extremity injury rehabilitation and return to sport. She volunteers her time educating coaches, parents, athletes, and the community about youth injury prevention strategies.   To learn more, follow Sylvia at: Twitter: @czuppons   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 Hey, Sylvia, welcome to the podcast. I'm so happy to have you on.   00:07 Thanks for having me, Karen.   00:08 Of course, of course. And, you know, we were talking before we went on the air about, you know, not seeing people in person and going to conferences. And the last time we saw each other was in Vancouver, at the third annual World Congress of sports, physical therapy.   00:30 Yes, right. That's right. Yeah,   00:32 I think that's correct. Yeah.   00:33 I can't believe it's been that long.   00:34 I know. I know. 2019. Right. Beginning of 2019.   00:39 I think it was. Yeah, it was COVID. Year, but it was before all that stuff. Yeah, yeah,   00:43 exactly. And, you know, shameless plug, the fourth annual World Congress on sports. PT is going to be outside of Copenhagen in August of 2022. Absolutely. So I encourage people to try and and your fingers crossed, it'll work. I keep saying 2022. It's gonna be the year. So shameless plug for that. Now, let's move into you. So today, we're going to be talking about life as a clinician and academia. And I love this topic, because I think there's a lot of clinicians out there who are wondering, well, how do I get into academia? How do I how do I do that? So why don't you give the listeners a little bit more about your background and how you did it? Sure. Yeah. So   01:38 I've been fortunate to be on faculty at Washington University in St. Louis for 15 years now. I think, approximately, it's been a while. And yeah, I sometimes I'm like pinching myself. I'm like, How is time flown that way? How 15 years? Yeah. 15 years? I graduated in 2002. So yeah, yeah, it is, oh, my gosh, I   02:05 can't believe it, I can't believe it.   02:07 So. So when I, when I joined the faculty, honestly, it was it was a nice, it was a nice mix of events. When I came out of PT school, I knew I wanted to do a little bit of teaching, but the Washington University at least, recommends that you have about a year of clinical practice under your belt before you join an academic institution. Like lab assisting. So that's how I got my start, I started lab assisting in classes that had orthopedic content. And when a position on the faculty opened up, I, I basically jumped at the opportunity got lucky enough to be hired. And away I went. So when I first started, my split, I think was 90% of my time was in clinical practice. And about 10% of my time was in, it was in teaching and it was all a lab assisting. And over the years, that is at has morphed considerably. I'm about 5050 right now. So I spent 20 hours a week in the clinic and 20 hours a week, teaching or doing teaching related things. And it's been a I don't think I'll ever go below that. But who knows what will happen. But I like that balance that I've struck right now, I can't ever see myself coming completely out of the clinic into teaching, like some of my colleagues have done, you know, you go to PT school to become a clinician, you don't go to become an educator, otherwise I go to, you know, to get my teaching degree. And I think that's probably been one of the biggest challenges is I am a PT, learning how to provide high quality education without an education degree. So there's been a bit of a learning curve associated with that as well.   03:42 And what do you feel are the advantages of being a clinician and, and working in academia? So what does your clinician hat bring to your students?   03:55 Yeah, you know, I think it's interesting. So, um, as a clinician, what is nice is I can give them I don't want to call it real world application, but it really is. So they students, we teach them in the ideal scenario, like, Okay, your your patient comes in, they have this positive test this positive test this positive test, what must be their diagnosis? Is any patient ever that cookie cutter clean No, 99% of the time, they're not right. So we teach our students in the best case scenario, the easiest ways to understand and so being a clinician, I can still give them a little bit of perspective, but like, here's where the gray areas come in. And this is why we teach you that ideal scenario so that you recognize the ideal, but here's how you can kind of think more with the clinical hat on it's a little bit similar to being like a clinical instructor. I think that's the greatest part about being a clinical instructor and shameless plug for those of you that are out there that are not clinical instructors. We need a lot more of them there. You know, our students are. It's such a rewarding experience. It really is. It's time consuming, don't get me wrong, but it is very, very rewarding, but I'm so be so being a clinician and being able to, to give the clinical the true clinical perspective on some of the things that students is learning, I think can be, can be invaluable. Like I have students all the time. They're like, Sylvia, this this sounds like a load of hooey like this doesn't even make sense, like help me understand when I would ever do this, and to be able to tell them look, you know, this is exactly why you need to know this level of detail, or this is why as a, even though, you are determined to go into sports, physical therapy, or you're determined to go into orthopedics. This is why you need to understand neuro for example, like, this is why they teach you neuro related things. I think I posted on Twitter, you know, like a couple of weeks ago, I've been to patients this year, that I think I'm, you know, not to toot my own horn or anything, but it's unfortunate, these people fell through the cracks, I think, in referring them out, both of them have gotten a diagnosis of ALS that nobody caught before this point. And it was based on what history they had given me, as well as some of the signs and symptoms that I saw with it within them. They referred to me like one had scoliosis, and horrible back pain, and another one that was a total knee replacement. And those are not diagnoses, you would expect to have ALS diagnoses associated with them. But some of the other things they were describing, it was terrifying. And just, again, like these are things to help students understand that they all do go together, you're treating a person that doesn't come in with a strict diagnosis, you're treating a whole person. And they don't always get that in the education setting when we're giving them fabricated cases.   06:27 Yeah, I couldn't agree more. And that's, that's amazing, by the way, from a clinical standpoint, that you were able to refer them to the right people to get the right diagnosis. Yeah. And that's, you know, and again, that's where physical therapists come in. And I'm sure that this is part of your teaching to your students that, you know, we can be that kind of primary care provider, you know, and even the second opinion,   06:56 sure, sure, yeah. And it is, it is one of those, you know, Missouri is not a direct access state. And so it's interesting, like teaching in a non direct access state, because we do typically get the patients they have the referral, it's generally pretty accurate, but you get some of these that fall through the cracks. And it's why we get the training that we get as physical therapists, you know, for those scenarios. But even again, in a non direct access state, these patients had been screened by other physicians, and it possibly just the complexities of their care, it just things got missed. So   07:33 amazing. Well, now, let's talk about what your responsibilities are, as a clinician, educator, so if you want to break it apart clinician educator, separately, or just let because I think it's important if people are interested in in, going in this direction, they need to know what it entails and what their responsibilities. Sure.   07:59 So I think it's a little bit different if you're so so my position is a faculty member means that I split my my time, assume a 40 hour work week, you know, nobody who actually works that when they're a faculty member on any any academic program, but, um, so I split my time for many people that come from a physician, whether lab assistant, in addition to holding a full time job, that's usually hours, in addition to whatever your hours are in a week. So when I was working as a lab assistant, before I joined faculty, I was working 40 hours a week plus lab assisting X number of hours a week, so there was a little bit of that, because very few employers will give you that time off and say, Oh, you want to live six, eight hours, we sure only work 32 hours here, like, it's very difficult to get that. And then depending on when the classes are during the day. So we have labs from like one to three, some people couldn't do that it's smack in the middle of prime, you know, treating hours. So that is definitely a consideration that people want to make. If you're working part time, it becomes a whole lot easier. Your schedules are a lot more flexible, as a faculty member, so I have 20 hours a week, again, dedicated to patient care, 20 hours for teaching. So in my patient care responsibilities, I basically have a set schedule that is has to be designed around the times that I'm supposed to be in class. So that has to probably be the worst for the person for my for my clinic boss who has to come up with the clinic schedule. He's working around everybody's class schedules and the times that we can actually physically be in the clinic. And so I treat in our clinic, we have a one on one model, so we don't overlap patients, you know, and so that's, that's really nice. We do have physical therapy assistants that we work with as well. And so I balance my caseload, I feel like any like I would anywhere else, I have autonomy to decide when I want to delegate when the patient needs, needs to come back to CV, frequency, duration, all of those kind of standard, standard types of things. Um, I am fortunate because I've been there long enough that I do get a little bit of flexibility and asking for the patient. Two types that I want to see. So I love the postoperative knees and any knee, really. So I do get a little bit more of those than maybe some others do seniority, it's great. And then my academic hat is complicated. So I'm depending on what semester in the year that we're in. And we're also going through a curriculum renewal right now, which is a whole nother whole nother topic of discussion. But in some semesters, I am a course master for for a class. And so that entails doing everything you would expect from a course to making sure the syllabus is up to date, to organizing exams, practicals, lab assistants, supplies, outside lectures, patient labs, etc. to an other the other semester I am, quote, unquote, just a course assistant, so facilitating the course master with all of those duties. So those hours are kind of wrapped up in our actual academic time. So if I have 20 hours a week, and I'm only in lab for 12 hours, my other eight hours are supposed to be spent doing all these other behind the scenes things which are, which easily kind of add up. So it is a little bit of a mix, and the curriculum renewal that I was talking about. So Wash U is going towards more of competency based education, which I think is the movement in education as a whole. And so we're we're in the beginning stages of that our first year classes going through the start of our new revised curriculum, and I am helping to craft the second year curriculum. So that's a huge task, taking what we currently have reorganizing it, restructuring it into an even better product than what we currently have. So there's a lot going on, that is certainly more than 20 hours a week. So yeah.   11:49 And can you explain competency based education versus what's currently happening? I don't know if that's like opening a huge can of worms. But let's go for   11:59 Yeah, yeah. It's also challenging my my full understanding of this, because it's all it's all this is like a complete foreign language. It's like going through, as I as I kind of alluded to earlier, I'm going through, I'm becoming like, I feel like I'm going through to get my education degree in the process of learning how to teach the this material better. So with the competencies, it's essentially like saying, Okay, you're competent in gosh, there's domains, there's, there's all sorts of terminology, but basically saying that, like, okay, that you have this one domain of patient and client care, within that you have different competencies, like, I'm able to take a, I'm making stuff up, because I don't know them off the top my head, but like, able to take a complete history for like, able to do communicate with respect and dignity for the patient and care provider, like things like that. So there's different things that this student is now having to pass and show competence in these competencies, a pass individual competencies, versus getting a grade in a class to say, you're good enough for that grade, it could be really strong in one area, but really not great and another, but their overall grade is enough to move them forward. We want to kind of raise the bar a little bit and say, You know what, that was good. But we can do better. And taking it to like each one of these competencies you need to pass in order to continue on curriculum. Got it?   13:15 Got it? Well, that makes actually makes a lot of sense.   13:19 Does now trying to make every lesson plan, every lecture that you give mapped to every competency that you have is a whole nother topic of discussion. Yeah,   13:32 good luck. Yes. Yeah. Good luck with that. And now something that you kind of alluded to before, which I want to dive into is, so your 20 hours practice care, 20 hours teaching, and I put 20 hours in quotation marks, right? So we know as clinicians, it's always more than 20 hours, right? And in teaching Gosh, it's definitely more than maybe what you signed up for. So how do you and here comes the question, how do you balance all of that with the rest of your life? Because you've got kids?   14:09 I've got two teenagers. Yes, got a dog.   14:12 I've got two dogs, actually two dogs, you've got a home, you have got a life outside of all of this. So what do you do to balance it all?   14:22 Yeah, so that was probably the most challenging thing that if I could have gone back in time and talk to my younger self, I would have been like, don't say yes to everything. That was probably the first thing that nobody really ever told me. Because I thought that if I said, No, nobody would ever asked me to do anything again, you know, you feel like this. Oh, this is a fantastic opportunity. I don't know where the time is gonna come out of but I really want to do it. And so I just started I would say at the time yes to pretty much anything that sounded interesting. And even yes to some things that I was like, I'm not sure if this is what I want to do, but I feel like if I don't say yes, I'm going to lose this. They're going to think I'm not interested in it. Think so, naively when I was when I was a younger faculty, um, that's what I did, I said yes to literally everything and almost put myself in a horrible spiral of I had so many issues in terms of that work life balance, I didn't have any it was work, work work. And then life was like a tiny fraction of that. And that was when my kids were little, I've got teenagers that are 17 and 14 now. Um, but what I discovered over the years was that those opportunities are at least and I still believe this, if those opportunities were meant to be, they're going to come around again, if people really want you, they value your expertise and your knowledge and your skill set, they will come asking around again. And you know, just saying no, one time, and just even saying like, No, you know, what, now is not the right time, I'd love to help you out. Can you come back again, like, you know, if you have another project, just ask me. I mean, hopefully I'll have time at that point, you know, there's no, there's good ways to not just firmly shut the door right to leave that still open. Um, so I've found a better balance for myself now, because I've figured out what is super important for me, and what is not, like really important. So I started saying no to different class commitments that I had previously done, because it was it was stuff that was okay. But it was not my passion in teaching. And so I started whittling down to the things that that made me honestly, the maybe the most happy to think about teaching or be involved in. And when I started doing that, I did become happier with with how that balance was shaping up, because some of that work really wasn't work anymore. You were enjoying doing it, versus looking at it and saying, Man, I got three more hours of this that I've got to prepare for, and I'm just not feeling it. You know, there's a reason nobody's ever asked me to be an anatomy lab assistant. And it's, I mean, enjoy anatomy. Don't get me wrong, but the level of detail I just, that would that was not my forte. No, that was not my forte. And it's like, I want to know the applications and things that I'm interested in. But some of the things that they have to learn for PT school, it just wasn't wasn't in my wheelhouse. You know? Yeah. So it's like, things like that, where, where I just prioritize a little bit better.   17:06 Yeah. And I was gonna follow up question I was going to ask is, How did you? Like, what methods did you use to decide what was best for you? And what methods did you use to break down? Like, no, like, this is a No, maybe not forever? But uh, no, for now, this might be a no forever. This isn't a solid? Yes. Do you know what I?   17:30 Yeah, yeah, it wasn't in certainly not easy. Um, it came again, across several, several years to try to figure that out. So part of it came down to okay, I was lab assisting in multiple classes. And did I really want to stay lab assisting in that context? If the context, if there was a, there was an immediate hesitation in my answer, then I thought, okay, that can't be the number one priority that I really want to stay in that class. So then I started adding up hours, and how many hours a week? Or really, am I spending in that class? What could I replace it with? Um, is there another opportunity right now that I want to replace it with? So it was sort of like, figuring out the timing of things would be one thing? And then some of it was just just deciding, okay, well, I know it's gonna throw me over the, the 20 hours or whatever that I have right now. Am I okay with that for a little while. And for a period I was and then now that I'm older, I'm not, you know, I've got I've got a, I've got a teenager that's going to be leaving the house in two years. And I've decided, you know, what this would, this is the time I actually I want to spend with her, you know, not that I didn't want to spend it with her as a little kid. But now I'm like, feeling that like, empty nest feeling starting to grow. And I'm like, I don't want to miss, you know, all the things that she's doing. And, and so I've just prioritize, you know, what, no, I'm gonna say no to that. Or I'm gonna say, you know, I can't do this this year, or I can only do this for part of the time, like, admissions committee, you know, figuring out who we accepted to our program. Like, well, I can't do it the whole year, but I can do it for part of the year Will that be okay, you know, and try to work out compromises with the people that are there looking for my time.   19:11 I love it. And, you know, so often women have such a hard time with this. Yes, you know, yes. Because we think if we say no, like you said, That's it, we're done, or we're gonna be labeled difficult, or, you know, someone that you know, she doesn't, she's not interested. We'll never get back to that. Right. So I think it's, as a woman, we really have to kind of get over that kind of thinking and and realize like, Hey, if you say it's a no for now, but not a no forever and the people are like, Oh, God, she was setting it up, well, then they're probably not your people. Right? And that's okay to let that go as well. Right.   19:52 I think what also complicates it a little bit is this whole Superman thing, right, like women that believe they can literally do everything. So you've got to be the best parent, you've got to be the volunteer at all the PTO, whatever school stuff, the sporting team, the in then at school, and then it works the same thing, I got to be able to handle this whole load and show nobody a crack in my facade, you know, so that they can see that I can do it, you know, and if I do you crack, then they're gonna think that I'm weaker, you know, just stereotypes that way. I think that's obviously it's really unfortunate that that still exists. Um, but, uh, I, we're not super human, like we have, you know, we have breaking points too. And we need to know what those are for ourselves for our own sanity, you know, for the sanity of our family members, our friends, all the people around us, you know, the pets, yo, all of that. So,   20:43 yeah, and your students as well, like Have, have you ever kind of displayed that vulnerability, whether it be to your employer, obviously, your family, and that's a different story, but maybe to your employer or to the university, to say like, I'm reaching a breaking point. And so how did you do that?   21:04 Yeah, definitely. to the employer. Um, yeah. So So there have been times where and unfortunate our program director, gammon Earhart is amazing. And her predecessor, the CCD singer, was was great, too. And they've always been wonderful with this sort of open door policy. So when you hit that point, or you feel like you're coming up to that point, I felt 100% comfortable going to them and saying, Hey, guys, look, I am, I'm over my head right now. And I don't know what to do. Like, I really need some help. And they kind of talk you down a little bit and say, Okay, well, how can we make this better, I have been very fortunate to be supported in that role. Same thing with even my immediate supervisors within the clinic. Same kind of idea. I had some personal struggles earlier this year, unrelated to COVID. And having and knowing that I had that support system, by being in a good place, I think this is true of any job. But being in a in a in a supportive environment, where they were like, take the time that you need to get your your self. Right. You know, it was it was very nice to know that I had that kind of support.   22:12 Yeah. And so I think the moral here is, it's okay. Absolutely, to let people know that you're not okay. And it's okay to be vulnerable. And if you're the people you're working with or for don't accept that, then I think it's a clear sign to say, Well, wait, wait a second, what am I doing here?   22:38 Right, right. Yeah. And I would love to say like that, I have been fantastic. And always being vulnerable. That is definitely a lie. Nobody, nobody, nobody, nobody is and I, I, you know, grew up in a, in a, in a household where perfection was like, required, it wasn't even, you know, it was it was an expectation, just as you know, my hair is black. And it will say, well, it's gray now, but that it'll say one color like it was the expectation you will be perfect you will be you will not show or have any flaws. So bringing that into a scenario like I am in right now and telling somebody I'm not like I'm vulnerable, I'm hurting, I need help, like even asking for help was was a huge, huge deal for me. But again, I had I had a good support structure, even within my workplace environment to allow me to do that.   23:24 Yeah. And it is, it's hard to ask for help, you know, because because you don't want people to think you can't handle it. All. Right. Right. Right. So asking for help is I know, I have a really hard time asking for help. But I'm getting better at it. Yeah. But it is, it's hard to reach out, it's hard to ask for help. Because you're afraid that someone will maybe think of you as less than or incapable or whatever, you know, all those bad things that spin around in your head, right?   23:55 Or just that if they're thinking about asking you to help out with something that you really want to do, they're not going to ask you anymore, right? Like, you know, and kind of where I'm at as a as an associate professor trying to rise to the professor level in a couple of years, trying to take a larger leadership role in our curriculum, there was definitely a fear of well, wow, if I tell them that I can't handle what I've got right now. There's no way they're going to ask me to do X, Y, or Z. So do I risk doing that? Or do I just drown? And I wasn't willing to drown? No, no, no job is worth that. My personal happiness was not worth that. And again, fortunately, everybody was very understanding the the fear that I had built up in my head was no near nowhere near what I experienced at all. Like it wasn't there. They were like, You know what, we get it. Take the time that you need, it's fine. We'll figure it out. And we'll help you figure it out. We'll give you whatever resources you need, whatever support you need. So it was wonderful. It's really wonderful.   24:47 Yeah. And it's so important to kind of voice that because like you said, you're trying to kind of climb up this academic ladder. So if you never voiced that maybe you would never, you would never reach that Professor level. because you would have burned out left. Absolutely. Yeah. Right. So why not put those fears out there and and find the things that like not to use Marie Kondo here. I don't know if you know Marie Kondo she's so Marie Kondo is like this organizational guru. And her thing is if it doesn't bring you joy, get rid of it. Yeah. And so I wrote that down when you were talking about how, you know, anatomy lab, not for me doesn't bring me joy. This does. So I'm sticking with this. And and what you find is when you do the things that bring you joy, this sort of Marie Kondo method, I mean, she doesn't like, you know, does this shirt bring you joy? And if it doesn't know, this book, this, you know, tchotchke, whatever it is, but you can you can apply those principles, I think, in this scenario, when deciding what to say yes, and what to say no to? And even if you have nothing else on your plate at the moment, you can still say   25:58 no, sure. Absolutely. Absolutely. Right.   26:02 You can still say no, and that's okay. Absolutely, well, this oh my god, I'm so glad that we talked about this is so good. So let's, let's talk about now, I would love to get from you, maybe two or three pieces of advice that you would give to a clinician who's trying to break into the world of academia. Yeah,   26:27 so, um, I think with with clinicians, the first thing is that you've, you've got to know what your, what kind of teaching you want to do, right. So like, if you're, if you're an orthopedic just being happy with, I'll take any orthopedic class, that could take you from going geometry and manual muscle testing, to examination and treatment kind of thing. So knowing sort of what level you want to be involved in helps. Because when you're then approaching the education division director of a program, that's usually who you send your resume or your CV to, when you're interested, they can have a better idea of whether there's a need honestly, in the in the curriculum, for another lab assistant for another lecture, if there are certain topics that you know very well, that you are passionate about, that he would love to lecture on. I'm even offering that up, like, hey, you know, I have a special interest in blood flow restriction training, but I'd love to be able to share that with your students. You know, this is my experience and background with that, let me know if there's there's any any availability for that, I think that's that's another part of it. I do think that it is, um, it is nice if you have a connection to the school, I mean, obviously, like, I got fortunate, I graduated from Washington at school, I'm now in faculty here. So I already had a connection to the program, it made it easier for me to get my foot in the door, because they already knew me as a student. And then as a clinician, because I was in the area. I do believe it is harder when you don't have those connections. But that's where I think networking in general is huge, right? So like you and I, we met through the Twitter verse, and then of course in Vancouver, but like making connections because people that you connect with have connections elsewhere, right. And they might know, just in talking to you. They might say, Oh, wait, I remember Sylvia said that they were looking for X, Y or Z at their at Wash U, maybe you should reach out and talk to her and see if there's anything going on. You know, I think connections are the other part that that people value, but you don't necessarily value maybe as much as you should. As a clinician, I think I take for granted that. And I don't know, if you feel the same way, we travel a lot, we get to go to a lot of conferences, we get to get a lot of all these pre COVID, we went to a lot of conferences. And that's where a lot of the networking happened, right. Clinicians do have to take continuing education in order to keep their their licenses active. But I feel like clinicians are probably taking the cheap local easy place near them to take on it because they don't probably have the benefit, always a funding behind it like I do at an academic institution. And I think that's, you know, you do what you have to do, but finding other ways to network, whether it's through your state organization, like the Missouri Physical Therapy Association here, through the national organization through some of the sections like sports section, ortho section, you know, getting involved that way to make connections, you don't have to attend conferences to do this, but you can get involved. I mean, everything's through zoom right now, you know, and so being involved that way to make connections can get you in the door in other ways. And I think that's probably an underappreciated part of the whole, how do I get my foot in the door?   29:41 Yeah, I would agree with that. And I love all the options that you just gave for clinicians and even students who are thinking, hey, one day I want to do both. Sure, right. So let's know what kind of teaching you want to do. Reach out to people in the school if you have a connection if you don't have a connection start making those connections. Absolutely right. And as a student, I think connecting through whether it's a PTA in general, or the components or your state is a great way to do that. And I would also say, stay in touch with the with your professors.   30:17 100% 100%. Yeah, I mean, and your clinical instructors as well, I mean, for me, my first job coming out of PT school, was because I went back to talk to one of my clinical instructors, and she's like, Hey, by the way, we have a job opening, would you be interested in applying? And I said, Oh, I'm not sure. And she goes, Well, I already submitted your name. And literally, that's how I landed, my first job was like, Okay, well, I guess I have to like, contact them now. So it was great. Yeah.   30:41 Yeah. I love it. I love it. Okay, so now, as we start to kind of wrap things up, is there anything that maybe we didn't hit in the conversation that you came in? Like, ooh, I definitely want to talk about this. Did we miss anything?   30:55 The one thing I will say is, is being on faculty, what did help me was naturally meshing and getting myself a mentor on the faculty. So not all academic institutions, like I know why she didn't have it at the time. They didn't really have like sort of a mentoring program for new faculty joining. And I don't know if this is true for all academic institutions. But for anybody that's interested in doing that, or joining an academic institution, as a clinician, academic, or as a researcher academic, is understanding if there is some kind of mentoring program because without the guidance of my mentor, Marcy Harris, Hayes, there is no way I'd be where I was at today, Marcy was like, kind of like my voice of reason, she was the one that was just like, Okay, you your interests are like humongous Sylvia, you need to narrow it down a little bit, you cannot keep saying yes to everything. She was the one that pushed me in certain directions, because she knew that a gentle nudge would help me get to where I wanted to be, even if I didn't want to take that leap for myself. If I was doubting myself, she would be the one that would say, you can you can do this. She was the first person that put me in front of a crowd of 300 people at CSM. So I have a lot to say, and I never would have, I genuinely never would have done that without for encouragement. And her understanding that I was ready for it. As well as it was something that was going to help me in the future. And that I'd appreciate it later on down the line versus my fear, again, of doing it on my own, would have prevented me from getting that far. So so definitely identifying a mentor. And again, this is for clinicians, even to in the clinic, like don't go into a clinic, and just expect to just learn it all just on your own or through Con Ed guy, I would hope that whatever clinic somebody joins into, has some kind of mentoring program as well. So that you can learn you can shadow you can get experience from other people. And it's different than just being able to say to your your pod mate, hey, I had this patient that was a little complicated. What do you think like truly having a mentor, I think is a big, big thing. To help enhance the level of clinician you are as well as again, if you're an academia, how to get up that level ladder and how to navigate it to I think that was the other thing Marcy gave me was some advice on how to how to get a little bit further because she was ranked ahead of me, and she had some great personal experience. Pros and cons, I guess you could say, to navigate that.   33:25 I love it. I think that's great advice. And I love how you said not only get up the ladder, but navigate it as well. Right? Because there's a lot of things that are gonna push and pull you along each rung of that ladder. Absolutely. So I think that's amazing advice. Okay, where can people find you if they need a mentor? Or they have questions?   33:47 Yeah, so Twitter's the easiest place. So I think you've got my contact information, but I am on Twitter, and an email is perfectly fine as well. So they can find my email address just to the washi website. Or really, if you just Google my name, it's pretty impossible to miss. There's not that many Soviet coupons out in the world. There's none, in fact, so it's pretty easy to find me I come up readily on a Google search.   34:10 Excellent. And we will have all the all of those links in the show notes. And now I have a question that I asked everyone at the end, but you already answered it, but I'm gonna ask it again. And that's what advice would you give to your younger self?   34:27 Yeah, totally. My younger self would be learn how to say no, and how to prioritize what you really want to do. prioritize what's going to make you happy. What's going to make you the clinician, the person that you wanted to be when you grew up, you know, because if you sacrifice what you want for what everybody else wants, you're not going to be happy. Perfect, I   34:52 love it. Thank you so much. I appreciate this conversation so much. I appreciate you for coming on. This was wonderful. So thank you so much.   35:00 Yeah, thank you so much for giving me the opportunity to be on I appreciate it   35:03 too, of course, and hopefully we will see each other in person soon. That   35:07 would be fantastic. Indeed, indeed. All right, and everyone,   35:10 thank you so much for listening, have a great couple of days and stay healthy, wealthy and smart.

In this episode, Physical Therapist at Kelly Hawkins Physical Therapy, Meagan Duncan, talks about creating safe spaces for the LGBTQ+ community. Today, Meagan talks about trauma-informed care, navigating trauma during the subjective exam, and the importance of consent. How can PTs make clinics safe spaces for the LGBTQ+ community? Hear about the discrimination faced by the LGBTQ+ community, doing community advocacy work, and get Meagan’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Gay men can undergo sexual violence at twice the rate of straight men. 50% of transgender people will experience some kind of sexual violence in their life. It’s even more if they’re a minority.” “Being trauma-informed is important in any discipline because you don’t know what somebody has been through.” “I think it’s about really small gestures.” “Starting with paperwork, gender has every option you can think of. If it’s a paper form, gender’s a blank space.” “We have small flag stickers for every flag that you can think of with all the colours that represent different parts of the LGBTQ+ community.” “Be more vigilant about asking for consent.” “Asking for consent is something that should be ongoing and all the time.” “Education is a big part of asking for consent, because in order to consent to something, people have to understand what it’s going to entail.” “Providing options Is a really important part of consent.” “It’s not patient-directed care. It’s patient-centred care.” “Don’t just go around touching people without consent.” “Find a niche. If you can find a niche that you are passionate about and that is needed, you are never going to struggle for work or for satisfaction.”   More about Meagan Duncan Meagan Duncan is a Chicagoland native who earned an associate degree as a Physical Therapist Assistant in 2013 from Kankakee Community College. She then worked for six years in an orthopaedic setting while earning a Bachelor's in Interdisciplinary Studies from Governor State University in Illinois. Later, she moved to Las Vegas to earn her Doctor of Physical Therapy degree from the University of Nevada Las Vegas in 2020. As a PTA, she developed and ran a pro bono clinic at her first post grad job in her hometown of Joliet, Illinois. She now practices in Las Vegas and specializes in pelvic health after completing a specialty clinical rotation with the VA Hospital in Las Vegas. Duncan currently works at Kelly Hawkins Physical Therapy, a prominent outpatient physical therapy company in the Las Vegas area. At Kelly Hawkins, she built a successful pelvic health program that she has overseen and grown over the past year and a half. Duncan also works for NPTE Final Frontier, a premier national physical therapy exam preparation company that works with domestic and foreign trained students to help them pass the board exam. In this role, she tutors PT and PTA exam candidates and assists them with content development. She advocates for students and professionals to balance life outside of physical therapy. Outside of her profession, Duncan enjoys hiking, biking, paddleboarding and anything she can do outdoors with her husband and dog. She is excited to welcome a new addition to her family soon, as her first child is due in a month.   Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, LGBTQ+, Inclusion, Trauma, Pain, Discrimination, Sexual Violence, Advocacy, Consent, Pelvic Health,   To learn more, follow Meagan at: Email:              mduncan@kellyhawkins.com Website:          https://www.kellyhawkins.com LinkedIn:         Meagan Duncan   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hey Megan, welcome to the podcast. I'm happy to have you on.   00:06 Hey, Karen, awesome to be here. Thank you for having me.   00:09 Yes. And like I said in the intro, today, we're going to be talking about creating physical therapy space, a safe spaces for the LGBTQ plus community. So before we talk a little bit more about that, can you let the listeners know where your passion for this community comes from?   00:27 For um, so I guess I feel like I'm just kind of a fan of the underdog in any situation. And I can't say that I have personally experienced, like so much in this community, aside from having a lot of relationships with people, and seeing what they go through and what life looks like on that side of our world, because it's a very different experience from what I've had as a heterosexual, white female. So when I was in high school, I just kind of ended up best friends with a gay man. And he kind of brought me into the circle of his friends, which ended up being just a really large, wonderful welcoming circle of people on all spectrums of the LGBTQ plus community. So I got really interested in just kind of gay rights and things like that went to marches and did all of that. Tried to advocate for the community as whatever I need to do as a 16 year old, which was not very much. And now I found myself in this position that I can do something which is awesome. And it's not even necessarily something I thought about when I went into the niche that I'm in. But I am really happy to be able to finally say that there's like some baggage behind this lifelong commitment that I kind of said that I had towards the community, but was never really doing anything about it other than like, your like Facebook posts here and there that talk about, you know, advocacy or supporting a community that's not well supported. So I'm happy to be able to do something about it now.   01:56 And let's talk about what you can do, or what we can do as physical therapists to help support this community, because I'm sure a lot of people may be listening to this and say, Well, what does the community need? That's so different from the rest of of other communities? So what is it about this community in particular, that perhaps they're more exposed to certain things? Or do they not get the care that they need? So go ahead, I'll pass the mic over to you.   02:27 Yeah, absolutely. So just discrimination in general, it's a problem in so many realms of social issues, being gender and sexual preference, of course, is one of those huge ones. So people feeling like or actually having less access to healthcare, getting denied health care, or getting given less than optimal treatment, or not really getting the best of their provider because of discrimination or because of biases that those providers have. Likewise, they might be afraid to go to facilities or go get treatments for things that are going through because they've experienced poor care before. So my niche actually, is pelvic floor physical therapy. And in this, there is so much that I can do for the community and physical therapists as well. And I was thinking about this podcast and thinking, what actually makes my job so different from the way everybody should be treating everyone. And I think there's a lot to learn, aside from just treating in pelvic floor PT. But in pelvic floor PT, I see a lot of people in the community because they are much more exposed to sexual violence and sexual trauma. And that correlates really significantly with pelvic floor dysfunctions. So we know from studies that gay men can undergo sexual violence at twice the rate of straight men, transgender people will usually experience about 50% of people will experience some kind of sexual violence in their life, which is a huge number 50%. And then it's even more if they're a minority. So that's a huge community of people where like, most of them need our help or need pelvic floor PT, or need more support than they're getting. So I think that we can play a big role in advocating for people and making spaces where they feel like are welcome. Or be that person that they can come to and after bad experience, bad experience or bad experience in healthcare, they can come to you and feel comfortable. And that's a really great feeling from my end. And I hope that other physical therapists out that out there feel better experienced that because it's awesome.   04:29 And you know, when you're talking about sexual trauma, or sexual assault within this community, I mean, the thing that sticks out to me is trauma. And so there is more and more research. And I think more and more people are now aware of trauma informed care. So can you share with us some of the principles of trauma informed care and why physical therapists should care?   04:56 Yeah, so this is kind of one of those things I was thinking about. trauma informed care and pelvic floor physical therapy is like, every class every time, we're always talking about every continuing ed course, because the nature of the work is so intimate, and very personal. And we're asking questions that make people uncomfortable, and hopefully not too much, but putting people in uncomfortable positions a lot of times, and it takes a lot for somebody to even come into my office to tackle these issues. But I think we should all be kind of treating in that same way. Because we don't really know like, of course, I know, when people come in for pelvic floor PT, they're probably uncomfortable. Like most of the time, people don't really like, want to be there. They're there because they need it. But that goes for a lot of things in physical therapy, right? Like people don't want to have back pain and come in and like, a lot of people don't want to get like touched and massage like, that's not what they intended on doing. But here they are, because they need it. So being trauma informed in any discipline is really important, because you just don't know what somebody has been through. So talking about trauma informed care, I think understanding a little bit more about trauma is probably a good place to start. So I do kind of think everybody should   06:10 reflect a little bit on what that means. So I was thinking of a good example. And I think that trauma can be kind of like pain, where we don't have a measurable, like objective measure for like, what pain is or what trauma is. So I know if a patient comes in says they're in six out of 10 pain, I have a patient with that same diagnosis that might say they're in two out of 10 pain. Or maybe I see, let's say I see somebody with a knee replacement. And I know that like a good healthy knee should have zero degrees extension, right. Or before they leave the hospital, we want them to have 90 degrees of flexion. But like I can't say to somebody, like you have a 15 degree trauma contracture. Like that doesn't make sense. There's no reference point that we know of other than what that person's experienced. So it's important to understand that trauma is different for each person. And some people could be really traumatized by an event. And some people could not really be traumatized by the same event. And that could depend on what factors they have in their cultural background in their other life experiences or the lens that they see things through. So somebody could experience their parents getting divorced, and maybe they came out of that fine. And they're like, Well, I came out of that fine. I don't know why it's so hard for everybody else. But you don't know what it was like to experience that with these other issues around you with being a minority or having financial distress or anything else like that. So understanding traumas is the most important part first. And then when we talk about trauma informed care. And this is from a Substance Abuse and Mental Health Services Administration, there's kind of the principles of trauma informed care, what does that mean? So the first part of that is to realize that trauma is a widespread issue. And it is invasive, and pervasive, and it affects people in a lot of different areas of their life. And then also realizing that there are pathways to potential recovery. After that, we should be able to recognize the five signs and symptoms of trauma. So recognize what is trauma look like? Sound like? How does that patient act? How can we pick up on if they're a traumatized individual. So seeing a patient being uncomfortable in your clinic, they might not make eye contact with you, they might not want to face you directly, you might see their body language is a little bit off, their arms are crossed. Things that we've all seen. We all have patients probably every day ranging anything from like that super bubbly, happy patient to the one that comes in and has done PT before and had bad experiences, and they're really unhappy. So recognizing what does that look like, and then responding by implementing that knowledge into practices and policies within just not just yourself, but the the facility as well. So using what you know, to actually change or adopt practices better, going to be more inviting or more informed and make more comfortable spaces for people that are traumatized. And then we have resisting retraumatization. And this, I think, is the most important part for us as clinicians. So thinking about what we can do to make an environment that does not correlate with any kind of trauma, anybody has had to make them have to revisit that. So and that could be anything again, like there's traumatic events that range from, you know, like really terrible sexual violence, and these are maybe things I hear about, but then there's also the trauma of like, having been misdiagnosed or having been told this or that by that provider or getting a hopeless diagnosis or being told that there's nothing that can be done for them. Those are things that we can actively try to resist re traumatizing that patient in. So being on honest and informative, making sure that we're not making false promise promises, but also that we're providing hope. And then thinking about what our space is like. And this is probably relative, maybe a little bit more for like LGBT, t plus LGBT plus community, where I am making sure that my space has signs that say All are welcome here. And things that make people feel invited, because they very possibly have had an experience before where they walk into a facility and like, immediately feel discriminated against or immediately feel like, this is not a place that I want to be here, this is not a place that's going to give me good care, and maybe the Carolinas without a dentist, but at any rate, they've experienced that and probably are very likely more than once. So I want to make sure that whatever I'm doing is not recreating any of that for them.   10:54 And when you are, understanding what trauma is, and really trying to understand the trauma of the person sitting in front of you, right, I would assume a lot of that comes through our subjective exam. So do you have any advice for therapists who are navigating these waters, even newer therapists perhaps are navigating or who maybe aren't, are not as well practiced in the art of the interview? Or in that process of, of that subjective exam? So do you have any like, what types of questions do you ask that kind of stuff?   11:34 Yeah, sure. Um, so I asked a lot of questions and pelvic floor PT. But I think the more important concept around that is, um, sometimes instead of asking questions, I, and that's not that we're talking at patients. But I do take a moment to do this. And if I am getting a sense from a patient, that they may have experienced trauma, that they're not going to share that with me. And that is probably more likely than not, especially on the first day, when I'm doing my initial evaluation, they don't know me, they don't trust me, they don't really want to share any of this with me, let alone even be there. So, a lot of times, I'll take the opportunity to talk about how trauma or how other experiences can relate to pain. So I might say to, let's say to my pelvic floor patients, I don't need to know or I don't need you to tell me any details or anything. But I am aware that trauma increases pelvic floor dysfunction increases pain, and it can really affect the way that people recover. So if there's anything that I can do during this treatment to make you more comfortable in any way, let me know if we need to stop anything. We're doing them, you know. So I might just take it as a piece of information, instead of asking a direct question, like making them tell me, maybe they'll do that later on in another session or two. Maybe I might need to know more at some point. But I've really never ran into that situation. A lot of patients will tell me the extent of it right there. They might do it another session or two. But it's not something that I really want to force out to people like day one, because if if I do that, like are they going to come back? Because that re traumatizing them? Have they been forced to talk about it before. I'm not a psychologist, I'm not a psychiatrist. I'm maybe not the person that they want to share all that with. So I want to make sure they have the open door to tell me about it. But I'm not like dragging it out of them.   13:22 Yeah, that's, that's wonderful advice. I really love that. And the other thing is, that I heard a couple of times during kind of these principles is creating that safe space, creating that space, where like you said, Everyone is welcome. How do you have any other tips and it could be from the person at the front desk all the way to, to the therapist and every employee in between? So are their conversations with the all the employees who work at the within that space? And and this may seem kind of like a silly question, but I think it's important, but colors on the wall artwork, things like that. I think it makes a difference. Right. So what do you what do you think?   14:10 Yeah, so I think that maybe places are a little bit hesitant to, like, fly this giant rainbow flag outside their door, right? Like, I would totally do it if I have my own clinic, but I recognize that I'm like, you know, working we're still working in a world that like from a business model. Maybe we don't want to do that because we want everyone to feel welcome, right? But it doesn't really take much. I think it's about really small gestures. So in our clinic, starting from paperwork, like they fill out paperwork online. And gender, for example, has every option that you can think of. If it is a paper form, gender is a blank space, so that blank space leaves people the option to write how they identify. And I love that option because That's even better than having to choose from like an overwhelming amount of options, or not finding the option that you're looking for. So a blank space for gender is fantastic. And then what we have in our clinic, like I said, small gestures, I think small gestures are really the thing, we have very small little flag stickers, like on the Plexiglas from our front office. Just little flag stickers for like every flag that you can think of, or it has like all the colors that represent different parts of LGBTQ plus community. So that little flag makes such a big difference, because I'll tell you, a lot of our patients are not going to notice it, like your patients that don't identify in any of those ways are not even going to notice it. But those people that do are going to see it, and they're going to love it. And we get compliments on that all the time. They think like, Oh, my God, people are so thankful for this little tiny sticker, we got like four pack on Amazon for like, probably a couple bucks, you know, just doesn't take much. And then another thing that we have in our waiting area is a sign that says All are welcome here. And that's such a simple thing, because that's not offending anybody that's making all people feel welcome. And people that are looking for that in their space, they know exactly what you're talking about when they see that fine. And everybody else is just like, oh, that's a nice thing. And they might not think very much of it. But it's certainly still a good thing to hear like, older people are welcome. Younger people are welcome. Everybody's welcome here. So it's really easy option.   16:29 And I love that these are all really easy, inexpensive, and accessible ways to show that you are working hard on creating a safe space for everyone. And like you said, a safe space for the LGBTQ plus community who oftentimes can't find those safe spaces.   16:48 Yeah, yeah. Another another small thing that I do personally, because I want my patients before I even go into their room maybe to like understand that I'm an advocate, I just have like a rainbow water bottle. And that's what I drink out of that work. And they see that sitting on my desk, and maybe some other stickers on like my laptop and stuff like that. But something that they might see like, Oh, that's my therapist, and they see like a rainbow water bottle. And it's just like a little thing that makes them feel more comfortable. I love it. I love my water bottle, so everybody's happy.   17:19 And do you go out physically into the community for advocacy work or as part of the clinic just so that people know that you're there? You know, like, how, how does that work within your community? Because I'm sure there are people who I mean, I'm in New York City, right? So I talk about like a large amount of people, right? So how do people know how to find? So how do people, especially in these marginalized communities know how to find the people who are creating spaces for them? Yeah,   17:49 so most communities, I'm in Las Vegas have support centers or community centers that support or provide or refer to services like my own or other providers that they know, create these safe spaces. So we have a support center here in Vegas, I've spoken to a little bit, I'm not necessarily within everybody's insurance providers. So that makes things a little bit harder. I'm in pelvic floor PT, I get so many patients from all over. And I've had a very long wait time, it's been tough to go out and mark it. And I'm also leaving for maternity leave actually in a couple of weeks. So I have plans for when I come back to reach out a little bit more, but I have been swarmed with what I have. But going out into these community centers, just letting them know who you are dropping off some cards, I have done that. And that is a really good way to at least get started. Get your name or your clinic out there. And maybe you're not what every person is looking for. But if they have your card handy, and they are providing social services to somebody, they might say, it sounds like you could benefit from this I know a great physical therapist that you could go to. And then, of course, we're a little bit bound by insurances. And that's definitely something I see in my future is trying to provide a little bit more preventive care to people that are uninsured or under insured. But that's probably a future problem for me at the moment. Right.   19:18 Right. And I think that's great advice. So if you're in a city, reach out to local community groups, community centers, things like that, and I think that's a great way for you to get out and in the community and really make a difference. And now there's one more thing that I want to talk about before we start wrapping things up. And that is the importance of asking patients for consent. So you touched on this a little bit, right? But especially in the pelvic floor world. Where does this explained explain to the to myself and to the listeners, how you go about asking for consent And why this   20:01 is yeah, this is definitely like if we can take home anything from if listeners could take home anything, it's to be more vigilant about asking for consent. And I can kind of trace this back to like how I've evolved in asking for consent. And I think about an IC O I think probably hope I'm probably not the only one guilty of this. But when I started, I started as a physical therapist assistant. So way back, when I graduated as a PTA, I went to work at a facility where the, the clinic was pretty manually aggressive, a lot of manual therapy, a lot of kind of aggressive manual therapy, which can be a little jarring for patients that are maybe not prepared for that. But I think about how many patients, I just went into the room and like started palpating, or like, Okay, I'm going to check this and then just like put my hands on them. And I think now about like how strange it would be to just like, grab somebody like psi SS without like telling them where you're going, like grabbing the back of their hips or having them like face a wall and then touching their back. And that can be like a very, that can like reiterate some traumatic events for people being grabbed from behind. That's, it's, I can't believe that I did this being the person that I am now. But I did, I did it every day all the time. And I never really thought about consent, I just figured the patient was there, maybe the provider before me had probably done similar the same things as a PTA, so I assumed PT had done the same. And I just think how crazy that is. Now, to me, it just is like so out there that I would have done that. Um, but asking for consent is something that should be ongoing and all the time. So from the initial evaluation, and education is a big part of asking for consent, I think too, because in order to consent to something, people have to understand what it's going to entail. And for me and pelvic floor, that's certainly relevant because I do do internal pelvic floor exams. So they need to know exactly what I'm going to be doing. And I use a model to demonstrate and to talk about what that's going to entail, and then discuss that they have the option to consent to that or to not consent to that, if they don't, there's other things that I can work on that I can help with. So I don't want them to feel pressured, that they have to consent to anything that I asked for. So consent, those should be informing the patient pretty much every step of the way. So instead of saying, I'm going to check your pelvic alignment, nobody knows what that means, like our patients don't know what that means. So I might ask, Is it okay with you if I touched the front of your hips, and then that's how I started just kind of simple and explaining in layman's terms, what I'm going to do. And a lot of times, I'm asking a patient or giving a patient options. And this is kind of part of trauma informed care is enabling or empowering the patient to make choices or have options. So instead of saying, say I want to do soft tissue work, instead of saying, I will be right back, I'm going to go grab some lotion, and then the patient knows I'm going to do soft tissue, but they didn't get an option to consent to that. I just went to go grab it. And now they feel like they're stuck there. And I'm going to come back with lotion and they're going to get a massage and they don't have a choice. So I might say, I would like to work on this. This is why. So we can do that. If you don't want to do that. We can work on mobility in this other way. So that way they have an option for what they want to do or how they want to do it. So providing options, I think is a really important part of concern. Um, I think yeah, I think that's mostly what I mean with consent.   23:42 Perfect. Yeah, I think that's great. And listen, I used to do the same thing. And I can't believe I did that either. Yeah, just like walking into a room and just like touching. Like, I wouldn't want someone to do that to me. I can't believe I did that.   23:55 I know. And I wonder is that like, a time? A time thing? Like 10 years ago? Was it just more like then we're just more informed now? Or was I just like totally oblivious? Because that's certainly   24:05 possible. I think it's just we're more informed now. I'm gonna I'm gonna go with that, you know, and yeah, and and maybe a little bit of a being oblivious? I don't know. But you're right. Like, I would just come first of all stand up and you just be like, hands on the pelvis. And it's like, what is like, how, what, what was?   24:25 And like next to I think, like, we were just yeah, like not grabbing,   24:30 grabbing onto people's heads and everything. What's that about? I would never do that. Now. You know, even if I'm just going to touch someone's arm. I was like, I'm just gonna put my hands here if that's okay. And we're gonna. Yeah, it just makes so much more sense. And I love the fact that you tied that in with the patient education component. Because I think like you said, you can't have one without the other. It's just so important.   24:55 Right? And I think that we underestimate like how much the patient wants to be educated about things. So and that's a lesson, I think I've learned pelvic floor PT, because so many people did, like they don't even know they have a pelvic floor or what it does. So education's been a huge part of my practice, like the whole first session is really education and training, and bladder and bowel training and things like that. But patients want to know, they want to know all the details, like they love it, tell them so they know what you're doing. So they know if they want that done or not.   25:24 Yeah, absolutely. At your right patients want to know, and it doesn't matter the age, they want to know, what's going on with their bodies and and what they can do to be a part of it. So it's also a great way to empower your patient to understand and take control over their, over their bodies. You know, and and give, give the patient some autonomy and some confidence.   25:49 Yeah. And to give that the patient the opportunity to, like collaborate with you, instead of be told what's happening. So to have the opportunity for them to feel involved and to have a voice in their decision making and understand even why they're making a decision, like so that they might know. Yes, I do want this internal pelvic floor exam done. Because I want to know more about the tone of my pelvic floor so that I can know why I have pain or why I have difficulty emptying my bladder. I want them to be able to make that connection in their head and be able to consent to it. Knowing why.   26:21 Yeah. And it's all part of patient centered care. I mean, that's what we're all supposed to be doing. Right? Yeah, absolutely. It's not patient directed care. It's patient centered care.   26:33 Right. And just as relevant as it is for me and pelvic floor. I think it's the same anywhere else across the board.   26:39 Yeah, across the board. Absolutely. Well, I, you know, I want to thank you. I think this was a great conversation. I feel like I've definitely learned a little bit more about trauma informed care. So I thank you for that. Now, where can people find you? If let's say they have questions, they, you know, they want to know how they can implement some of the things you're doing in your clinic in their own clinics.   27:06 Yeah, sure. So I typically use my work email for anything like that. So that is M Duncan at Kelly hawkins.com. And I like I said, I'm not much of a social media person I wish I could say I was that's probably not the best way to contact me.   27:24 I know you're not missing anything. Don't worry about it.   27:27 Yeah, but I'm always happy to check emails and respond that way. For people trying to figure out where to start. I did want to mention CSM has a lot of great topics on this, I've certainly gotten a lot of information, or directed myself onto what things I'd like to learn more about by going to CSM and going to these discussions. There is some information on trauma informed care at CSM this year, as well as introductions to pelvic floor PT, for those that are interested. And there are always platforms and other lectures on what we can do for the LGBT Q plus community. Excellent.   28:04 Thank you so so much. And before we wrap up, I'll ask you the question I asked everyone. And that's knowing where you are now in your life and in your career, what advice would you give to your younger self?   28:14 That's fine to not just go around touching people.   28:18 Yeah. That advice to each other.   28:21 I think I'm fortunate that never really panned out to be anything too negative, but I would love to go back and not do that. But what I do tell people and recommend as far as career is to find a niche. So my niche is pelvic floor PT. Within that my niche is being passionate and treating the LGBTQ plus community treating patients that are transgender, that is a great niche to be in, not everybody is doing it, it is so needed. If you can find a niche that you're passionate about, and that is needed, you are never going to struggle for work or for satisfaction. Um, it really is kind of been if you build it, they will come situation. And people told that to me when I began pelvic floor pt. And that's what I did, I built a pelvic floor program, the company that I work for now. And like I said, I am very busy, very satisfied with the way my career has gone in. So find a niche and it's not something that every new student is going to know right away. But get out there and explore like go shadow and go find places that are outside your comfort zone. Like I wasn't I didn't think I was going to go into pelvic floor PT. I don't think a lot of us that end up in it do. It's maybe not something I would have thought to shadow I would have been like, that does not sound good. I don't want to do that. But again, outside your comfort zone, go shadow and find therapists that are doing things that you don't think you would ever do, and see if you can find somewhere that you're going to land and be successful.   29:50 I love it. That is great advice. Thank you so much, Megan. I really appreciate your time and your knowledge sharing with myself and the Audience So thank you so much yeah thank you and everyone thanks so much for tuning in and listening have a great couple of days and stay healthy Wealthy and Smart

In this episode, Associate Professor at the University of the Sciences and Director of BTE Laboratory, David Logerstedt, talks about monitoring and responding to load injuries on the knee. Today, David talks about the most common loading injuries on the knee, difference between external and internal loads, and how to improve tissue capacity. What is mechanical loading? Hear about David’s most recent research paper on mechanical loading and the knee, how therapists can monitor and respond to loads, how clinicians can apply the information in the paper, and get David’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “A lot of the stresses that cause the injury also are some of the same stresses that you can use to rehabilitate the injury.” “Most of us have enough tissue capacity to walk, but we might not have the tissue capacity to run a 10k.” “You really are trained to look at how the joint is reacting to the loads that you’re placing on it. Measuring irritability is probably the best way to describe it.” “Even just asking how they feel can give a lot of information.” “If people understand the ‘why’, then maybe they’re more likely to do it and follow through.” “Don’t say no. Always say yes to opportunities. Especially in that early career, if an opportunity comes along, take it.”   More about David Logerstedt David Logerstedt, PT, MPT, PhD is tenured Associate Professor at University of the Sciences and Director of BTE laboratory. He graduated with a Bachelor of Science degree in health and human performance from the University of Montana and a Master of Arts degree in exercise physiology from the University of North Carolina. He earned a master’s degree in physical therapy from East Carolina University and a doctorate in the interdisciplinary program of biomechanics and movement science from the University of Delaware. Dr. Logerstedt has been a practicing rehabilitation specialist for over 25 years and is board certified in sports physical therapy. He has presented his research on knee disorders at national and international conferences and has published in high-impact sports medicine journals on ACL injuries. He has co-authored several clinical practice guidelines on knee disorders. His goal to improve the implementation of clinical research into practical and accessible for all clinicians.   Suggested Keywords Healthy, Wealthy, Smart, Knee Injuries, Loading Injuries, Tissue Capacity, Stress, Research, Rehabilitation, Recovery, Physiotherapy   Resources: Effects of and Response to Mechanical Loading on the Knee   To learn more, follow David at: Website:          David Logerstedt's Bibliography Twitter:            @DaveLogPT LinkedIn:         David Logerstedt   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'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. 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. If you're already using Net Health private practice EMR, be sure to ask about his new integration, head over to net health.com forward slash li tz why to sign up for your complimentary marketing audit. And it's great, I use it and it works. So I highly recommend it. Now onto today's episode. So I'm really really happy to have Dr. David lager stead on the episode today. And we are talking about monitoring and responding to load injuries on the knee. So Dr. Lager stat is a tenured associate professor at the University of sciences and director of the BT EE Laboratory. He graduated with a Bachelor of Science degree in Health and Human Performance from the University of Montana and a Master of Arts degree in exercise physiology. from the University of North Carolina. He earned a master's degree in physical therapy from East Carolina University and a doctorate in the interdisciplinary program of biomechanics and Movement Science from the University of Delaware. He has been a practicing rehabilitation specialist for over 25 years he is board certified in Sports Physical Therapy. He has presented his research on knee disorders at national international conferences and has published in high impact sports medicine journals on ACL injuries. He co authored several clinical practice guidelines on knee disorders. His goal is to improve the implementation of clinical research into practical and accessible, make it practical and accessible for all clinicians. So yeah, so today we're talking about a new paper, that he co authored the effects, the effects of em response to mechanical loading of the knee to great paper, you can go to podcast at healthy, wealthy, smart calm, to find a link to the paper. And a big thanks to Dr. Lager stead for breaking it down for us and everyone enjoyed today's episode. Hey, David, welcome to the podcast. I'm happy to have you on.   03:04 Thank you for having me. Yeah, and I'm excited. Today we're going to talk about a new paper that your co author on that came out on to be very precise, October 20, of 2021. And it's the effects of response to mechanical loading on the knee. So of course, my first question, I'm sure this is the first question everyone asked you is, why write this paper? What is the why behind it? You know, as a, as a clinician, as well, as somebody who is now in academia, I've always kind of had this question myself, you know, what kind of loads are on the knee? And I've always had this, you know, concern about dosing and trying to figure out like, how can we can best dose exercise around the knee. And as I, as I really started to think about this more, really started to find that there hasn't been any review, or any kind of clinical commentary kind of brings at least the concept of mechanical loading, kind of in one place. And the knee is always a good model, because it does seem to have a lot of a lot of research around it. And it's an area I'm familiar with, because of my work in ACLs. And so I, we, you know, we just started, started thinking about, okay, how can we best talk about what kind of loads are being placed on the knee and, and some of it kind of kind of came out of some conversations I had with another colleague of mine, where we've really started to talk about the use of inertial measurement units and how those can start to give at least some general indications of what loads are occurring through the lower extremity. And so we decided to just kind of put a team together   05:00 who had expertise in in loading? And then expertise in specific structures related to the knee? And so that's kind of how it kind of came together. And when we're talking about loading of the knee, so in this, in this paper, you're talking about mechanical loading. So let's, let's go with some more definitions here. So what is mechanical loading? And why is it important in respect to the knee will stick to the knee? Yeah. So, you know, in the paper, we really describe mechanical loading, this is the physical forces that act on are free to make demand on the body, either at the system's level, or even on structures at a specific organ or tissue level. And so if you think about mechanical loading can kind of subdivided into different variables, such as, like the magnitude of the load, how long the load is being applied, how frequent it might be applied, or even maybe the direction or the nature of that load. So   06:05 so when we think about loading, though, all those components kind of interact, can interact with one another, and then create different loading patterns that can impact again, the knee is the organ itself, or specific structures within the knee. And when we're talking about loading, I think most people think of loads as external, so something that we are placing on that knee, but there are external loads in their internal loads. Can you kind of differentiate those for the listeners? And how, and why are both important? Yeah. So when we think about, you know, external loads, to kind of think about is like, really kind of that work that's being performed? So like, how far did I run today? Or how high did I jump? So when we think about like, like that, it's almost, it's almost kind of like that outcome in, in an essence when we think about external load. But when we think about internal load, you can either think about what what's the physiological process that's going on inside the body related, potentially related to the external load, or maybe even the psychological. And again, maybe even that biomechanical response to that external load? So So usually, when we think about internal load, it's like, you know, how what, you know, what is your heart rate doing related to how far you run? Or what is the extra? Or what's the amount of stress that's being placed on the knee after you land from a jump? Yeah, so so both are important, especially when it comes to knee injuries, and loading injuries. So let's talk about what are some of the common loading injuries on the knee?   07:54 Yeah, so if you think about some of those different types of loads, you can kind of really subdividing at least at Deneen to kind of three major categories. In essence, whether it's a compressive load, a shear load, or a, you know, a tensile load that occurs, there's some other loads that can occur, such as some hydrostatic pressure loads, but the primary ones are really related to that. And so then if you break that down into specific structures, such as a ligament, you know, like the ACL, which is one of the more common injuries that occurred the knee, you know, that's usually related to some kind of tensile load that's occurring on that ligament, it can occur either from, you know, cyclical loading, where you can continue to put stress on that ligament until that ligament ultimately fails. But usually, it's one usually large load that occurs that relates in, you know, a traumatic tear. That's probably an example of kind of one of the more common ones. But, you know, we, you know, we commonly see other tissues damaged, you know, the meniscus is another common injury. And that's usually again, that's really related more to some compressive with shear load. And then, you know, cartilage also kind of was kind of relies on   09:24 a shear load to be damaged. So   09:28 all those different loads occur on the knee, it just sometimes it depends on again, all those other variables that we've talked about, you know, the nature of it, or the compressive versus the shear versus the tensile load, but then again, how quickly does it occur? Maybe at what angle your knee is bent that can impact all those types of things? Yeah, I would think angles, speed, fatigue levels, hydration levels, you know,   10:00 All of that I can only imagine goes into   10:04 a type of injury from one of these loads, right? And you say, you know, and if think about, you know, again, you have that that external load, but then, you know, think about some of the other internal loads, you know, the muscles around the joint contracting, to maybe unload the knee at a specific time, because, you know, we have, you know, you've seen many athletes like they cut and pivot 1000s of times in a career, why is it that one certain time, they do the exact same maneuver, they've done 1000 times before, their ligament tears or their meniscus tears. So there's, there's so many other underlying factors that lead to it.   10:50 And so part of this papers, at least trying to describe some of those things, so people have an understanding of what is the underlying loads that can can lead to an injury. But then,   11:03 what can we do after that? How can we use those exact same parameters of same loading parameters to rehabilitate them? Because the same, a lot of the same stresses that caused the injury   11:17 also are some of the same stresses that you can use to rehabilitate the injury? Right, and I would think have to use to rehabilitate the injury. Right? Right. Yeah. So so they, so they can adapt to that stress and be ready to handle the stress the next time it occurs. Exactly, exactly. And now what one of the figures we were talking before we went on the air within this paper is figure four. So for everyone who is listening to this, we'll leave a link to the paper in the show notes. But when you go through, you'll see there's one figure it's figure four, it's a conceptual model of loading of the knee. And it's like a monster of a figure like it is. It's large, it looks very intimidating, and very complicated. So can you break it down for us? Yeah. So this is how, you know, we started to think about taking a lot of these other models that have been out there that have described, you know, maybe the physical stress model, or many people have commented on the,   12:24 on the die model, related to the envelope of function, and also the dynamic recursive model related to injury, probably the, is the best one, best way to describe it. But you got to take into all those factors that can influence or just leave somebody susceptible to an injury,   12:52 as well as including this their underlying physiology. And again, that could just be related to those non modifiable factors such as your age and your sex.   13:04 And then again, your underlying physiology, you know, your genetic makeup, maybe even just some kind of a little bit of your underlying fitness level. And then what are some things that can predispose that tissue to injury? And again, it could be, you know, do you have a strong tissue or a weaker tissue? Does the, you know, do you have certain types of muscle fibers, you know, that can influence again, things like fatigue? And then what are the external factors that lead into it? So, some of these models have already been kind of described in the ACL related literature, you know, you know, shoot a surface interactions, whether that occurs out there is, is it turf versus grass. So, those types of things can all potentially influence an injury and then,   14:00 you know, moving into the next part, then you just think about the mechanical load. So, again, all those factors related to magnitude and duration and frequency. And then we wanted to kind of   14:15 try to articulate that, again, if you took, you know, just conceptually took it is looking at each of the different major structures in the knee that could be impacted, and then talked about how those tissues respond to some kind of stress and strain. So, you know, if you put it,   14:39 again that load under a specific type of compressive versus shear strain, how does it respond to that, and William Thompson did a really nice review in ptJ a couple of years ago, looking at some of the Meccano therapy and McKinna biology that occurs at specific   15:00 tissues that Karim Khan had kind of initially proposed back, God 10 years ago or so. And then if you take all those things account, and the stresses and strains, so then you start to look at how that impacts how the tissue adapts to those stresses and strains. And, you know, using kind of the fitness model, or the fitness fatigue model is, is if you apply the right stresses at the right time. And you do that consistently over time, it basically builds up into tissues adapt to it, and it gets stronger, and fitter. But if you don't do it, or you do it at a delayed time, it may stay at a homeostatic level, or than if you do it too infrequently, or the loads are too much, too frequent, then you can actually fatigue the tissues. And, of course, if you get too much fatigue, and you get the right amount of load placed on it, then that can result in injury. And then you kind of go through, go through again, and go through it again. And again, that's part of the rehab process is taking all those things into account. And so   16:22 that's how we tried to really try to conceptualize it and think about, you know, and so we really kind of focused more on the the tissue levels and the response to injury, and how you can use that kind of this conceptual model of kind of stress and strain along those other factors, too. I think it's important to note that we're not only talking about ligaments or meniscus when we're talking about the tissues around the knee, ligaments, meniscus tendon, articular, cartilage bone. It's not just, we're not just talking about ACL 10. Lien, you know what I mean? There's, it's really the all the structures that that make up that knee joint, correct? Correct. Yeah. And, I mean, I think that's even a really important point to like, when we're rehabbing. You know, somebody and you know, you take somebody with a meniscus tear, not only are you impacting the meniscus that you're working on, you're also impacting a lot of the other structures around it. And so you can influence the all that rehab, or that rehab impacts all those tissues, depending on how you're providing the specific load. Right? Absolutely. And, you know, one of the the words that's in that figure is tissue capacity. And so during the rehab process, certainly after injury, but even, let's say, without injury, right, I think one of the goals is to always improve tissue capacity. So can you kind of talk about what exactly that means? What that What does tissue capacity mean and as physical therapists, what where do we stand in the improvement of that capacity. And on that note, we'll take a quick break to hear from our sponsor and be right back.   18:18 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 this new integration, head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit.   18:55 Kind of an in a general layman's term, you think about just tissue capacities, it's all related to the under I think sometimes so the underlying tasks that's being performed, right, you can have a certain level of tissue capacity that allows you to, to walk or run the tissue can meet the demands of that load placed on placed on the body by that specific task. Right. But if the task is too high, or the load is too high, relative to what the tissue can handle the tissue than this doesn't have the capacity to handle that load. And again, it may be able to handle that load one or two times. But over a repeated bout, it may fail much quicker. And so I think sometimes tissue capacity is it's also related to the task that's being performed. may know most of us have enough tissue capacity to to walk community levels and things like that. But you know, we might   20:00 not have the tissue capacity to run a 10k, even though that we may have the underlying structure that we could build up to that, I think those are the things you have to take into account. And from a rehab perspective, you know, you always have to think about kind of that starting point of what people can handle, and then how, how you can adjust the rehab process to improve that capacity over time. So that that leads into what are some ways we can monitor load and respond to that load? So we're the therapist, we're taking care of our patients, how can we monitor and and, and change that load as necessary? Yeah, so.   20:46 So from, you know, a clinician standpoint, you know, most of us probably in the clinic, you know, we don't have high tech equipment, like global GPS units are inertial measurement units to measure   21:01 acceleration, and   21:04 you know, how far people have gone   21:08 a certain amount of distances they walked or jogged or done the whole thing, like you have seen with some of the devices like catapult or, or   21:18 I measure use IMU units. But I think from a clinician standpoint, we still have a lot of great tools that I think are that we still under utilize, to some degree. So,   21:32 you know, I, I always like to tell my students   21:38 that you really are kind of training to look at how the joint is reacting to the, to the loads that you're placing on it? And are you making the tissues more irritable or less, irritable, measuring irritability is probably the best way to describe it. And the knee, you know, you can see things like, you know, increase swelling, you know,   22:02 which is a common, probably a common measurement to see for, for increased irritability, but it can also be, you know, is the joint getting sore versus the muscle getting sore, right? And so trying to be very clear,   22:20 with   22:21 the person you're working with is, you know, does it hurt inside the knee, or is it just hurt in the muscles around the knee, because we'd expect to see some muscle soreness if you're working those, right, but you don't want the, you know, the irritation to be in the knee. Um, so those are probably the two major major, major ones that I like to use. But   22:44 you can also look is, you know, do Did they have a sudden decrease in a range of motion, you know, which can be an impact, or, you know, a factor of them, having some irritability, has their strength gone down, which is probably a little bit harder to assess more consistently, but those are probably the major things I would consider looking at is, if you're starting to see some of those means the tissues become a little bit more irritated. But if you don't see those, then you know, the next, you know, maybe the next session, the next couple sessions, you can start to slowly increase the load a little bit, and see how they respond. And I think that's always the challenging part. Like, I like to challenge my students with is, but that's one of the great things about being a therapist, who is we get to see them again, and see how they respond to our treatments. And we can regress or progress them as needed. Yeah, and and I think that's a really great thing that you said at the end, we can regress or progress as needed. So if someone if you give someone some exercise or some loading, and they come back with like an angry knee, it doesn't mean stop everything and go back to passive range of motion. It means okay, let's just take it down a notch. But continue. Yeah. Yeah. And I think when the the last one I meant should have mentioned is, you know, just even just ask them how they feel. Mm hmm. You know, how are you how do you how does it feel today can give a lot of information then you can use things like you know, a session RPE schedule, you know, scale, say, Okay, your knees a little bit angry. Let's back, let's back your exercise session down two or three today, instead of working at a seven. Mm hmm. So you can still do something still keep the knee moving. Still keep it kind of moving forward, but you've kind of backed off in gave it a little bit time to, to calm down. Yeah. So it's, it's sort of this combination of what you're seeing objectively and then asking them how novel What a novel idea you're doing or you're having   25:00 Having trouble? Yeah. The other day you were doing stairs really well. And now you're having trouble doing stairs, you know, some of these functional day to day things? Yeah, exactly. I mean, I think, like you said, those are just really simple tools, I think we, we get so focused on, you know, what we like to call the objective data, instead of just asking people, how do you feel today? Yeah.   25:23 Absolutely. And now, how can we and I say myself, we, I'm a clinician, how can how can we clinicians use the information in this paper to start applying load to a REIT to the rehabilitation of an injured knee? Or post surgical knee? Or what however you want to categorize? Yeah, yeah. I think, you know, as we were talking before, there's a, there's a, there's a lot of data in this in this paper, too, that the clinicians can think canoes, and so I don't want them to get overwhelmed with all the numbers in the data, but it's really there to be is it as a resource for clinicians to say, Okay, I have somebody who has a pretty irritable knee, and these are the activities that we're doing before, you know, and we can get a sense of, okay, that that activity, you know, was, you know, three times body weight, I need to find an activity, that's maybe two times body weight.   26:27 So we can regress them a little bit. And this is an activity that kind of fits that or this was an activity that put this amount of stress on the ligament, we know that that stress is still within us safe range to, to push it a little bit to the next level.   26:47 Because, you know, I think some of the, some of the fear is, is that if we're putting stress on the ligament that we're going to injure it, or even on any tissue, right. But we, as we know that, especially after the initial inflammatory phase, you need to start putting a little bit of stress on the healing tissues, because that's how tissue gets stronger is that it has to respond to stress. But if you're putting, you know, if you're putting state and I'll put an air quotes, safe, safe stresses, or stresses that are below kind of the the below the failure rate, and you're monitoring the knee for those inappropriate responses, then you can use that information to slowly progress them through a rehab safely and adequately the healing structure to then kind of into the next level of repair. The one of the tables, we talked about this, again, before we came on, was table seven, within this paper, where you have some activities where it's like this is like you said, maybe it's 1.4 times body weight, or this is 20 times body weight, or this is eight times body weight. And I think that's a really nice guide for clinicians. But I think it's also a really great educational tool for the patient. So you can show this too, because most patients get it. I think a lot of times we underestimate our patient's ability to understand. Yeah, a lot of these concepts, you know, and and so I think if we can say the patient, hey, listen, this is X amount, your body weight, this activity is less than that. And let's say you're a month out of like some sort of surgical procedure, hey, let's go with the one that's less times body weight than this. And because people say, well, what's the big deal? It seems like it would be fine. But I love that because I think it's a great way for clinicians to use the paper also is a great educational opportunity. Yeah, no, no, I think that's a that's a really valid point, is it? I think if we can educate the patients on, you know, these are the activities that you should be doing right now. And as you strong, get stronger and get better than you can move into these activities the next time, right. And so they're always asking, patients are always asking, like, what can I do now? What can I do now? And so, you know, this table can give them some insight of, okay, this is where you're at. These are the things that you start doing now. And these are the things that probably wait a little bit longer. I think that the patient will really understand the why behind, you're giving them the exercises that you're giving them. Yep. And that's really important, because if people understand the why then maybe they're more likely to do it. Yeah. And follow through. Yep. So I mean, I think it's great. I think this paper is great. Is there anything   30:00 thing that we didn't touch upon in the paper, the process of doing this paper that you would like to share before we start to wrap things up, no, you know, I'd really like to, you know, first of all, thank my co authors who were willing to, to sit down and write this, it was, it was no small feat, you know, pulling together, clinicians from around the world to, to do this. And so, you know, definitely want to, you know, think tour MacLeod, Brian higher shyt, J uebert. Tim Gavitt and Brian eckenrode, for, for agreeing to do this, you know, this, like I said, this was a paper that had been mulling around in my head, probably since I was in PT school, you know, for a long time. And, you know, this just felt like the opportune time to pull it together. And fortunately, you know, in the last several years, last 20 years or so, we have, we have the data now to support a lot of the things that we do is physical therapist that I think intuitively, we've always done. But I think now that we can, we can demonstrate a lot of what we do, and some of the value that we bring to, to rehabilitation into to patients and to clients. Yeah, and and I mean, I like this paper from a rehab standpoint, but I think it's also really great from a strength and conditioning standpoint, right? Because as physical therapists, we don't have to just be the people there when the athlete or the person is injured, we can also be the person that helps to keep them strong and kind of improve, especially in I know, in a lot of professional settings. You've got strength and conditioning coaches, and athletic trainers and pts. But for the average physical therapist, like if you're in a small town, maybe you're it. Yeah, you're doing it all. Yeah. So I think this paper is really helpful not only to progress, people after injury, but to kind of look and say, Hey, this is the load that we can place on you that will hopefully help to decrease your chances of getting injured. Yeah. So I appreciate that in this paper. And now, where can people find you? And like I said, we will have a link to the paper in the show notes. But where can people find you if they have questions of you specifically? Yeah, I'm fairly active on Twitter. And so that's primary, my primary social media outlet so you can find me It's Dave, log PT. You know, if there's any questions or anything like that, that's probably the best, best way to reach me is either directly through DMS, or, or through my Twitter feed. Perfect. And now before we wrap things up, I have one more question. And it's a question I asked everyone is knowing where you are, in your life and in your career? What advice would you give to yourself? Let's say as a new grad, right out of PT school, I would probably, I would say, at that early stage advice, actually was given to me before is don't always don't say no. Always say yes to opportunities, especially in that, that early career, that if an opportunity comes along, take it, it may or may not be the perfect opportunity. It may not be what you dreamed of, but it more likely or not, will   33:32 be the a value to you. And many times it's a huge stepping stone. I would say you know, an opportunity comes along, say yes. Especially when you're young. Yes, yes. Young and full of energy. I think that's great advice. So listen, David, thank you so much for coming on the podcast breaking down this paper. It's a great paper. So congratulations on that. So thank you for coming on. You. Thank You, anytime 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 Dr. David lager stat for coming on the program and talking all about load parameters around the knee joint and of course, a big thank you to Net Health. So again, their digital digital marketing solutions can help your clinic win by allowing you to get found get chosen and get those five star reviews on Google. They have a new offer if you sign up and complete a marketing on it to learn how digital marketing solutions can up your clinic when they'll buy lunch for your office. Head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit today.   34:41 Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media

In this episode, Founder of the Concussion Corner Academy®, Jessica Schwartz, talks about the nature of concussion treatment. Today, Jessica talks about her concussion experience and how it has shaped her work leading up to the Concussion Corner Academy®, the reality of long-term concussion symptoms, and some of the top concussion myths. Is it ever too late to have your concussion symptoms treated? Hear about treatment barriers, some of the surprising statistics in concussion and TBI research, and the importance of education, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “When you’re young, make sure you have extended disability on yourself.” “There’s no evidence-based, agreed upon international definition of concussion or traumatic brain injury.” “There’s been zero phase 3 trials on TBI and concussion in over 30 years.” “Up to 30% of folks now have persistent symptoms of concussion.” “If we can teach one, we can serve many.” “2012 was the first year the International Consensus Statement discussed the cervical spine in terms of examination treatment.” “2015 was the first academic year in which there was a formal training for both TBI and concussion if you were a neurology resident.” “2017 was the first year on the International Consensus Statement that we identified concussion as a rehabilitative injury.” “The injury of concussion is an injury of loss. It’s a loss of your ‘I am.’” “Join Twitter.”   More about Jessica Schwartz Jessica Schwartz PT, DPT, CSCS is an award-winning Physical Therapist, a national spokeswoman for the American Physical Therapy Association, host of the Concussion Corner Podcast, founder of the Concussion Corner Academy®, and a post-concussion syndrome survivor, advocate, and concussion educator. After spending a full year in rehabilitation, experiencing the profound dichotomy of being both doctor and patient, Dr. Schwartz identified the gaps in concussion treatment and management in the global healthcare community. Her role has been to identify the cognitive blind spots and facilitate collective competence for healthcare providers, physicians to athletic trainers, focusing on comprehensive targeted physical examinations, rehabilitative teams, and concussion care management.   Suggested Keywords Healthy, Wealthy, Smart, Concussion, Research, Statistics, Physiotherapy, Neurology, Concussion Corner, Myths, Healthcare, Rehabilitation, Injury, Loss,   To learn more, follow Jessica at: Website to Join the Program:          The Concussion Corner Academy® Facebook:       Concussion Corner Twitter:            @ConcussionCornr Instagram:       @ConcussionCorner LinkedIn:         Jessica Schwartz YouTube:        Concussion Corner LinkTree:         https://linktr.ee/ConcussionCorner   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full transcript here:  00:02 Hey Jess, welcome to the podcast. Finally, I'm so excited to have you on.   00:07 Thank you so much for having me. I can't believe we haven't done this yet.   00:10 I know it's like absolutely insane. And just so people know Jessica and I both live in New York City, and we actually see each other quite a bit. And this is the first time I've had you on the podcast. But I'm really excited to have you on today because we're going to be talking about concussion, persistent post concussion symptoms, and you'll talk a little bit more about that name changed in the bulk of the interview. But before we get into some common myths around concussions, I would love for you to let the listeners know a little bit more about why you decided to really specialize in this niche within medicine and rehabilitation.   00:52 Awesome. Well, I thank you for the softball pitch care know. For those that don't know, Karen used to play softball on Central Park quite a bit. But yeah, no, I mean, I thank you so much for having me on. First. I've been listening to healthy, wealthy smart forever. So just thank you again. And yeah, I mean, gosh, I think back to I was a we were one of the first six residents actually, we were the first six residents in orthopedics at NYU in 2010. When I finished up grad school and all that jazz, and we I had it, I got the dream job, right, got the dream job. I had to leave New York City for it, which sounds crazy. But I think a lot of folks can connect to that, you know, working in, you know, the old adage, Jay, we used to call mills and things like that are seeing three or four patients plus per hour. And I was like, this isn't why I went into physical therapy. This is not why I wanted to do this. And I found this great clinic out in New Jersey during residency and we saw one to two patients per hour. And we had a support staff and they were emotionally intelligent. They were physical therapy owned, and they let us grow. And keep that like use of excitement, right? I don't know about you. But I'm hopped up on caffeine and too little sleep as we launched a new business this week. But it was great. And it really it fed my soul. It was wonderful colleagues and we ended up I ended up starting kind of in the opposite end of things, a civilian prosthetics program. So I was, you know, volunteering and showing up at the Manhattan VA, which has a wonderful prosthetics program. And then we also launched a breast cancer program and be launched a concussion program. So that was kind of like my first entree into concussion about 1011 years ago. And we were the only really only office in New Jersey with that type of rehabilitative practice at approaching concussion. And so very Dunning Kruger ask, it was like, you know, you don't know what you don't know until you kind of are made self aware of it. I got hit by a car. So I was hit by a car in October 3 of 2013. And right before then, oh, actually, it wasn't even right before then care. I'm sorry about that. But it was two years before it was our last day of residency. We saw that there was a conference at NYU at the hospital. And it was on concussion and it was NY us first concussion conference. Now this was 2011. So my best friend from Italy Beatrice, you know, hi, BIA. She's in Lucca. She's a great physio, if you're out in Italy listening in. And we were like, What do you want to go and it was our first weekend off for residency. I mean, we were exhausted, excited. And we're like, let's do it. So we went to this conference, I fell in love with it. And so we were at least aware of what this program was at NYU. Fast forward two years from there. And I was actually hit by a car here in Manhattan. So that's really where it's my life's work and passion is to become because I actually live with persistent symptoms. So and went through quite a recovery. So that's kind of how it all kind of came together and coalesced.   03:49 And when you suffered a concussion, and this was in 2013 It did you did you have kind of the self awareness at that time to think, well, you know, I've been learning a lot about concussions, I think I can I can kind of help myself here and did that then really propel you to learn more and to dive in even more.   04:19 So when I was hit, I was hit by an unlicensed driver from behind and my airbags did not go off. I was in my Toyota Prius you may have even been in that car at some point. And I didn't think anything of it but I knew I when I said the story is I I got out of the car. I want to get out of the car. I got hit so hard. I was stoplight at a red light wasn't looking behind me because we were stopped. And it was the traditional traffic right care like we're just inching forward. And I was probably on that block of 12 Street between Fifth and Sixth Avenue for about two or three light cycles because of traffic. So I just got Walt from behind and so the New Yorker in May right so born and raised New Yorker You know, unbuckle the seatbelt and get out of the car to give this guy the business. And I was just so dizzy care. And I held onto the top of the hood of my roof of the car and I was like, I gotta sit down. Fast forward. I thought this was quote unquote, just going to be a concussion. And at that time, we really thought concussions were pretty much resolved spontaneously within seven to 10 days based off of the literature from 2002. From Brolio and McCrea at all from the NCAA study. But we don't have that's false. And we have so much updated information we can chat about if you'd like. So I thought it was just going to be seven to 10 days. I went back to work for for a week, I thought, you know, I would just be sore, kind of like a whiplash or like a Dom's. And now, I just kept D compensating and then from there went from 10 to 14 hours of rehab a week for 14 months.   05:53 And how did you continue to work and continue to function during all this time?   05:58 I did not. So I went off of I went out of work, mind you, I was just promoted to junior partner the week I got hit. So I remember I was like directing a prosthetics program, we had all these other programs, I just became junior partner, which would have been a profit share with a company and I loved my job, I would still send people back to that clinic, those four clinics in New Jersey in northern New Jersey. So essentially what happened was, it was a conversation that went on for months. So I was on short term disability for six months. And I say this to all physical therapists, physicians, OTs, PTs, whoever's listening to this, when you're young, make sure you have extended disability on yourself, because our bodies are so fragile at the end of the day. And again, I was an athlete, I was a cyclist I was training for, for a century bike ride and life changes in the blink of an eye. And I was underinsured with a $50,000 policy policies for car insurance to go up to 300,000 to 3 million for certain policies. And it would have been an extra $12 a month. But again, you're a new grad, you're just out of residency, just out of DPT school and you know, you're thinking about student loans and just being out of school. And so you don't really plan that far. So that's a whole other conversation we can have on another podcast. So I was on short term disability and we all know the legality of and we all have our own cognitive biases about this, right? So when people are involved in litigation, we know that their care tends to go a little bit longer. So I just I knew that. And I didn't want to, I almost didn't want to set myself up for failure, right? I just wanted to be a good soldier, show up for therapies, neuro psychology, vision therapy, talk therapy, vestibular therapy, regular musculoskeletal for the whiplash therapy, and just be a good soldier and show up as a good patient, just thinking that I would get better and slightly different than a musculoskeletal injury. The difference is with with brain injury is that there are cognitive and behavioral impairments that differentiate those from brain injury from musculoskeletal injury and rehab. On top of that, add the environmental aspect, and that's a whole other aspect of the injury. So there's no finite, you know, six to eight weeks of tissue healing or things like that, when it comes to brain brain injury, that it's a very gray area. So I was on disability for six months. And then that ended and that was petrifying. So two weeks before disability ended. I wanted to burn it down. That's when I got angry. And I think that's when I really went through that whole grief cycle, because I just kept showing up to therapy thinking I was going to get better, and then I did not. So went back after 14 months, I had the no fault car insurance, which helped pay some bills back home with mom at the time. And that was it. So after that, when I went back to work, I actually realized I had a vision handicap with overhead LED lights. So I still live with persistent symptoms, I still live with neuro fatigue, I still have an ocular motor disorder. But we learn how to manage and cope and I have wonderful support systems and definitely a grit that a lot of people don't have as well, I think I'm missing a chromosome there somewhere.   09:03 And you know, and this was eight years ago. So I think it's important for the people listening to understand that, you know, when one is diagnosed with a concussion, it's not just like you said over and seven to 10 days or maybe a week or a month or even a year, and that there are symptoms that can persist. And I think that's a great segue into what are some common myths around concussions. So I asked Jessica give me like maybe your top three common myths that surround concussion and and post concussion. So Jessica, I'll throw it over to you. So what would be Myth number one that is circulating out in whether it be layman's world or even the medical world? Well,   09:53 um, I was actually I'm going to give you something that we didn't speak about. I'll kind of combine one of them with three but One of them, actually two that we didn't speak, I'll surprise you as well. But there's actually no evidence based definition agreed upon international definition of concussion or traumatic brain injury. And that kind of will segue a little bit into two is that there's actually been zero phase three clinical trials on TBI concussion in over 30 years. So, when we're talking about research, I mean, talk about ground floor ground level, I mean, we were in the basement 10 years ago, just not having any idea what we were looking at. So I even I try to tell people like when we're talking about this, and looking at the literature, the medical legal literature got ahold of this injury 50 plus years ago, and it's been in the trapped with closed head injury and medical legal literature, but really not until 22,004. And on how we've been talking about this as a rehabilitative injury, and things like that. So, you know, historically, when we don't know what to do with someone in medicine, we tend to send them down to trajectories, we send them, we allude that they're milling, lingering, or looking for a secondary gain, or we tell them that's all in their head, and it can't be real, right. So that's what's kind of happening with these patients that we know up to 30% of folks now have persistent symptoms of concussion, they don't just spontaneously. You know, in even two weeks, we even actually, because we didn't really know what we're looking for right care. So we didn't have an agreed upon definition. So how can you know what you're looking at unless you know where you're looking for. So that's so very important to connect to is that a lot of the mismanagement of concussion was so much more prevalent in a well cared for patient.   11:38 That's wild. And so before 2004, basically, if you had persistent persistent symptoms after a concussion, it was like, good luck.   11:50 Yeah, you were allude that you're faking it. You were looking at this, that it was a psychological injury. Yeah. You know, and   11:57 that, that in and of itself is crazy making?   12:00 Yes, well, that's the whole thing and the chicken or the egg, right. And you can't deny psychological conversations when it comes to the brains like Hello. However, you know, it's really the chicken or the egg, you have these somatic things that we have the ability today in 2021, in a well versed clinician to validate the patient's symptom profile by doing targeted, comprehensive physical examinations as it pertains to concussion. So we actually the best thing that we can do for a patient like this, and I'm sure you've had all the chronic pain people on your podcast and things like that is validate their symptom profile. Listen, you're not crazy for seeing words coming up off the page. No, you didn't drop some LSD or an illegal drug. You have an ocelot Xia? You know, but the difference between the moderate and severe TBI is is that these folks have the self awareness to know that something's not right. But they do not have this objective language to express the what or how they feel with brain injury. So what do we do all day care? And how are you feeling? What's your pain level? What's your number? How are you feeling? But brain injury folks do not have the subjective language to express that so when they go to the mall and our fear avoidant of that, or they go to the supermarket, and they are don't like to be in a complex visual sensory environment, because the colors may blur, and things like that, that is then looked at as a fear avoidant behavior. And that's been sent to psychological counseling for decades. So how can we as physios how do we get these guys first and gals? So not to Detroit too much to keep you on track. But those are two. The first two is that there have been there are over 43 working definitions of concussion. One of them is evidence based. And to that there are zero phase three clinical trials in over 30 years for TBI concussion.   13:42 Wow. Wow. Wow, those are two biggies. Two big myth.   13:46 I would think so then I'll combine the last three because there are points. So the third one is, you know, I really, I'm really into education care. And I really believe that if we can teach one we can serve many, okay. And that's just what I've been privy to. And this implicit trust in the last, like eight to 10 years with this injury, that I've been invited to all different conferences for emergency physician athletic training, PT, you name it, because we all need to be on the same page here. So folks really need to I always say that we need to have a really humble approach when we come here because and I say this with kindness and I but I say this very firmly, is that with concussion, we have infinite ports of access to entry to care. Okay, you can go to the urgent care the emergency department, you could even be at your OB GYN appointment and you might have had this fall and a ski injury over the weekend and in your annual or biannual you know OBGYN appointment if you're a woman. And you know, you could have had you could have pre presented with signs and symptoms of concussion and not be aware of it. So I see that because there's infinite ports of entry on like cancer or unlike cardiology, you have a heart attack, where do you go care and you go to the emergency room, right? And then you see the cardiologist just right or you get diagnosed with cancer or your PCP or you start losing weight, you have some red flag showing up. Where do you go? Yeah, young colleges right to the oncologist, right. So that's a, that's a defined pathway. With concussion, we don't have a defined pathway. And that's not necessarily a bad thing. However, it's where a lot of this mismanagement has come up over the last few years and decades, and that's where patients start to suffer. And that's where it healthcare, we've actually imparted something that's called AI atherogenic suffering, which is where actually the health care system where your doctor is actually part of a way of suffering on a patient. So I bring that to our attention with these three quick facts. I'll say them quickly, and then we can chat about them. Go for one 2012. That's the number you got to know. 2012 was the first year the international consensus statement discuss the cervical spine in terms of examination treatment, that whole stick that connects the central nervous system to the peripheral nervous system and runs the autonomics up and down, right 2012. We just started talking about the cervical spine internationally. 2015 was the first academic year in which there was a formal training for both TBI and concussion, if you are a neurology resident. So if you were a brain physician in 2015, that was their first formal didactic year, they had training in concussion and brain injury. So just let that settle in there for a second because that's, that's just wow. Again, this is a place to build up, not tear down, but that was taking place within the behavioral neurology section of the American Academy of Neurology. And the third one was that 2017 was the first year on the international consensus statement that we actually identified the concussion as a rehabilitative injury. 2017. So, like, what? So if you think about it, as physical therapists, congratulations, happy 100 years care. We just had our centennial, right. So we were rehabilitation aids, literally in the trenches 100 years ago, like now, and we were treating what we were treating brain injury, what are we doing in the ICUs for treating brain injury? We're getting them up, we're getting them moving. But what do we prescribe when we don't know what to do with someone and healthcare rest? So we now know that that's not the ideal thing to do beyond the first 72 hours, but yeah, 2012, cervical spine 2015, brain physician started learning how concussion and 2017 was we call the rehabilitative so that's my third.   17:29 Wow, that's, it just seems like that cannot be possible.   17:33 Yeah. And, and it seems like that and because we know better, right? But imagine then being, you know, having deficits and having trouble thinking and processing, and what's our most valuable resource attention, but then you can't process. So it's, it's so horrible when you're a patient, and you have to negotiate the system, if you go through a no fault, or you go through a worker's comp, and there's all these other aspects, you know, of that of, of the injury. So I always say, sorry, I always say is that concussion as an injury of loss of it, I am, so you have to really pay attention to where your patients are in space and time when you when you meet them.   18:10 And it all seems to me like just not having a clear pathway. To me sounds like barriers to treatment, and barriers to to improvement. And then my question, I just one quick question. It. If you if the patient doesn't quite know who to go to, they don't know that they're they they have a concussion? Because some people like oh, you know, he got his bell rang, or whatever. And they don't even go to see a doctor, but they're having some symptoms, but they're not quite sure who to go to? Is it that the longer your symptoms go on, the less likely you are to recover?   18:50 So there's a yes or no answer to that. I don't want to say it depends. But the good news is, is that we have folks five and 10 years out who may have not sought treatment, like the patient you just alluded to, or sought treatment, then kind of plateaued, the brain wasn't ready yet. And that's totally fine. And we've got to tell patients that No, hey, maybe we need to take three to six months and just kind of let this settle. Let's reset, regroup, and then let's come back. Because the brain just may not be ready. You cannot force this. This is not about grit and resilience, in terms of being sore and pushing through. You've got to listen to the brain and I talked about it with like the knee effusion principle. You know, we have residency in orthopedic so I talk ortho all the time, although I love the neuro, neuro world these days as well. But you know, it's like the knee effusion principle, right? You do too much the knee fuses, we want to give it if it doesn't come down in two days, we did too much. Let's cut in half, right. So it's the same thing with concussion except the difference that is super frustrating to both patients and clinicians that aren't in the know is that you can have delayed symptom onset. So you can do something within the therapy office or they can do something like for example, have a vestibular migraine, where they feel good while they're walking outside and they feel okay walking But as soon as they stop their body like isn't really caught up to them yet. And then they get this distributor migraine within 20 to 60 minutes, and then they feel like garbage. But then they don't know what even to associate with. And that right there, Karen will make you feel crazy. So so it's very important to have somebody in the know, but you said something right before that question about barriers? And you're absolutely right, there are barriers, but I'll do you one better is that we're not only have barriers to accessing quality care for concussion, we also have i atherogenic, suffering, where they come and I, as a provider may not know enough about concussion to look at this from 360. So we have providers that don't know, they may be maybe in 2021, we'll be able to pull up the international consensus statement. But that's only for sport, and it's very limited. So it doesn't go through the nuance of the suffering and the delayed symptom onset and things like that. It's very white paper esque, right? So we actually then cause harm by quote unquote, just treating the neck, not looking at the vestibular system, not looking at sleep, not looking at the ocular motor system, not looking at is the the migrant or aspect of it, not, you know, all these other things and aspects that make concussion concussion. So from a symptom profile standpoint, so if you feel typically I should say,   21:15 yeah, and, and, you know, like you said earlier, you're all about education, and getting people to therapists, and whether you're a physical therapist, occupational therapist, you've been a personal trainer, physician, really understanding the ins and outs of concussion. And so I'm going to, I'm going to plug your educational entity that is that is launching, and it's concussion, corner Academy. And so now, I really like that you're coming at this from the patient and the provider standpoint. So talk a little bit more about concussion, quarter Academy, and what separates it from other educational programs. Because, you know, as you know, there's a lot out there in the world, right? So how, what, what is it about this that makes it different, and that you're really proud of as you should be?   22:08 Oh, I appreciate that care. And, golly, I mean, talk about like, your life's work, right? And I really, I just get goosebumps thinking about this. And I'm like, wow, this is this is really just a dream. And I'll be very honest with you, this is a we're in a pandemic, still, some people may not want to admit that. But we're, we're still in a pandemic. And we all kind of went through something, right, especially in New York City, we really went through it initially in the acute phase of this pandemic. And I did, I lost a good chunk of my practice, and I had to really sit with myself and I said, Gosh, just what do you want to keep doing? You know, what do you want to do with your life, I had patients no less than four years, some 11 years as patients. And I was like, I'm not doing this again, I just don't have the energy. And that was from just a like a, like, almost like a burnout aspect. I just couldn't imagine re building up my my practice again, I have no problem seeing patients, if they call me but I have no desire to market. Now. I was like, Well, my ideal life based off of my symptoms and persistent symptoms. You know, I really work every other day. So yeah, I can push through every five days and do a regular work week if needed, but I don't feel well. And then I'm not pleasant. And it's just, you know, I just know my limits. So with the neuro fatigue and the stuff that I live with, I said, Well, what's, uh, what's, what's something I can do? Well, if I could work remotely, that was kind of it. And I said, How can I help the concussion community? So we decided, and my partner is a graphic designer and in to animation and editing and all of this stuff. We said, how can we make this beautiful, and deliver it? Because the user experience was so important to us? And then how can we deliver it internationally to where it's accessible? So we're, we formed the academy, and essentially, the goal has always been to promote healing, decrease suffering, increase support, and deliver it with kindness to this mismanage patient population, but we need to have access. So I have a tremendous faculty. We're launching we are we have a nonprofit partnership. We have the faculty are actually the people on the international consensus statement. They're the people treating the the boots on the ground, their clinician scientists, and they get it, they get concussions, and they're vested in concussion. So it's going to be a 12 week online course for our first cohort. It's fixed. It's from January 16 to April 10. It's going to be two hours per week one posted for you and one live on Sunday mornings at 10am. Eastern which will allow for our European friends and our California friends as well on the West Coast. And it's going to be 24 hours of CEU activity for for for physical therapists and athletic trainers. As long as we have 10, ot speech pathologists, neuropsychologist, psychologists, social workers, we can see you them as well, but it's the first round so it's kind of a lot of investment here. So I'm just going with PT and 80 to start unless we have 10 of the others. And we're going to have a nonprofit partnership, but the the beauty of it all is already I'm actually going to have, we're going to be doing research on our students. So we're actually going to be looking to change outcomes based off of evidence based practice and education. So we're going to be able to study our students, and then link up with our nonprofits as well to support them because it's really an underfunded sector of research where cancer gets billions and trillions and and TBI and concussion tend to get hundreds of millions. So we're really going to try and support the folks you know, who are boots on the ground.   25:29 I love it. It sounds so great. Where can people find more information about it?   25:34 Sure. It's going to be it? Well, it's already at it's at concussion corner.org.org. If you follow the podcast, we tried to give things away just like you do with healthy, wealthy smart. So we've had the concussion corner podcast is 2018. I hosted the Super Bowl concussion are moderated, I should say, the Super Bowl concussion conference in Minneapolis and we launched it then it's been around in over 50 countries, it's been so well received, we have a lovely community. So we're going into education, and how can we have a supportive community with open office hours and open office hours and things like that, that will what will provide our students with, with eventually a rehabilitation video database, where that's going to be searchable for folks as well. So they can search, you know, cervical spine examination intervention, what's the referral process look like. So it'll be a robust program, but we're going to be beta in January with I just want to point out, we're going to have a referral program. And, again, I'm a person and have one right, so we're not going to have an early bird special, like we're used to at conferences. But the whole thing is to spread this word of mouth. So instead of taking $100 off, we're going to give a $75 referral. If you have seven to eight people that you refer your whole tuition is paid for Plus, you get your 24 hours of CEU. So we want to really just want this to be word of mouth, from from like grassroots, let's build it by conversation and internal marketing and get people in who are invested in wanting to learn about this injury.   27:02 Awesome, awesome. And of course, we'll have a link to it in the show notes here at podcast at healthy, wealthy, smart calm for anyone who wants to learn more about the program and about the modules and how it's set up. Or you want to just get some more information. Or if you're ready, you heard this and you're like, I see people with concussion all the time. I'm not 100% comfortable, I need to learn more, or this is something I want to learn more about, I think now you have the perfect opportunity to learn. So we'll have a link there in the podcast notes for anyone who is ready to pull the trigger and join Jessica in January. So now just is there anything that you really want the listeners to take away from this conversation around concussion and rehab of concussion?   27:58 Yeah, so I'm sure there's, there's so many things off the top of my head, really connecting to that concussion is a rehabilitative injury. And if we can connect to that the injury of concussion is an injury of loss. It's a loss of your I Am your I am funny, I am husband, I am wife, I am Doctor, I am surgeon, you're I am. So if we are sensitive to that and connect to that concussion is an event, it's not an event there, it has to be a mechanism of injury, don't get me wrong, but it's not an event, it's an actual process. And we have this neuro metabolic cascade. And then we tend to have this loss of function in our in our environment. So that is really what I want folks to connect to. Because we have to make sure we're meeting our patients where they are and their moments of recovery. So that's really the big thing to connect to is that folks tend to really connect to the event of the concussion, you know, the post traumatic amnesia, the domestic event, the loss of consciousness, and less than 10% of those folks, but they're not connecting to where those folks are in their trajectory. And how many folks have they seen before you on average, people see six to 10 providers before they walk into my door. Okay, connect to that. Do they trust healthcare providers before they've talked to you? Did they have physical therapy in a hospital gym that wasn't really, neurologically sensitive to their needs, their smell, their sound, their lights, things like that. So connect to your patients in a different way. I can guarantee you if you're a new grad, this is going to this is going to get you excited. And if you're a little more seasoned, like Karen and myself and you're feeling a little burnt out, this is a great way to look at your patients 360 We're looking at autonomics we're looking at neurology, vestibular ocular motor. The physiological aspect of its sleep, nutrition, neuro endocrine, let's talk about sexual dysfunction and concussion. That's a whole other podcast. But it really is something that you can hear my passion about, or these patients are being mismanaged much more probably than they're being well cared for. And we can change that and there's no reason that we can't change that for next day. Not Knowledge Translation in the clinic, so I challenge your listeners to that care.   30:03 Amazing, amazing. And now I have one more question to ask. And it's one that I asked everyone. And that's knowing where you are now, in your life and in your career, what advice would you give to your younger self, let's say, you know, straight out of straight out of Ithaca physical therapy school.   30:21 Um, let's see here, straight. So I've honestly joined Twitter, I have had so many, I've had so many positive experiences, the 99 that I've had positive and the one negative, you know, and you really have to conduct yourself in a certain way, of course, but I joined Twitter, I've had so many amazing opportunities. I was invited to the Super Bowl, I was asked to be one of our spokeswoman like you for American Physical Therapy Association, I've been invited to speak at conferences and, and just network with people who I would never have access or touch points to. And I really think it was the most powerful thing I've done for my education, besides, you know, maybe a residency postdoc, really. So I really do and we wouldn't have met the same way either. So I think it's been great.   31:05 All right. Well, that I think that might be the first time I've gotten that. What advice would you give to your younger self is to join, join Twitter and join social media. So thank you for that. And like you said, you have to make it your own, and you have to approach it, approach it in the right way. So I think that's great advice. And now, again, people can go to concussion corner.org. To find out more. And of course, like I said, we'll have all the links at podcast at healthy, wealthy, smart, calm. So a big thank you, Jessica, for coming on the program busting some concussion myths. So thank you so much.   31:42 Oh, thank you so much for having me and to all your listeners. Thanks so much for your time and attention. I really appreciate it.   31:47 Of course and everyone thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart

In this episode, Creator of Practiceology, Paul Wright, talks about 7 critical mistakes that healthcare professionals can make that can hurt their bottom line and their business in general. Today, Paul talks about Perfectionist Syndrome, the implications of discretion, and doing your own PnL. What is the true role of your business? Hear about the danger of falling in love with your product, packaging an outcome-driven solution, and maintaining effective recruitment and internal systems, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “If it’s [your business] robbing you of your life, it’s not what it’s there for.” “Find the hungry market and satisfy that need.” “If you’re not embarrassed by the first launch of your product, you’ve launched too late.” “To the blind man, the one-eyed man is king.” “If you haven’t upset someone by midday every day, you haven’t said anything really important.” “One of the single biggest and most effective things you can do in your practice is to tighten up the reporter findings conversation.” “Remove discretion at the operating level of your business.” “Once you are the only person that has that program, you can’t be compared on price.” “You can’t put a monetary value on family time.” “There’s no such thing as quality time with your family. Family time is quantity time.”   More about Paul Wright Paul Wright is a Physiotherapist and former owner of multiple allied health clinics in Australia (which he rarely visited). He is the author of the Amazon Best Seller "How to Run a One Minute Practice", founder of the Practiceology™ health business freedom program, and has helped thousands of allied health business owners across 57 countries, earn more, work less, and enjoy their lives.   Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, PT, Business, Practiceology, Supply, Demand, Mistakes, Solutions, Healthcare, Entrepreneurship,   Resources: Get a hard copy of "How to Run a One Minute Practice" ($4.95AUD. Use promo codes below) Promo Codes: Non-Australian Buyers: KARENOS (Get $15 OFF) Australian Buyers: KARENAUST (Get $5 OFF) Register for the next Practiceology demonstration   To learn more, follow Paul at: Website:          PhysioProfessor.com                         HealthBusinessProfits.com                         OneMinutePractice.com LinkedIn:         Paul Wright   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:  00:02 Hey Paul, welcome to the podcast. I'm happy to have you on.   00:06 Absolute pleasure to be here. What a boss.   00:09 I know it's so we're doing a little podcast swap here which I love. I love being able to swap podcasts with other hosts where you come on mine I come on yours and we get to know each other better. So it's been really great leading up to these podcasts. And today, you are going to talk about seven critical mistakes that healthcare practitioners can make. That can really hurt their bottom line and their business in general. But before we get to that, can you tell us your story of your career and how you ended up where you are so the listeners get a better idea of who you are?   00:52 Well, I'm I was born for a young Karen. Now I'm from from a small country town. I'm obviously Australian by my accent. I live in beautiful Newcastle but an hour north of Sydney. But I grew up in a small town about seven hours northwest of Sydney in the middle of the outback. They talk about Australia next so I'm in the outback. And what does what does a young kid do as in a small country town he Bhikkhu like sport, he becomes a physical education teacher. Because that was all I thought you could do as as a kid. I love sport. So I went to Newcastle University studied my physio, field education qualification, and then didn't even know what a physio was, but I met a physiotherapist at a party. And I liked anatomy I liked physiology. I thought, gee, that sounds cool. I don't think I could be a teacher for a long time I had an entrepreneurial streak I think so I didn't know I could work for someone else for my rest of my life. So I'll get into this physio course went to Sydney Uni did my physiotherapy degree and within two years after graduating I had started my first practice I then ended up with six of them in Sydney, one in Newcastle and five in Sydney. And I think my claim to fame Karen is I as I went through this journey I didn't go to them I was fortunate that I stumbled across the E myth by Michael Gerber very early in my business career and and I'm trading at my window counter in my practice and and looking out on the road that goes past in Sydney and there's a bus keeps going past one on the side of the bus why most small businesses fail and what to do with that is on the side of the bus and I'm getting there watching the sun come up in the morning watching the sun go down like most most help business owners and this bus kept going past and I'm getting better now I wasn't good there but I'm better now that the universe was telling me something followed up with this with this he ended up getting it to a Michael Gerber seminar read the book EMF and then I created then systematize the practice and as I said eventually had six didn't go to any of them and I then sold them which is a lesson for all of you guys the major role of a business is eventually to sell it and then started teaching other health business owners how I did it how I was able to run the remotely and how how you can still be a great health professional and have a successful business and still have a great quality of life which I think most of us miss out   03:19 yeah that's a great point talking about quality of life and I think that we'll probably get into that throughout this interview so without yeah without further ado, why don't you share with us these seven critical mistakes that can reduce your profits increase your stress and really not allow you to live your life outside of your business. So let's start with number one.   03:47 Well the first one having said I've done all of these by the way so you have earned the right to   03:52 I can't I kind of I kind of assumed that so I've done   03:57 I've done all of them but the smart people learn from other people's mistakes so hopefully you'll listen to what's happening now. That Mistake number one that I identified early is failing to understand carrying the true role of your business and if you think about what what does what does your business do for you and if it's robbing you of your life it's not what it's there for the role of your business is to serve you it's your certain needs to give you more life yet when you ask most health business owners why they started this I I wanted to be my own boss or I wanted to make my own decisions or the guy was working for before was an idiot. Whatever they like to say but is this really happening now and as Gerber talked about when I first read it you're now doing the hands on work of the practitioner plus you're also doing the business stuff the marketing the recruitment in any wonder we get overwhelmed so early. And and that's why Gerber talks about it's true. I was probably better off opening a plumbing business because I couldn't do it. plumbing work I was better off opening a business that I couldn't physically do then I could list run the business and that's the whole idea of this. My brother who's a plumber would be staggered because I'm hopeless with power tools and I he's banned me from using any sort of manual labor things but the idea of the businesses to serve you and one thing I suggest you look at guys, his his work out what I call your freedom score. And your freedom score is simply how many hours per week on average? Do you spend treating patients at your practice? How many hours per week do you spend physically treating patients and if you're telling me that we've done this in seminars, 50 6070 I've heard I've had one guy doing it five hours. And they're still trying to run the business, you just, you just can't do that. So and we talk about this thing between practice ology, right is law, which is, which is as your number of team members increases, your freedom score must decrease, you can't keep adding team members to your roster, because they time suck, they have to take energy out of you, and still see all the patients, there's going to be this balance. And that was how I was able to run it. But when that being said, you have the choice of how you run your business. Now my model was to replace myself, get therapists in do the work for me. So I had freedom of time and freedom of money. But some of our clients have a Mr. X. Mr. X is the guy that runs healthcare practice, but he runs it on his own terms or her own terms. Doesn't work, school holidays, start at nine finishes at two sets his own hours or her own hours charges, what they feel it. And guys I'm thinking about that don't even have sometimes receptionist though, sometimes if the surfs up, they don't turn up at the practice, they just gave surfing. But the patients know that's the deal. If you want to see this person, that's the model. But even in that case, Karen, the business is still serving that person. It's, it's it, you're the master, but not the other way around. And I don't know if you've ever made that. But that's understand what you want your business to do for you. And make sure it does it. Otherwise it'll suck the life out.   07:17 Yeah, and I think that's why when you look at your business, whether you're just starting, you've been in it for a couple of years, you've been in it for 20 years, if you've never written down what your goals are for your life, not what your business goals are, but you know, do you want to spend, do you want to be able to watch a movie a week workout five days a week, spend dinner with friends, pick up your kids from school, drop them off, you have to write those goals down while you're looking at your business. Because that's that's how you're going to have that freedom. And that's how you're going to have your own life outside of the business.   07:58 And the natural recourse for all health business owners is typically to see more patients, regardless of what happens in their business. Regardless, they need more money, they see more patients, team member leaves, I'll see more patients. So that that's that's the recourse their natural recourse is to go back to what they know. We teach our clients sometimes that's the worst thing you can do. You need to do something exactly the opposite. And one point also to this is that this is probably one of my worst moments. You've got understand to the concept of current bank and future neck when you think about your business. Now I had a current bank business meeting. I had one of my practices earlier was inside a fitness center. So I had a physiotherapy practice inside a fitness center in Sydney. And it was a good business. It was a cash cow. But what I didn't realize at the time was it was fragile. So it was it was making me lots of money at the time. How I knew was fragile. I got a phone call from one of my clients would have been a Thursday night. He said, Paul, I've got some news for you. The owner of the gym I've heard hasn't paid rent for three months. Okay, this is a $300,000 business like I'm running here. Oh, that's the good so I ring the owner who when you will do the gym tonight what's the deal? He said it'll be sold out Don't worry about Okay, I arrived at the practice the next day cancer that patient list hard to track proceeded to put everything inside the trap that day. So by Friday, five o'clock, I've been everything inside the event saying what are you doing wrong? What are you doing? Well, I said I'm taking everything out because I don't know what's happening here. This is all a bit unstable because I went to give the owner the gym my rent check for the month and he didn't accept it. He said hold on to that for a second. Roger, you might need it. So okay, the writing's on the wall, drove off in the truck and everyone's saying Ronnie, another another gym Chad's gonna buy this place, you'll be back open on Monday. So when I open on Monday, I'll bring the truck back and I'll check everything back in then I'll be fine. But I'll tell you, I never again set foot inside that building. It shut that day and I never will went back in there. So overnight, a business goes from 300 grand to zero. What's the lesson I had a current bank business, there was nothing. I was relying on someone else's rent someone else's tenancy. If you're leasing a space in a Medical Center in a fitness center in something else, you think you've got a business you can you can sell. There's no real future banking, that you are at the mercy of your landlords. So it's not a bad way to test the market to see if there's available market. But that's not your long term gig. Because there's a problem with it, and I've suffered badly. Anyway, yeah, yeah, start number one.   10:41 Big mistake, mistake number one. So let's talk about Mistake number two.   10:46 All right, we do this all the time. We fall in love with our product. We fall in love with the idea of being a therapist, like I fell in love with the idea of being a physio, but I didn't know was there a market for that? Was there a need for more physios, I just wanted to be one. But we do that all the time, we fall in love with our product of therapy, what we got to fall in love with is, is the market, you got to fall in love with the market once, so you might have a passion for trading on that elbow pain in one arm. Gullfoss, that might be your passion. But if there's not enough one arm golfers out there, you're not going to do any good. So the market doesn't care what you want, find what the market wants. So your job is to listen to all of your patients, listen to the doctors, listen to the community, what's missing, your job is to fill the need. And if you do that, you'll be successful in business. My favorite one, hope you guys watch Shark Tank, you guys have shark tech in the States. That's shark tank with a my favorite one is the guy that turned up with the pad for guys shirts. So now that so you put up your stick to pads on the ROM so your shirt didn't get all sweaty, there was his product. The Sharks wouldn't touch it. I said I'm not really interested. And they said how many have you sold? I've been doing it for seven years now. I've sold about 500 so in seven years, and out the back the entity in there. So what are you gonna do now he said, Our, I believe in this, I'm gonna keep going I fell in love with this product, the market had already said they didn't want to move on. So find the hungry market and satisfy that need. If you do that, you will be okay. And you see that lock county if people so they open a practice in, in a country town or regionally because they might have identified there's a market for that service. So they've done well. But the part that missing is the available labor supply. Because there's two drivers of every business available market available labor, you haven't got enough labor, you're going to be staffing that thing yourself for the rest of natural life. And that happens all the time. So be very aware, don't, don't fall in love with a product, fall in love with the market, what's the desperate need in your community? solve that and you'll be halfway there. And that's that's kind of what I did in my second my next career because I I knew help business owners struggle with business and finance and marketing and other things. And it happened to marry up with something I liked and was good at. So that was a fortunate thing. But you've got to find the hungry crowd first.   13:18 Yeah, do your research. If you don't do your research first. You're in big trouble.   13:22 I had a guy come to me once and he said, Paul, I want to open seven practices on the northern suburbs of Sydney That's what he said to me in the seminar. I said oh is there is there enough market for that automatically sell so i think so he said he just he cuz he wanted to do it. Karen he wanted to open I saw Kenya available. I was a bit tired. Can you staff those seven practices? Will you find your start? I'll just advertise. There's a guy with his head in the sand. It's not funny. But I think the key thing I want to do I want to do this. Now that's okay, if that's a passion project. But if you want to generate a revenue and a business successful and you can sell it down the track if that's what you want to do, solve solve the desperate problem. Yeah, yeah,   14:14 turn it around. It's not about you. It's about you, but it's not about you all the same time, right.   14:21 If you get married up, it's great if you can find that that thing but be careful of what you do. So make sure there's a hungry market for an audit this we found out in one of our practices, there was a real market for lymphedema treatment. So massive market lymphedema and we had a guy who knew all about it the therapist and knew all about it. So we got him doing the lymphedema program. It was great. But But don't be Dora here didn't get him to train everyone else on how to do you know what happened? The guy leaves. Three years after we're still getting phone calls from people wanting lymphedema treatment and every time they rang it killed me. So Solve the desperate problem. Yes. But then protect yourself with the viable labor supply if you're doing something like that.   15:06 Yeah, absolutely. That's a great example. Okay, what's number three. So we've got failing to understand the true role of your business falling in love with your product, your product number two, what's number three,   15:18 we'll do this falling in love or falling victim to our own perfectionist syndrome. I was probably fortunate, I had some good mentors early in my career, and they'd tell me, Roddy, it's better to be 80% and out the door than 100%. And in the drawer. And it's so true, we just worry so much about putting something out there, because it's not quite perfect yet. Reed Hoffman, I think, was the founder of LinkedIn. one of the founders, he said, if you're not embarrassed by the first version of your product, you've launched too late. If you're not embarrassed by the first version of your product, you've launched too late. Meaning put your put something out there and you see if it's got traction, is it going to get some market share? Is it going to work for me? If it does, then you can then do version two, then do version three. But so many health professionals I get so caught up in making it perfect. I just want to do this, I just want to finish this, I just want to do this. And they end up not doing it. They wait that long, and they just slowly implement. Maybe it's because we're analytical thinkers, we're sometimes slow to implement, and we just, we drag the China bit. And I like this expression to, to the blind man, the one eyed man is king. But one of my mentors said to me, Roddy, you don't have to be the best in the world. You just got to be the best in their world. Say there might be a nice specialist down the road, who's who's a superstar does all the courses and is on all the all the seminars and other things and you've got your own new program. That's great. But don't let that stop you from what you're doing. Just be the best in your clients world at it. You don't have to be as good as that guy. You just have to be the best in the client's world. And, and that also, I think, Karen, sometimes maybe it comes from our universities that that we want to be anointed or we want to be awarded, or we want to wait for someone else to recognize me. Don't Don't wait to be anointed by your profession. Don't that's too slow, anoint yourself. Someone. Someone says to me, Roddy, who's the best health business mentor in the world? Well, I want to do wait for the National Association of physical therapists to make the announcement I'm not going to wait for that I am. And I think we're going to have some balls do that. But people take you at your own appraisal aren't going away in? And if not, that's your choice. But that's it again, don't wait to be annoyed because it's just too slow to do it that way. So don't fall victim to perfectionism because it's just a curse   18:12 for us. Yeah, very, very common. Especially I think I see it more in women than men. Men will often center feel like I'm just gonna do it and see what happens and women are more like, okay, it needs to be like this, it needs to be perfect. And I think sometimes our women judged more harshly than their male counterparts for things. There aren't as many women in leadership positions so you don't have that person that looks like me in those leadership positions as a point of reference, and so I think oftentimes women tend to keep putting things off because it's got to be as almost perfect before it goes out because we don't want to get judged harshly on something. And I see that consistently. Again and again. And a lot of men will just throw shit out there and it's like, yeah, this is fine. Who cares and women are like a   19:12 you got to remember littering once I was I did electric in the fitness industry years ago and in the in the personal training space. And I remember doing anatomy lecture one day to a group of trainers and I in the audience was my anatomy tutor from uni, like a superstar like this person, you everything about everything and I'm at the front talking anatomy and and it was a pivotal moment for me because I'm so self conscious about what I'm saying in front of this, this mentor. But no one asked her any questions. They all asked me the questions. I was at the front of the room. I had the clicker. I was in charge. I was the best in their world. She was the best in mind, but I was the best. There's that's it. I'll leave all of you to make the comments about Gaza girls, I can't say that sort of stuff. So knock yourself out cam   20:05 Yeah, yeah, I'm just that's just what I've seen, you know, over and over again, is, is that women tend to be a little more hesitant at putting themselves out there. And I get it, you know, as someone who has and who does put themselves out there, the criticism is harsh people can be mean, mean spirited, especially when it comes to social media can be a little toxic and, and you are judged very harshly and people say really mean things. So you have to grow a thick skin, I think if you're going to want stepping into kind of those leadership positions   20:43 that was published one of the key things, I think my management style of the business that you had to have a thick skin to work for us. I mean, maybe I was more suited to being an owner back then that I would be now I don't think I'd be as quite as sensitive as I'd need to be now. Anyway, that's if one of my mentors said to. And I love that when I say this, if you haven't upset someone by midday every day. You haven't said anything really important. What everyone's gonna agree with you You don't you don't have different doesn't have to agree with you. You just you haven't you have the right to have your opinion in this, but I think you need to do you'd have to agree with me, that's just what it is. But if everyone's agreeing with you, are you really saying anything of any importance possum?   21:24 Right, right? Very true. Very true. You don't want to surround yourself with Yes, people all the time, that's for sure. Because then you'll never move forward because you're never kind of grow and challenge yourself. Okay, let's, let's move on to number four.   21:40 Number four, ineffective, non existent. And unsupervised internal systems. You we've seen it, we've seen it, countless times someone goes to a seminar or they or they get an idea and they launch it into their practice. And, and they seem so excited about it. But the team have seen this before they've seen you come in with an idea and they've seen you launch it and they know you'll just it'll blow over. Once you get you'll see more patients and get busy so so that sometimes they do it for a while and you can see this owner because you'll say to them, do you have for example, you have a follow up system in your practice? I think we did here we look we did do something like that. Ryan, are we still doing that follow up system so that they haven't followed up and measured it. So one of the best things give you the tip, one of the single biggest and most effective things you could do in your practice is to tighten up the report of findings conversation. That's that's after I've done your history of January, your examination, and I'm saying what we're going to do to fix you that's the chiropractic wellness report the findings in their words, it's the action plan or it's our treatment plan, get get that script, right? Get that conversation, right? Write it down, sit the person next to you and write it down Mary to get you back running in that marathon in two weeks time. You need to see me three times a week for the next two weeks. I'll reassess you then and we'll get you ready for that race. How does that sound like that? Does that conversation that that currently is not done? Well in most practices? And and because I'm an analytical guy can often How do I measure that? How can I control that conversation. So I created an action plan a written plan. And, and the penny dropped for me when there is a number at the bottom. So the numbers at the bottom was how many how many sessions, how many times a week for how many weeks. So that's three times a week for two weeks, I had a number six, so that person needs at least six sessions before the next assessment. So I then made it mandatory that every patient would walk out at the front counter with that sheet that would give it to the admin person who and would verbally hand over that patient current to get married back to her run in two weeks time she's doing a marathon she's gonna do it really well. She needs to make three appointments for the next three weeks for the next two weeks and we'll get there admin to person books in in. And then I then got a spreadsheet that we created that has consults on plan. So that would be a six, the column next to it, consults booked. So you recommended six and how many were booked. Now if I if I then log into that spreadsheet and I see that my therapist has recommended six and a booking one so 616151 to one with it's a one on that on that booking column. I've either got a therapist problem or I've got an admin problem. Has the therapist not been good enough to get the confidence in the patient or is the admin under pressure and hasn't got time to book those sessions in advance. And you will know the dangers of a session by session appointment diary. It's just it's a recipe for disaster it's but that's that's an example of a system Karen you've got to put in to your business that you can then measure and stay on top. And you'll love this. So in true Polaroid style there was only one time in All of my practices where the therapist did not have to do one of those sheets written physical shit. And I get them all in a room and say guys, what's the only time that you can get away without doing one of these things? And they'd say, the person need to go and see a specialist or I ran at a time or whatever else that said, Now none of those things. The only reason I'll accept the no completion of this form is if the patient dies during the consultation and they've got a chuckle it's a chocolate gets a check. I want to talk about it now. But there's an element of truth to it. Everyone else gets one. Now that's that's the problem with most health businesses, we don't enforce our systems, we don't put them in and we don't make them mandatory. One of the keys to business success, remove discretion at the operating level of your business. Remove discretion, remove the chance for seminar I was going to give them a plan but I didn't think they needed it or the Garda see the surgeon or like, I want to look at the that report and say, Okay, what happened with Mrs. Johnson yesterday said news about Mrs. Johnson. She didn't make it through the consultation. And the therapists were Hi, can I get it ready? And then I can say, Man, I've noticed Mrs. Jones didn't get an action plan either. What's happening here is, is something that I'm wanting to do not sinking in, is there, imbalance here? And if it happens a third time we're gonna have a serious discussion. Now that's that may be used multiple that's hardcore. But   26:37 would you tolerate a therapist turning up without a shirt on? Would you tolerate that? horrifically bad breath? Would you tolerate them being late all the time? What are you going to tolerate? removed discretion?   26:53 Yeah, yeah, she just, Yep. Yep. That's a great system. Yeah. So really making sure that you've got systems in place that work for your practice, because every practice is different. And so you have to know what works for you. What are the KPIs that work for your business?   27:12 And quints of non compliance? What if you don't do it? Unfortunately, can we notice it now with with available library a bit short? Too many owners don't enforce this systems because they worried the therapists will leave so they're trapped they're trapped because they can't enforce this system. So what if they leave Well, what are they costing if they stay you know there's a cost for them to stay you're happy to where the cost make the decision. We've got a client in practice soldier now he's got an admin person just off sorry, a therapist, but just might want follow that action plan system to the letter, but he's got a labor supply issue. We know our numbers, we know what she's worth to the practice. We just made a decision to tolerate it for the moment that we could jump on if one day but it's not worth the fight because we're gonna have trouble with that off. Better Off fighting our battles in the right order. But it's a decision. It's a strategic decision.   28:07 Yeah, yeah. makes sense to me. Okay, let's move on to number five.   28:13 Number five, using your accountant to do your p&l for you. is a mistake because most accountants on average your account but assuming even give you a p&l, like most accountants, their job is to keep you out of out of jail and to make sure you pay enough tax and that's pretty weird. But what we want to know is, is a down and dirty profit loss for your practice. We want to know take out all the dodgy expenses take out the trip you took to the conference in New York take out all that. Even the year there was a conference there, but it's a bit dodgy like what take everything out of the car, all the other things that are legally claimable, but aren't really required for the business, get a down and dirty profit loss on a calendar month basis. Revenue we build, this is what we spent a know your numbers every month, and you shouldn't be able to wait for the end of the month to come to track your numbers. And one thing you must allocate Karen, you must have an owner consulting wage in there. Which is not the amount of money your accountant told you to take. It's not the dividend. It's a reflection of your consulting effort. So how you do that freedom school, so how many hours per week you're at the practice, multiply that by what it would cost to replace you, as a therapist, assistant your replacement costs, that money is not changing hands, by the way, the accountants looking after that. But this is we've got that in our p&l as a reflection of your consulting time. Because I can tell you now from having done this a long time, the only way sometimes you can get over practice to drop their consulting is to show them a down and dirty profit loss and show them that it hasn't changed or has improved if they dropped their consulting hours. Then you got it and you don't do that with your accountants p&l because it's a different spreadsheet, you got to deal with a down and dirty p&l. But because our natural recourse, Karen is to just consult more, whereas as a result of that we're not mentoring our team. We're not recruiting, we're not marketing. We're not with the kids, all these other things we're not doing.   30:17 Right? Yeah, no, that makes perfect sense. Yeah, I yeah, yeah, it's different. I mean, my accountant does do my p&l. But I also do monthly p&l is for myself. So on a month to month basis,   30:32 it can work if you're if you're doing a percentage of grossmith. But I just the problem with most therapists, we don't know their personal contribution to consulting and the overall scheme of things and we've show owners if you if you cut your hours, 20 hours a week, we can maintain your profit. Would you be happy to do that and see it because they're their natural recourse is to see more patients that just happens all the time. Sure. Anyway, can do it? He's know the numbers, the numbers will set them free.   30:58 Yeah, absolutely. Absolutely. No, I like that. And so when you're saying putting your consulting numbers in, you're talking about not just the time that you're with patients, but time that you're working on the business as well. Or just time when you're   31:14 just you're just you're face to face consulting time, because everything else is part of your profit margin. Right? Right. But the other thing is product and it's the other stuff is discretionary. You You can do your marketing when you want you can cancel a staff track you can you can you've got freedom to that, but your patient list. That's that's the one that use you're stuck in. So that's when you would change your business. Got it? Yeah. And, and most of ours, we try and get that down to zero. We try and get your owner consulting wage to zero maintaining your profit, then they have discretion. They can go to work if they want to say they're doing they're seeing patients because they want to not because they have to. Yeah, that's a differentiation. Not enough of us, Mike.   31:55 Got it. Okay, that makes sense. All right. So let's go on to number two to go six.   32:02 ineffective recruitment systems is a is a classic problem. And I know what it is we just we take it personally if they don't, if they leave we we don't get the right people always stuff this recruitment stuffs a nightmare. And I think it comes back a lot of it. As an owner, you have to make make a big decision regarding your team. Do you want to be liked? Or do you want to be respected, to be liked, or to be respected. I believe too many health business owners worry so much about being liked by their team, they can't have those difficult conversations, they don't have the respect of the team. And you're not always going to be like just accepted as an item of business. You know, there was going to be popular, you control the way ours you control the wages, you control everything in the business. It's important to be liked all the time. And if you're trying to be liked, it's going to be very difficult for you. Everyone is replaceable, except that and if they're not you want to make them replaceable. You need to think about the systems in a bit like my lymphedema God big mistake. I, I had an epiphany one night, I often have these epiphanies there. So there I am. And my admin, I had an admin superstar one of the practices and she knew everything. And she was so good everything she just did everything. And I had an I'm in there in bed one night, when I bought up right? What happens if something happens to Gina and I remember I couldn't sleep the rest of night. So I rang Gina, June at nine o'clock in the morning, I want you to come in, I've got someone to replace you at front desk, I've got my camera, you're going to show me everything. And we sat in the back room with the camera, show me how to do this show me how to do that show me and we just that we did that for a whole day. And I had all this stuff so if something happened you can watch the Gina file that someone can do. If you aren't doing that you are you are in all sorts of trouble. So recruitment systems, people are replaceable, except they're going to move on Don't take it personally. One of my mentors, we did a recruitment training program recently and one guy said, Just accept the fact that people are gonna, your business is like a train journey. People are gonna get onto certain station, get a bit down the track and then they get off the train. That's just that's what this journey is like they're not going to stay with you till the end of the line. Don't expect them to that's just just accept they will move on. And the final one and are running in the time, final one, not packaging your services, not packaging it into into an outcome driven solution. The bite write program for TMJ, the run marathon pain free program, whatever you do, we had a corrective orthopedic rehab program with exercise so name it something because once you are the only person that has that program, you can't be compared on price. If I'm bringing around the practices and you're charging 80 bucks and someone's charging 75 you're commoditizing yourself but If you're the only person with the x y Zed migraine program, because no one else has got that you can't put a price on that. So So you got to make sure you don't you have to package your services as a solution driven outcome, not just as a session by session deal. If you do that you're reducing the church have been caught up as a commodity. Now we've got time for one bonus mistake, I think. Yeah, all right. This is one bonus mistake. And too many owners do this. They, they think, well, they put a monetary value on their family time. They put a monetary value on their family time. Meaning I could finish at four o'clock in the afternoon. Or I could I could if I stay I'll make an extra $1,000 whenever I stopped but but I'll miss my daughter's concert. There's there's a so we put a monetary value if I do that, it'll cost me this. You just there's some things in life, you can't put a monetary value on. You just you can't put a monetary value on your family time. And people who told me that it's that it family time, I don't have much but I have quality time. And again, I don't want to guilt you into this stuff. But there's no such thing as quality time with your family. Family time is quantity time. things just happen. When you're around them. things just happen. I'm on. I'm on the back porch of my house. My second youngest daughter was about 17 on home a lot as I was on the on the back porch in she comes in she stands at the door. Not a crier young Jade. She's a very, very stout young lady. And she I said okay, down, and she dissolves like just the tears coming up. Right? a Cadillac for five minutes. Yeah, Caden are just a few things happening at school done. Um, right now, as you took off, yeah. I couldn't plan that.   36:59 I can't, you can't. You can't plan that. That just happens because you're around. And again, I'm not I'm not guilting you guys. Yes, you have bills to pay, they have other things to do. But the business is there to serve you. You do what you need to do to make sure your family is happy and fed and everything else but don't put a monetary value on it. Because it's it's a it's just not a fair comparison. You can't price it. It's just ridiculous to even think about it. Anyway. All right. Sorry to guilt everyone into something but that's the deal. Now I've lost you can you muted yourself.   37:40 There's a loud siren going by sighs just   37:44 could not go to Yes.   37:53 That was allowed one. Well, obviously edit this out. But I was like, I couldn't even I couldn't even It was so loud. Because it must have been like right in front of my apartment. So we'll edit that out. So annoying. That's that has not happened in a while that was allowed one. And didn't I don't even know what it was. Anyway. So we'll just sort of I'll do a little clap, and then we'll start. So this helps me for editing. But uh, you're killing me. I know, he's, I don't like it's fine by me. You know, I don't even realize he's there. But okay. So all right, so we went through seven mistakes, plus a bonus, which is great. And, you know, if you weren't taking notes, don't worry, we'll have all of these written out in the show notes to make it really easy for you and to follow along. But now, where can people find out more about you get some more resources so that they don't make all these mistakes.   38:59 best place to start, we do a monthly demonstration of practice ology. It's a webinar we do every month. And we'd basically show how our clients across 54 countries earning more, working less and enjoying their lives, even during a pandemic. So we talked about some of the principles to talk about today. And it's really a very interactive demonstration of how we do it. So if you go to my practice, ology.com forge forward slash Litzy li Ts Ed, why obviously. So my practice ology.com forward slash, let's see, you'll get the you can log in and register for the next next session. And if you want to get a copy of the book, I wrote a book how to run a woman a practice, as Karen explained at the start. It's not a it's not a big book, I didn't want to write it. It doesn't make sense to have a massive journal for how to run a woman in practice. It's got to be a woman's book, you should read that in less than an hour. Just covers a lot of the action plans and the bookings and there's great resources sample action plans you can get from the book If you just get to one minute practice.com forward slash book sales. So one minute practice.com forward slash book sales. And if you just put in the code, Karen Oh s for overseas. So if you're not Australian, which I don't imagine you will be if you're not Australian, do Karen r West. And it'll take 15 bucks off and you get it for $4.95 Australian which I think's about $1 us. That's a bit more than that. But it's not it's a pretty good deal. If you happen to be Australian, listen to it put in Karen, au, s t. So I'm going to practice.com forward slash Bob sales. Karen Oh s get it for if you're if you're outside Australia, or Karen a USD if you're Australian, and you get that for $4.95. And we'll post it out for you. And my social media platform is LinkedIn believer not I'm an old school, LinkedIn. So follow me on LinkedIn. Paul, right, Newcastle, I'd love to have a chat. And I hope you can join it for join us for a webinar and get some of those great resources from the book. And posted sorry, posters is a bit slow, I think we've covered but once you, once you buy the book, you do get the PDF of the book straightaway. And there is a second page, a link to all the resources and the action plans and all the scripts and stuff. So that's perfect.   41:16 And we will have links to all of that at podcast at healthy, wealthy, smart, calm. So one link will take you to the webinar to the books and to your LinkedIn page. And before we wrap things up, I'll ask you one last question. And it's one that I asked everyone knowing where you are now in your life and in your business and in your practice. What would What advice would you give to your younger self?   41:40 Oh, you love this one? Okay. I would probably be a podiatrist or an optometrist. You're sitting thinking, Okay, what are those things got in common? Well think about it. They've got a product arm. They've got a range of products, because I, I did what we talked about earlier, I became a physiotherapist because I wanted to be a physiotherapist. I didn't know I could be limited in what I can sell our products. So if I could go my time again. podiatry, I would, but I don't like feet. So maybe it's a problem. optometry, I'd be okay. Maybe orthodontics? I'd want a product range. That would be that would be why don't go and say all my diamonds done. Put a product range in your current business, if you can. That helps. But the idea of relying on your hands and trading time for dollars, I'd probably do differently.   42:38 Right? Well, great advice to your younger self, for sure. Thank you so much for Paul, for coming on and sharing seven mistakes that you've made and probably a lot of us who have been in business for more than a couple of years or more than a year have made and hopefully all the listeners out there you will not make those mistakes because we have covered them here. You've got them in your head. You'll sign up for the webinar and you won't make up and it'll be clear sailing. Fingers crossed. So thanks, Paul, for coming on and sharing all of that with us. I appreciate it.   43:14 Absolute pleasure, your superstar. Thanks for having me.   43:17 Thank you and everyone. Thanks for listening, have a great couple of days and stay healthy, wealthy and smart.

In this episode, Founder of PT Crab, Luke Hollomon, talks about the importance of reading, dissecting, and understanding research. Today, Luke talks about how PT Crab can help PTs, the most common research-reading pain points, why reading the abstract isn’t enough, and how to make the whole research process easier. What does it mean to keep up with the research? Hear about how to find exactly what you’re looking for, how to understand what the research says, and how to apply the research to your clinical population, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Research has shown that, in our specific field, over 90% of the abstracts are at least misleading, if not inaccurate, relative to the paper.” “It’s important, when you’re reading a paper, to read it a little bit critically.” “A lot of times, research is written for researchers. It’s really important for researchers to write for physical therapists.” “If you have a paper that doesn’t specifically address your patient population, you can translate that to your population with good communication.” “Try to make [your] favourite journal one that you have access to.” “Get focused in on something a little bit earlier.”   More about Luke Hollomon Luke Hollomon is a writer, teacher, and student from Richmond, Virginia with a special interest in sharing complex information with those who need it. Using his background in physiology and education, he started PT Crab, a newsletter that brings physical therapy clinical research, awesomely brief to the inboxes of thousands of physical therapists every week. His true passion is helping people understand and use scientific information. When not writing The Crab, he writes science and technology articles as a freelancer and is currently finishing his degree in physical therapy from Virginia Commonwealth University. Afterward, he plans to pursue a PhD in exercise physiology and study the limits of human endurance. When not doing all of that, he’s a bikepacker, rock climber, and trainer of his deaf adventure dog, Kiwi. If you’re ever in Richmond, look for her in her trailer behind Luke’s bicycle as they explore the city together.   Suggested Keywords Healthy, Wealthy, Smart, PT Crab, Physiotherapy, Research, Papers, Reading, Keywords, Critical Thinking, Science, Knowledge,   Resources: https://www.researchgate.net   To learn more, follow Luke at: Website:          PTCrab.org Facebook:       PT Crab Twitter:            @lukehollomon   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

In this episode, Managing Director of Sagesse Lumiere, Dr. C. Adam Callery, talks about small In businesses in the wake of the Covid-19 pandemic. Today, Dr. Callery talks about the implications of the pandemic on future business strategies, the importance of agility, and understanding cashflow. How often should a business of any size check their financial status? Hear about some emerging trends, three critical activities for success, how Dr. Callery helps other entrepreneurs, and get his valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Never confuse faith that you will prevail in the end.” “If you want to be successful moving forward, you have to be ready for these unexpected changes.” “You can’t be afraid to act fast, but you don’t want to be reckless.” “You have to take a step back sometimes and attack a problem formally.” “I cannot just assume that because my bank account has money in it that I’m actually in a good position.” “You have to position yourself, or maybe carve out specific time, for you to really learn your industry.” “You have to be close enough to the operations to know what’s going on.” “It is extremely important, whether you’re an existing business owner or a new business owner, to truly understand what cashflow means.” “You can do it. You can actually be an entrepreneur. Just go out and do it.” “Bring people around you who have the knowledge that you need, because you’re not going to know everything, and if you adapt that knowledge, you’ll be successful.”   More about Dr. Callery Dr. Callery is an entrepreneur and higher education educator. For the past eleven (11) years, Dr. Callery has worked directly with the start-up and emerging business communities at a national level. For ten of the eleven years, Dr. Callery has held the roles as facilitator and trainer for two (2) nationally recognized small business growth programs, the US Small Business Administration’s Streetwise MBA Program in Chicago and the Goldman Sachs 10,000 Small Businesses Program. His company, Sagesse Lumiere, a small business coaching and consulting firm, was established seven years ago to complement the work he was doing in these programs. To date, Dr. Callery has advised over one thousand small business founders while participating within the national programs cited above. Dr. Callery, as a coach and consultant, works with small business owners on approaches to effectively build value by deploying new business practices and processes to improve financial performance and operational efficiency. Prior to working with small business owners as a business coach, Dr. Callery worked for several Fortune 1000 companies such as IBM, Dow/Dupont, Pepsi, United Airlines, and First National Bank of Chicago. His broad industry experience has prepared him to be a capable business consultant. Since leaving the corporate arena, he has become a trusted advisor for many small business founders. As a higher education educator, he has served as an Associate Dean for workforce development programs and currently works as a tenured faculty member for Harold Washington College, one of the City Colleges of Chicago. Dr. Callery has earned a Bachelor’s in Chemical Engineering from Illinois Institute of Technology; a Master of Business Administration from University of North Carolina, Chapel Hill; and a Doctorate in Higher Education from National Louis University, Chicago.   Suggested Keywords Healthy, Wealthy, Smart, Small Business, COVID-19, Research, Success, Cashflow, Entrepreneurship, Mentorship, Finance   Resources: The Goldman Sachs 10,000 Small Businesses Program WSC1998: AVOIDING THE BLUES FOR AIRLINE TRAVELERS   To learn more, follow Dr. Callery at: Website:          https://sagesselumiere.com Twitter:            @callerysagesse Instagram:       @callery_sagesselumiere LinkedIn:         Dr. C. Adam Callery   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, Dr. Callery. Welcome to the podcast. It's an honor to have you on. So thanks so much for joining me.   00:10 I'm so happy to be here. And so glad you invited me to attend your podcast.   00:14 Oh, this is great. And you know, like I said in the, in the intro, you were our lead instructor for the Goldman Sachs 10,000 Small Business program. So I owe a lot of my being a therapist and having to be a business owner to now being a business owner who happens to be a therapist to you and the rest of the staff and business advisors. It was really life changing. So thank you so much.   00:40 Well, I think I thank you for being a participant in the program. It's a hard program, we asked a lot of you for an extended period of time. And I have to say, I cannot do it solely by myself. It really is just a good strong team that covers so many different areas of business management that's needed for most small business owners. So I'm just having to have good people around me, that helps make the process very smooth.   01:05 Yeah, absolutely. And today, we are going to talk about sort of small business owners, and the effects of COVID-19, which we have been in for the last 18 months and doesn't look like it's ending anytime soon. But we are back to work. There are mitigation factors in place. But now, how do we position ourselves for the long term in this new world? So my question is, what are some of the lessons you have learned over the past 18 months? And what are the implications for your future business strategies?   01:50 Well, I think that's a great question. Because myself, I'm also a business owner, I am a small business coach. And I would have to say for the last 18 months, that's been a question that's been raised many times, I can think back to March, when we first moved into COVID. Everything shut down. And to be honest, it seemed very dark at that time. And then for the next three to four months, I was working with a lot of small business owners, and we were having those discussions, what are what's next, you know, how do I get out of this. And in fact, if you started to look at the newspaper, you'll see headlines saying this is the worst crisis since the depression or behind closed doors, there's calamity. And when you read those phrases, it actually diminishes your ability to be a leader, and organizer of your business. And so what I had to do as a coach started having different discussions and say, we must look forward. And the way I did that was having a time with individuals to stop and say, Hey, if we take a look at the Great Depression, or the great recession of 2008, those same phrases were being said then, yet, we were still standing in 2020. So we have to believe that we're going to pass through this period as well. And so the discussion became, how do we do that, and in most cases, and then bring back or I should say, shorten your horizon from looking out two to three years, to just make it now bring it down to three months down the six months, make it manageable, it was easier for you to see out three months, it's easier for to see how six months, and then just be very tactical. And so during that last quarter of 2020, through the beginning of the initiation of 2021, many of the conversations with business owners have centered on that, how can we focus on some short tactical goals that keep the lights on, they keep my current employees satisfied, so they stay with me to make sure the customers I do have still like the services are providing or the product that they're buying from us. Therefore, we have to maintain the same level of quality. So just being very tactical that way. And then hopefully, when we're on the other side, we can then return to a posture where we're thinking longer term.   04:06 And all that, to me just sounds like a small business owners that we have to be really agile, and we have to be able to pivot. And so can you speak to a little bit more about agility as a business owner, and how we can foster that if it's something that we're not used to?   04:28 Well, agility, you know, it's a strong word, right? So it means that we're flexible. But again, coming through this COVID period, it didn't seem like flexibility existed. Everywhere I turned, something was shutting down. So I've seen closer to the end, then something that was gonna be an opportunity in the future. And I came across a quote, it came out of the book called Good to Great. That was written in 2001. And I wrote it down someone just read it verbatim because it's a unique quote, but I think it addresses issue. It says never confused. That you will prevail in the end. So that saying this thing of, I have faith that I'm going to win, I have faith that my business is going to win, it's going to be successful, and I'm gonna make a lot of money from it, or I'm going to be fame, I'm going to become famous from it, you have this faith, you got to have this confidence, that's probably a better word, I got to have the confidence that I will make it through. But here's what the rest of the quote says it says, I can never lose that confidence. However, I must have the discipline to confront the most brutal acts of your current reality. So the current reality of 2020 was, everybody's impacted at the same time, my competitors, my peers, people across the ocean, everyone is getting hit with this calamity. So now I have to think out of the box, and I also have to think very practically, so that's where the agility comes in, I didn't have a lot of time to wait six months to see if it's gonna work, because I may not be here. So I may have to take some cost cutting measures that are going to be very draconian, but necessary, I may have to talk to my staff and negotiate with them, and maybe get them to take a cut and pay, letting them know I'm trying to keep everyone alive here, I may have to talk to my customers in a different way and find out, are you still here? You know, are you still viable, because my customer is also impacted by this. So then I can sort of forecast what my sales potential could be. Because many of the customers went out of business for many of my clients. So agility means that you are being sorry, that you're focusing on today. And you're being very practical, very tactical, you're using your experiences, from your I should say, your past experiences as a business leader, and a business owner. But you also are willing, and here's the key, you are willing to take in advice from subject matter experts who are in your industry, and also outside your industry to help you navigate this because this was so unknown, a lot of unknown territory that we were crossing through.   06:55 Absolutely. And I would also think that in that time, I'll use the example of the physical therapy profession, but kind of acknowledge acknowledging emerging trends during this time. So for the physical therapy world, certainly here in New York City, we were close, literally shut down ghost town from March to almost June or July of 2020. So what do you have to do to keep things going? So the emerging trend was telehealth? Yeah, telehealth has been a trend and it has been coming up and coming up. But I think as a PT, if you didn't acknowledge that that trend existed, and didn't hug that trend, like it's your best friend, you you were in trouble, right? So what other kinds of trends Did you see within the small business world that people had to acknowledge and embrace in order to not only bring them through 2020. But I'm sure a lot of those trends have continued well into this year.   07:56 I agree 100%, the hardest trend, and I don't know if I can call it a trend, that's probably more of an action, the action that I may have to return to what I was before. And what I mean by that is, maybe we're a sizable business, you had 50 employees, or maybe employees and contractors working for you that accounted for about 50 people that you're responsible for, had a fairly good customer base that you're working with COVID hits and everything shuts down. Now, you may have to go back to what you were three years earlier, that's when you started the business where you were a smaller company, not as nimble because you were smaller, but you were very focused and very targeted. And that was the trend, I was saying that people say I'm at the roll back to where I was before. And that by rolling back doesn't mean I'm failed, which is another trend element. It doesn't mean I'm failing, it means I had to adjust, you know. So it's realizing that businesses aren't always going to go up with hockey stick and grow, grow, grow, grow without interruption, that there will be these troughs. And if I hit a trough, I may have to back up a little bit. In this case, people have to back up a lot. A great example of that would be the restaurant community. Here in Chicago, I've seen it all over where people physically had to change the menu, they may have 30 items on the menu. And they just took duct tape and started covering over things and reduce the menu down to something that they could manage based on staff based on a cost of the ingredients based on just pure demand, because now they're doing just takeout services, no longer doing to sit in services. why they do that, because I have to still pay the rent, I still have to pay some utilities, I still have to pay something. So I have to have some money coming in. And I want to be here for the next day. So I may have to swallow deeply. And Take another deep breath and say I have to go back to where I was maybe when I started the business so I can survive this period not knowing if you remember not knowing back in April, how long is this going to go? Because the predictions were two months, six months, two years, five years. Nobody knew. So You had to be very specific and very intentional about how far you will go back in time in order to survive and be here for the future.   10:09 Yeah, I mean, gosh, back in March, when New York City shut down, I was like, ah, six or eight weeks, we'll   10:15 be back up and running. Let's see, 18 months later,   10:21 not quite back to where we were. But getting closer. But to your point, yeah, I thought it would just be like six or eight weeks. And this will be a little adjustment that I'd have to make in my business. But it, it actually turned into a long term adjustment that I love. And I'm glad now that it's part of my business. So that ability to pivot quickly actually turned into a big positive for my company, because now I can actually see more people because I don't have to see them in person.   10:51 I agree. I agree. And I stole something else out to you. It's not so much of a trend, but it's probably a revelation. So we know a lot of business owners have different backgrounds, and they come from different walks of life. And so if we put an academic hat on, we have individuals coming out of MBA programs, and they have knowledge around business. The key is what does an MBA program teach? What MBA program teaches is that you need to go out and look at the environment that you're in. So that means you research on what some of these latest trends are. When we have a situation like COVID, I know many business owners typically don't worry about what the trends are, they worry more about what's going on in their daily environment in their community, and their marketplace, and they're just focused on can I sell something tomorrow, I think COVID has opened up a new reality that if you want to be successful moving forward, you have to be ready for these unexpected change as well. How can I reduce the number of unexpected changes, I start to do some research, I start to do some reading in my industry and also outside of my industry. So I can see those trends that you were talking about earlier. So telemarketing has been or tele health rather, has been around for a long time. People talk about it, but it wasn't economically feasible. Then when I need it, those who knew about it jumped on it. So but I had to know about it, I needed to have that information. So this is an important time as business leaders now to say, what else do I need to know? Do I need to join my industry associations? Do I need to go out and and go to conferences, go to particular training programs, where I can start to learn about what is going on around me so I can be better equipped for the next situation may not be a pandemic? Or it could be droughts, if you're out west? Who knows? It's going to be something so how can I be prepared for the next something?   12:39 Yeah, because you know, something that you had brought that you brought up in our kind of communication before we recorded this is and I like this phrase you put in quotations, you can't be afraid to act fast. But you don't want to be reckless. Yes, yeah, right. And so by doing the research, you can act quickly, and not in a reckless manner. Because you know where you are, you know, what the industry is holding, and you've got that research. So you can act quickly with authority. And with some sense of operation.   13:15 I agree. And ask where, you know, we want to say, you want to be intentional. And that's what that word really means. And especially when we're in our programs, we use that word a lot. But it's good to unpack it. So you just mentioned and that reckless, and I'm not trying to be strong willed. So when I'm talking to my employees, I'm trying to hit them over here with a club, but I'm intentional. So I have I know where I want to go, I've taken the time to do some research. So I've set a goal in mind, I've also decided on a path that we can take, but I'm also willing to ask around to see if that's the best path. So that's where I'm not being reckless, I'll go ahead and qualify it by talking to other subject matter experts, talk to other people in the industry and say, This is what I want to do based on my capabilities. What do you guys think? What do you people think? And that can help me then to minimize risk? Because we'll never eliminate it. We're just trying to minimize risk. So we can be successful.   14:10 Absolutely. And so now, we've we've sort of identified research we have we spoke to people, we got advice. Now we want to move forward. So we need some sort of formal operations. So these operations, as you said, they kind of revolve around three critical activities. So can you share with the listeners what those critical activities are, to make that those formal operations successful?   14:38 So I can that'd be beautiful. We've met through the Goldman Sachs program and what I've learned over the last 10 years in that program, is that you have to take a step back sometimes and attack a problem formally. And so we start off with the purpose, what is your business purpose? And what that means, of course, is what do you think? to do in your marketplace, who you're trying to sell to, why you're doing it, why are you actually involved in this work? The second thing we try to do is examine how we actually do the work. And this is the operational piece. So how do we actually do the work? How do we earn our revenues? How do we manage our team? How do we actually produce the product or service? Are we doing it efficiently? And then the last piece I call her reflection, but that's the research piece. I've been doing this for five years, I've been doing it for 10 years, is this the best way to do it now, based on the changes in the business environment, changes in government regulations, changes in social trends, changes in the number of competitors, or the type of competitors that so the three pieces are looking at my purpose? Why did I get into this business? Why do I want to do this or continue to do this kind of work, I look at my model my business model in general, and think about how I currently conduct business and see there's a better way I can do it more efficiently, more effectively. And then last but not least, I have this reflection or research activity that I do continuously continuous learning to make sure I understand my marketplace, understand my industry, understand what's happening with competitors around me also start to probe and find out are my customers still satisfied with what I'm doing? And if not, what do I need to do to reach them?   16:21 Yeah, and I'm glad that you said that you're continuously looking at this, because this isn't something that you do when you start your business, you assess your purpose, your model and solutions and reflect. It's not like you just do it once. Yes. Like how often would you say do you recommend even the business owners that you work with, kind of go through these three critical activities?   16:47 Well, I think we can take the model from the corporates. Now you understand corporations are huge, billion dollar places, but they are billion dollar places for a reason. And that is because they do take the time to annually look at what they do, and assess whether or not is making sense. So if I was any business owner, I don't care what size you are, I would make it a point to say maybe in the fall, that November period, Christmas period, when it's kind of quiet, people focused on vacation or focus on the holidays, you take that time, sit down with your management team and say, hey, let's think about how our last year went. Is there something that we want to do better, right doesn't mean that you did anything wrong? Is there something that I can improve upon? Or are there some new things coming down the pipeline that I need to be aware of, or we'd need to be aware of, that we need to plan for starting in January. So doing an annually isn't a bad practice. And if you do it formally, and you do it every year, it just becomes part of your routine. And you'll start to think about the questions you want to ask each other during those sessions. And you'll be able to flesh out what is happening with the business. In fact, you probably want to go ahead and bring in some of your key employees that sit them around a table, get some insight from them on what they're experiencing, when you're engaging your clients, when they're engaging your suppliers, or if what they see, in general, they may see some things in the market that you have missed. And it's a good time to sit back and get their feedback as well.   18:16 And how often would you say suggest to a business owner small of any size, but let's say a small business owner, to really look at the financials of their business once a quarter every month, every week, every night before you go to bed? Like is there overkill? Or? Or what? What are your thoughts on that?   18:40 That's a tough question is a tough question, right? Because Is there any should you have any limit on when you look at your numbers, because for instance, everybody will tell you, you need to know your numbers. So if I'm sitting in front of an investor, or a banker, they're going to say you need to know your numbers. But I guess the question is, what are they really asking me? They're probably just asking, do you know enough about your numbers to tell me whether or not you're profitable? That's really the question they want to know. And they want you to be able to tell them that, tell them you're profitable in a confident manner. And they can easily see if you're sort of dancing around the question, right? Because you really don't know your numbers today. They can sense that in the way you respond, your eye contact, and so on. So to your direct question, how often should I look, if I put on my accounting hat, we typically look once a month. So every month we take a step back, and we see how the business is performing financially. In order to do that, we probably need to have some type of system in place. That could be a QuickBooks system, or it could be a cell spreadsheet. It depends on the complexity of your business. And that's when we have to define a small business. So small business can be defined as any business with less than 500 employees. That's a big business. But let's say I'm a mom and pop I have less than 10 employees. In fact, I am the key employee and everyone else is a contractor. If I'm that size, once a month is probably still appropriate, I need to take the time to stop. And look, I cannot just assume that because my bank account has money in it, that I'm actually in a good position. So if I take the time, look at it once a month, that's probably enough. The furthest I would like to go out is probably three months, you know, quarterly, but want to go beyond that. Because a lot can happen to a business in two days, let alone in 90 days. And if I'm not keeping track of my numbers, I may find myself in a very dire cashflow position, and maybe find myself going out of business fairly quickly.   20:42 Yeah, excellent advice. Excellent advice. Thank you for that. And you know, as we start to wrap things up, what would be if you could give one or two pieces of advice to let's say, a new small business owner, so their business is less than a year old? What is your best advice for those business owners?   21:04 I think it's extremely important for the person just getting started to do some of the things we're talking about earlier, you have to position yourself or maybe carve out specific time for you to really learn your industry. So that could mean joining an industry association, going to those industry association meetings. So that's gonna take time, read some of their white papers that they generate about your industry. So for instance, I was at one time I was looking at buying a limo service, I love this guy service used to take me to the airport all the time, all his drivers were professional, his cars were clean, well maintained. And all I knew about the business at the time was the fact he took me in a limo to the airport. But that's not knowing the business. So I went ahead, I contacted limo Association, they sent out to me information on the business, you know, on the industry, the cost factors, the maintenance issues, some of the trends in the industry. After reading all those materials, and learning that it was a very highly capitalized business, I realized that it wasn't for me, at that time, still like the business. But I knew I was not in a position where I had enough capital to keep the cars up to spec to meet the requirements of running a limo business. So if I'm starting a business, whatever it is, I need to know as much as possible about that industry and the business model itself. How's the business make money? What are the cost factors? What are the what are the cost influencers, I need to know that like the back of my hand, then when I'm running the business on a day to day, I need to be in the business to see how it really operates. I've met some people that have started a business. And I've started another one that started know when I started another one. And I now ask them I said, Well, how do you possibly run three businesses at the same time? Well, I got people working for me. And what comes to mind is something someone told me many years ago, is that you have to smell the people. And what this is gain from Business School, and the professor was saying, you have to be close enough to the operations to know what's going on. And if you're too far away from it, there's too many things that can happen to the operations that will shut you down. And so if you're just getting started, your focus needs to be in the business and getting the business to a place where it's stable, and is sustainable. That usually means creating cash reserves, that usually means bringing in solid employees, it usually means having a great understanding of your customers so that you know you have returning customers that'll help keep the business afloat.   23:42 Excellent. Thank you so much. I know a lot of people that listen to this podcast or maybe budding entrepreneurs, they've been in business for maybe a year or two. So I think that advice is really great for that group. Now, is there anything have we not covered something that you were like, I want to hit this point during this podcast?   24:02 I think it's important, we haven't used that key phrase. And that's cash flow. It is extremely important whether you are a existing business owner, or a new business owner to truly understand what cash flow means. And so when we talk about cash flow, what it means in general, is that we're talking about the money that's coming in. And that's where most people focus is, Hey, I'm making revenues, things are going well. But you can't just stop there, you got to think about the cash outflow. And people say I write the checks every day, I know how much money is going out. The third piece is timing. You have to think about when the money has to be paid out. When does that liability has to be paid out, and whether or not I'm going to have enough cash on hand to pay it on time. Because once I default on that payment, I'm now in trouble. The bank is knocking at the door. My creditors are knocking at the door, my investors are knocking at the door and I'm going to have problems paying my employees so on and so on. So cash flow is very important. And it's important from the standpoint of you have to truly understand the definition of it. And what it means is inflow is outflow. And it's also timing. When is the money coming in to pay those current debts that I have? Will I run into a situation where I don't have enough coming in to pay those debts? And if I do, what am I going to do about it? Am I going to reach into my personal account and pay it? Am I going to run down to the bank and ask for a line of credit? Do I need to run out and find investors? Who can give me additional cash to help me close that gap? So cash flow is critical?   25:36 Yeah. And I think, as you were saying that the thing that popped into my mind is, ooh, this is why Ponzi schemes ultimately fail.   25:44 Yes, yes. Because the money stops coming in. And their commitments outweigh our Yeah, extend beyond the, the amount of money that's coming in.   25:54 Right. Right. Yeah, that is why a Ponzi scheme fails. And, and I agree that cash flow is so important. And it's something that I didn't really wrap my head around fully until the Goldman Sachs program. You know, I knew like, yeah, money's coming in. But once I started doing cash flow statements, I was like, Ah, okay, yeah. Now I got it. No, I know, I can now I understand this as, as one of the three sisters, you know, your cash flow statement, your balance sheet, and your income statement.   26:32 Exactly, exactly. And it's the cash flow statement, and we never talk about, you talk about it. If you again, be school, we talk about all the time, but most people just stop at the income statement. In particular, they stop at the income side, then when you introduce the balance sheet, I don't see why I really need it. I don't have any assets. But they don't combine the two to come up with the cash flow. And that's what you really want.   26:53 Yeah, yeah. Excellent. All right. Now, where can actually let's talk before we before I asked, Where can people find you? Why don't you talk a little bit more about your business? And how you help other entrepreneurs, your coaching business and what you do to help entrepreneurs?   27:12 Well, what I do is I focus in the business development area, as well as the operations or organizational development area. And what does that mean? So I come in as a business coach, not as a consultant, I sit down with my clients, and we have discussion. So it's like we're doing now and we focus on the issues that are facing them. So in a business development side, for instance, such as a marketing issue, we're not talking about social media, what we're talking about is more around a target market. Have they identified the right persons, or the right audience? When it comes to marketing? Also, you got to think about the delivery of the product and service. Are there some challenges in terms of quality, some challenges in terms of delivery, that they're facing? And then we start to peel back a little bit? And this is where we get into the operations? Why are you having those challenges? Is it a capability issue is a capacity issue, these things have to be fixed, or the marketing, social media really won't matter? So I focus on a business development sort of working backwards? What are you trying to sell? What are you servicing? How are you working with your clients? And what are your business capabilities, what is what is your business capacity, in order to essentially achieve the goals that you've set for the business or to meet your current demand for your customers, those are all very important pieces, because most businesses will suffer or in a trough when they get to that third and fifth year when they try to scale up. And they always find, hey, I have this resource deficit. And I usually think it's money but it's not so much money, it's really capacity and capability, they may not have the right people on hand, they may not have the skill themselves in order to scale up and they need to go back, build up those skills so that they can grow. And that's where the coaching comes in and sort of help the build up those skills.   28:57 Awesome. Now where can people find you?   29:00 Well, they can find me right on the internet. I have a website out there, my, my company has a very unique names, it's called suggests luminaire and will suggest and stores wisdom, and then luminaires light. And so right out there on the internet, I have a web page where you can contact me through that or you can come back contact me through LinkedIn. So I do have a LinkedIn profile out there. That's probably the best way most people will contact me through LinkedIn. And then we'll set up an appointment and we go from there.   29:29 Perfect and we will have direct links to all of that at podcast at healthy wealthy, smart, calm and the Show Notes for this episode, so don't worry if you didn't have a pen you can take it down. totally get it we will have one click direct links to all of that. And now, Dr. calorie for the last question, which is a question I asked everyone, knowing where you are now in your life and in your business, what advice would you give to your younger self   29:57 so what I would tell my younger self I'm fully invested in entrepreneurship, I would tell my younger self is that you can do it, you can actually be an entrepreneur. To be honest, when I came out of school or coming came out of undergraduate, my mind wasn't there, my mind was I had to go through this career track, because that's the only possibility that entrepreneur thing, or that small business thing was just too far out there. You have to literally be born into it. It has to be a legacy relationship in order to start a business. Today, I recognize after meeting so many people in this space, that's really not it is really tied to have any interest. People use the word passion, but I go beyond the same passion, you really have that ambition that you're willing to give all in order to accomplish this. And so I would tell my younger self, that you do have that ability, you do have that ambition, just go out and do it. Bring people around you who have the knowledge that you need, because you're not gonna know everything. And if you adapt that knowledge, you'll be successful.   31:03 And I think that's great advice. And especially for a lot of the physical therapists who listen to this podcast, because so often we graduate, and we think, well, I'll work at a clinic, I'll work at a hospital, I'll do that for 40 years, and then I'll retire. You know, it's like, it's never it. Because in school, we're not really given any entrepreneurial mentorship or classes, you really have to seek it out on your own. And so I think that's great advice for any students listening or newer graduates, who think, Well, my mom wasn't wasn't an entrepreneur, my dad or I don't, I don't have any real role models in my immediate family, but that you can do it if you surround yourself with the right people, and you have the ambition and passion to do it. So I think that is excellent advice. So thank you for that. Well, and thank you again, for coming on the podcast and for being a great instructor in the Goldman Sachs 10,000 Small Business program, I can put a link up to that too, if people are interested in learning more about the program because it is a life changing program. It was for me and I'm sure as an instructor, it must have been for you as well.   32:13 Oh, it hasn't. It hasn't, I have to say, I never, I never thought I'd have this experience. It's been now going into my 11th year and I've actually set before 1000 business owners never thought that could happen in my wildest dreams and having the ability to have conversations like we're having now. Again, it's opened up my mind to say the The possibilities are limitless in this country when it comes to being able to create something that you want to create. And that's the beauty of it. So it's it's a fantastic opportunity. Fantastic country fantastic. Time, even though it's difficult time, it's a fantastic time to to do something that you want to do.   32:57 Excellent. And on that note, I will wrap things up by saying thank you again and thank you to all of the listeners for tuning in today. Have a great couple of days and stay healthy, wealthy and smart.