Healthy Wealthy & Smart

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Tricia Brouk to talk about how to land a TEDx Talk. Tricia is an international award-winning director, author, speaking coach, and podcast coach.  In this episode, we discuss: What is a TED talk? How do you get chosen? Why do you need to vet organizers? What makes an exceptional TED talk? How do you prepare?   Resources: Round Table Talks   Tricia's Website: Tricia Brouk   www.TheBigTalkAcademy.com   www.speakersalonapplication.com   Tricia's Social Media:    LinkedIn   Facebook   Twitter   Instagram   YouTube   Podcast   More About Tricia:  Tricia Brouk is an international award-winning director. She has worked in theater, film, and television for three decades. Her work includes the writing of two musicals, both produced in New York City, a one-woman show, and four documentaries, two eligible for Academy of Motion Picture Arts and Sciences nominations. She had an extensive career as a dancer performing all over the world. In addition to her work in the entertainment industry, Tricia applies her expertise to the art of public speaking. Tricia founded The Big Talk Academy where she certifies speakers in the art of public speaking. She was the executive producer of Speakers Who Dare and TEDxLincolnSquare and now The Big Talk Live. She has shepherded more than fifty speakers onto more than fifteen TEDx stages in under three years. She is currently being featured in a new documentary called Big Stages, which highlights the transformation of her speakers. Tricia’s commitment and devotion to inclusion is a priority as all of her shows, events, and communities are diverse. She curates and hosts the Speaker Salon in NYC, The Big Talk, an award-winning podcast on iTunes and YouTube. She directed and produced The Big Talk Over Dinner: Race and Immigration that premiered at the Be Your Best Self Expo in 2020. She was awarded Top Director of 2019 by the International Association of Top Professional and is relentless about her vision of amplifying voices all over the world. Her book, The Influential Voice: Saying What You Mean For Lasting Legacy was #1 New Release on Amazon in December 2020. Tricia lives in New York City with her husband, Joe Ricci, and their two cats, Lola and Bella. Their building faces the Alvin Ailey Dance Theater where she gets to watch young dancers realize their dreams every single day.   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: Speaker 1 (00:01): Hi, Tricia. Welcome back to the podcast. Third time. Third time on I'm so excited to have you here. Speaker 2 (00:08): I am so excited to be birth. Third time, Karen, it's always awesome to talk with you. Speaker 1 (00:14): Agreed, agreed. Awesome to talk to you. Not to me. Now this month we're talking all about TEDx talks, how to get on that stage. We've spoken to, we're going to speak to a couple of TEDx speakers, which I'm really excited about and you help prepare speakers for the TEDx stage. So we've got a lot to talk about. My number one question is what is a Ted talk? Speaker 2 (00:43): This is such a great question. And for anybody out there who really wants to dig deep and go into the world of Ted Chris Anderson's book, the official guide to public speaking, Ted talks, the official guide to public speaking is really the place that you need to go. A Ted doc is an 18 minute or less talk. And Chris Anderson actually says, 12 is the new 18. It is a gift, not an anus. It is an idea, not an issue. And you want the audience to adopt your idea as their own. At the end of this talk, a Ted talk is an idea worth spreading, and it is really meant to get the audience to think differently. And there's very specific format and outline when it comes to what a Ted talk is. And I highly recommend you dig deeper with Chris Anderson's book. Speaker 1 (01:37): Yeah. And for those who are watching here, it is. I just happened to have it coincidentally right on my bookshelf next to me. So this is the book. Great. And, and because I do want to differentiate that a Ted talks, not a keynote talk, Speaker 2 (01:54): Right? A Ted talk is 18 minutes or less, and it's really all about getting the audience to think differently. A keynote is 45 to 60 minutes long, and the keynote is going to start out by you telling the audience why you're the credible expert to talk about this idea. You're going to share with us what you're going to cover. Then you're going to cover it. Then you're going to summarize what you covered. And then there's a very clear call to action, which is buy my book, sign up for my program, donate to a worthy cause. And when you're thinking about that in relationship to a Ted talk, it is so different because literally you can open a Ted style, talk with music. This is how I see the world though, through Spiaggia trickle lens, you can open with music with video, with compelling slides. And it's really about taking the audience on a journey from where you start. What is the idea worth spreading that you want the audience to think about, taking them on a personal journey, your personal story, or someone else's personal story, and then wrapping up so that they think differently and potentially walk out of that theater, adopting idea, adopting your way of thinking as their own and maybe even behaving differently in the world. Speaker 1 (03:06): Yeah. And I, a great example of that is a Ted talk from Ted X, Lincoln square that you produced on forgiveness. You know, the one, I mean, right. Speaker 2 (03:18): I do Sarah Montana, one of the most compelling speakers I've ever had on my stage, she applied to TEDx Lincoln square with a talk about forgiveness. The idea was about forgiveness and how do we teach people to forgive? We all know forgiveness is important. It's good for our health. It's really important, but nobody teaches you how to do it. So in her application, the written application, she submitted her talk about forgiveness with a personal story that her mother and brother were murdered on Christmas Eve. And I thought, how in the world is this woman going to be able to share an idea worth spreading from the stage where I don't feel bad, the audience doesn't feel bad. We are not just sad hearing her talk about this horrible tragedy in her life. So I gave myself the challenge Garren, I thought, okay, I'm going to challenge myself and ask her to submit a video because I could not imagine how this story could be shared in a way that was an idea we're spreading. Speaker 2 (04:22): That would get me to think differently. All I could focus on was the trauma. So she submitted this incredible video and what was wonderful about this, and this is really an important takeaway here. She was healed from the trauma. She did not share a vulnerable story before she was ready. And she was able to tell us the story. So she set up context and then take us on the journey of her journey of forgiveness and how she ended up forgiving so that we could potentially put into motion, her practices of forgiveness into our own lives. And that is an incredible example of someone who is sharing a powerful idea, worth spreading, also giving context and her personal journey so that we can observe as the audience member not feel bad, but observe and adopt this idea as our own. Speaker 1 (05:19): Yeah, I, it was such a powerful story. We'll have a link to it in the show notes. It was just so wonderful. And that actually leads perfectly into my next question is how does one get chosen? So you gave us a little bit of the backstory of how she was chosen, but for the listeners who are thinking, Oh, I really want to do a TEDx talk or a Ted talk one day, how does that happen? Speaker 2 (05:41): This is really great. You have a million search engines looking for Ted talks all the time. The best thing to do is start with cities, TEDx, Philadelphia, TEDx, New York, TEDx, Dallas, TEDx St. Louis TEDx, all cities. It doesn't have to be where you live, but there will be amazing Ted X events in major cities, TEDx, Los Angeles. That's where you want to start, because the reason you want to start there is that they will have been around for a while and they will know what they're doing. And we'll get into that leader of the next step is universities, TEDx, university of Nevada TEDx case Western reserve, university TEDx rush, you universities put on TEDx events all the time. And the other reason that's a great place to start is because they will have the support of the school. They will have the support of the, of the university. Speaker 2 (06:38): Tedx UCLA is an Epic event. It's really hard to get into that one. And it's wonderful. And that's because they've been around for awhile, they know what they're doing. So cities, universities, and then you can actually go to ted.com and they have a map of all the TEDx events in the world. So if you want to speak in Ghana, if you want to speak in the UK, if you want to speak in New Zealand, you can search the map and it will identify where those TEDx events are happening. And then you just get in touch with the organizer. So the next thing you want to do is subscribe to all of the TEDx events that you can get on their mailing list so that you are notified when the applications open applications are rolling for many events, meaning you can apply all year and many have a specific window. So you want to make sure that you don't miss that six, eight week window where their applications are open. And this happened to one of my clients. She lives in Chicago. I gave her the application information. We worked on her application for months, months so that it would be right. She knew the deadline and she missed the deadline Speaker 1 (07:55): For heartbreaking. It was Speaker 2 (07:57): So heartbreaking. There was a little bit of is this self sabotaging thing happening right now. So just know that they do close. So make sure that you understand if you're notified, get those dates on your calendar, create a spreadsheet for yourself. Because if you believe you're going to apply to one event and land that event, you're a unicorn. I Speaker 1 (08:18): Have had unicorns. Trust Speaker 2 (08:21): Me. I haven't had unicorns. I currently have a unicorn, Dr. Kristin Donnelley, we just started working together and her first application was accepted. So she's going to be speaking itself, Lake Tahoe in may, which is super exciting. It does happen. However, she'd got my support. So if you are working on applications, apply to as many as possible. And if you are chosen for more than one, guess what you can do more than one, or you can determine which one you actually prefer. And you can take that stage. So making sure that you start with cities, moved universities, go to ted.com and search that way. Google is not your friend here. There's a million million, million ways that you can go around that and find the actual events that you want to speak out. And Speaker 1 (09:07): Let's say, I, there are three TEDx events that I want to speak at. Can I submit the same talk to all three? Or should I have a different talk for each one? Speaker 2 (09:18): Submit the same idea. We're spreading to as many applications as possible. And when, and if you're chosen for more than one, you can determine with the organizer. When you want to switch your idea, most organizers, 99.9% organizers are not going to let you do the same talk at multiple stages. You can absolutely speak at multiple stages, but you want to speak with the organizer about, Hey, I just accepted TEDx South Lake Tahoe, and I'm talking about tolerance. Can I talk about empathy at your event? It's similar, but I want to talk about something different and you can have that conversation with the organizer. Speaker 1 (09:56): And when it comes to the applications themselves, is there, are there any tips or tricks or to make yourself stand out? Speaker 2 (10:08): Yes. Very, very important that you do not pitch your business. This is not about how to get sales. This is about an idea worth spreading. So if you have a business where you are connecting rescue animals, to people who need support and that's your business, that is not your idea. We're spreading. You have to dig deeper and find a reason to talk about why animals can serve us in humanity. The other thing is, if they're asking you a little bit about yourself, go, go above and beyond. Don't cut and paste your bio. Tell us who you are. Tell us that you love cooking. Tell us that you absolutely that you've been married. And then you have two cats or personal things. The reason that is going to make you stand out is because nobody else is doing it. I coach all of my speakers to incorporate who they are in that question. Speaker 2 (11:05): Tell us more about who you are. And that is because you want to be a human being. When producers are choosing their speakers, it starts with the idea worth spreading, and then it moves into do I want to work with this person for nine months? And if you are high maintenance or lazy by cutting and pasting a bio into the application, we take cues. We are looking for who you are in those applications, which means if I say, I want one line for your idea worth spreading, and you write three, you can't read directions. You're not going to follow the rules, which means you're going to be difficult to work with once I book you. So I'm not going to, I'm not going to choose you. If you submit a video. And I say, I want a two minute video and it's two minutes and three seconds. You just disqualified yourself because I have hundreds of other people who are actually following the rules. So it's really important when you apply to these events that you answer the questions they're asking, you do not pitch your business and do not cut and paste a bio because that tells us you're lazy or somebody else supplied for you. Not you. Speaker 1 (12:15): Ah, I love the rule following thing. I'm a rule follower, but it, you know, I think that's great for the listeners here because that's how specific TEDx talks are because hundreds of people are applying. So like you said, if I say one sentence, you give me three. They're not even, they're not, you're not going beyond that. It's a next Speaker 2 (12:38): That's right. That's how I do all of my operations. It, we don't have, but not brutal, but smart, efficient, efficient. Yeah. We don't have time to handhold. We want to work with speakers who we know are going to show up prepared. And if we say you have eight minutes that they're going to actually deliver eight minutes. Because ultimately, if you are working with an exceptional TEDx producer who knows how to produce a show, they are putting on a show. There is a journey here. There is an arc and a through-line to that performance, to that show, to that event, which means you're going to put you in specific orders as speakers so that the audience goes on a journey. And I say specifically, a good TEDx producer. And that's something that is really, really important to remember. Not all Ted TEDx events are created equally. Not all TEDx events are going to give you the support that you need. So it's really important that you understand that as well, when you're looking for events Speaker 1 (13:41): And how can you pick that out? Like if you're like a newbie to the TEDx world, this is your first time applying, how do you, how do you know who's good and who's not good. Speaker 2 (13:53): First thing you want to do is go to the YouTube channel and watch the videos from past events. If the sound is bad, if the set is wonky, if the lighting is terrible, you can't trust that event's going to be improved. If you decide you do want to speak, there, have a conversation with the organizer, making sure that they have the proper audio and video. That's the first place you want to start. The next thing you want to do is get in touch with people who have spoken at those events. And this is the thing that people are afraid of, or have not been given permission to do. Karen, it's reached out to other speakers who had the experience. They will tell you the truth. They, if it's a good event, they will tell you it's a good event. And they may even put you in touch with some of the organizers, some of the, the the volunteers, so that you can talk with them about the process. Speaker 2 (14:45): So make contact, reach out, ask all the questions you want to ask. Were the organizers micromanaging your script. If they were think about that, did they take your voice out of your talk and make it their voice? If they did, you need to think about that. You need to create boundaries immediately, which means I'm so excited that I'm going to be speaking at your event. I am very, very competent in terms of writing my script. I will absolutely take your feedback, but the final script is mine. Not yours, set boundaries right away. People are afraid to actually tell organizers what they want. And that's something that I want to invite you and all of you to give permission so that you take back the control. It's your talk. Now let's be real. You do not own that. Talk. Once you take a Ted stage, head owns it. It is forever there's you cannot do it anywhere else. So be, be mindful, your image and your script will belong to Ted for the rest of eternity, which is also why you do not want a bad video to end up on YouTube for the rest of your life, because you have zero control over it. You cannot take it down. So really important that you vet organizers and that you're clear on how they work, what the process is. And if it's something that you are willing to champion or risk. Yeah, I would be safe. Speaker 1 (16:15): So nervous to say that to a Ted organizer. I mean, just because that's my personality, as you know, I would be like, Oh, well, you know, I mean, this is, this is what I want to do. And if it's okay with you, I'd like to do it this way. So to be able to set those boundaries, but not be dismissive of them. Yeah. Speaker 2 (16:37): Right. Their event, you want to honor, it's their event and Bay. They are the producer of this particular TEDx event. And you can absolutely respect all of that. And I encourage you to take that very seriously. They're in charge and reminding them that it's your idea worth spreading. They chose you for a reason and they need to allow you to be your amazing self and not try to infuse you with something else in that moment. Speaker 1 (17:06): Yeah. And, and that makes perfect sense. And you just have to keep your, have your confidence in yourself Speaker 2 (17:12): And in what you're doing. Absolutely. And I've had speakers who are extremely seasoned that I've worked with, who have come back to me because the TEDx events will, will provide you with a speaker coach for free. And I've had clients come back to me and say, the speaker coach thinks we need to do it this way. And they want to take this out of our script. And I'm really freaking out right now. It's two weeks before the event and all these nerves. And like all this panic, my talk is terrible. All that happens until you say, thank you so much for your feedback. I really, really appreciate it. And I'm going to do the talk I've written and they all say, no problem, no problem. They all say no problem. Speaker 1 (17:53): Excellent. Well, that is great advice for, for those folks out there, like me who are like, Oh, I don't, you know, want to offend anyone. And so that is really, really good to know. And the other thing that you said earlier that I just want to circle back on is when you're vetting these TEDx producers, you said that this might be someone you're working with for nine months. What can you explain that Speaker 2 (18:20): If you are going to work with a TEDx producer or say yes to an event, it needs to be yes. To an event that is not two weeks from the day you're accepted my event applications, whether it was TEDx Lincoln square or speakers who dare applications opened up in September, I made the decision in December and then the event was in March. So January, February, there was three months of speakers preparing. Now. They were also submitting in September. So September, October, November, December, January, February, that's eight months where I was spending time with these speakers, watching their videos, reading their applications. So you will want to have at least three months no less to prepare for your event. If you're being asked to speak in an event that happens in less than four weeks, I would gracefully decline because you are not going to have enough time to write a powerful talk and memorize it so that you can be your best self on that stage. And trust me, it has happened many organizers. This is really important. The one question Ted X does not ask on the application to become a licensed holder and organizer is, do you know how to produce an event? Speaker 2 (19:52): Anyone can get a TEDx license if they go through the process and they're granted a license, not everyone knows how to produce an event. And that is why vetting is important. And it's also important for you to know that this is an opportunity for you to share a very important message that you care deeply about in order to serve in order to reach people. The Ted brand is a massive platform. You have an opportunity to end up on ted.com and reach millions of people, which is why you want to set yourself up for absolute success and have a runway so that you can write an amazing talk, get the coaching you need, and then perform it beautifully. And that leads Speaker 1 (20:39): Perfectly into my next question. You answered it a little bit just then, but what makes an exceptional Ted talk? Speaker 2 (20:48): If the talk is really truly an idea worth spreading, that's the audience to think differently. And if you are activating from the stage, which means, you know how to deliver this content in a way that is how is MADEC in control in command while also sharing the idea worth spreading. And it doesn't mean teaching. It means sharing the idea worth spreading gifting, this idea, making sure that it's not an issue. And it's truly an idea. For example, teachers in public schools do not get enough support financially. We all know that to be true. It is an issue. If we reframe that as teachers are the GPS of our children's future, that is an idea. So really be clear that you are sharing an idea worth spreading, that you were in command of the material that you care about it, and that you are gifting this material to the audience so that they adopted as their own. Speaker 1 (21:56): And that was a great example, just switching the, the framework of the title makes all the difference. And, and I like that. It's, it's an idea, not an issue, an idea worth spreading, not an issue that we all kind of know, or maybe take for granted or something, right? Yeah. And that makes a big difference. Okay. How do you prepare for a Ted talk or a TEDx talk? It seems so daunting. Speaker 2 (22:25): It's the same preparation. If you are a speaker for any kind of stage, you are about to take, you begin with the writing process. You write and you rewrite and you write and you rewrite and you edit and you kill your darlings and you end up hating your talk and you think it's terrible. And you get past that part of the process. And now you have your, your final talk, your script. Then you begin to memorize. There is nothing sexy about memorization. It is boring. It is wrote. It is hard work. It's bicep girls it's plays. It is over and over and over start with the first sentence, move to the second, finish that paragraph. If you cannot prevent yourself from glancing down at the script, you are not memorized in that first paragraph. Do not do not cheat yourself. You want to make sure that first paragraph is memorized before you move on to the next, once you have the next paragraph, go back to the burst and tie those two together with the transition. Speaker 2 (23:27): So the last sentence of the first paragraph with the first sentence of the second paragraph, connect those dots. Once you have that and you are in complete control of those two paragraphs, then move on once you've done that through the whole talk, start in the middle and go to the end. Then mistake speakers make again. And again is they have the first half memorized cause they keep starting at the beginning and then they get on stage and nerves happen and they can't remember the second half. Once you have it all memorized, go back to the middle and work on the middle to the end. Once you are truly memorized and you can also record yourself doing the talk and listen to it in the car and listen to it on the treadmill, listen to it outside. When you're walking, when we're listening to songs, we memorize them because we're doing it while we're doing something else. Same thing applies here. Listen to yourself, give the talk over and over and over and over once you're memorized and really memorized, then do what I call an Italian run through. And this is from the world of theater, fast as possible, no emotion at all. You just want to give the talk as fast as possible. So your synapses are firing and you know that, you know the words, the moment you don't know the words, that's the section you're not memorized. Speaker 1 (24:35): Yes. And I remember doing this in the speaker salon, and I will say everyone, all you people listening that what Tricia just said, how to prepare, how to memorize. It works. Like, don't think your way is better. It's probably not. This is what works. Trust me. I did this when I had to give a keynote talk a couple of years ago. And the other thing that you cannot just glance over is the writing process. Because Trisha, remember when I first came out and gave my talk and Trisha is so wonderful because she'll say, Oh, you know, I really thought this was very strong, but Mike, you think about, and then she'll give her feedback and it's such a gentle way to give feedback. And you can, you can expand on that in a second. But I remember giving my talk and you were like, is this about you? Speaker 1 (25:30): And I said, well, yeah, it is. And you were like, why are you doing it in the third person? So I have this clever talk. It was, I mean, it was all written out. I was ready to go. I was prepared. And like Trisha said, you're gonna edit, edit, edit. You're going to feel uncomfortable with it. And then you're going to do it. And that's exactly what happened. And it was all the better for it. So the other thing I would say is get feed back from a coach from a trusted person, because when you're in it, it's hard to see out of it. Speaker 2 (25:58): And we are not comfortable being vulnerable right away. We often need permission. We often need to have a safe place to become vulnerable. And that's what I witnessed with you. Karen, as you walked up on stage, super confident sharing the story, it was very compelling story and zero vulnerability. And the moment you told us it was about you and that it was about your chronic pain. We all leaned in and could not take our eyes off of you. It was the most powerful transformation. One of the most powerful transformations I've seen. And I've seen a lot when you're talking about feedback and this is really, I'm great. I'm really grateful that you brought this up. Karen feedback is paramount. And you also need to know when you're asking for feedback and from you. Many of my speakers in the past have asked for feedback one or two weeks before their Ted talk and we're not specific. Speaker 2 (26:58): And all of a sudden they're getting feedback from random people. I think you should change the beginning. I don't really like what you're doing with the choreography and the blocking is not good. And all of a sudden they have absolutely no confidence. And that's because they weren't specific in asking for feedback three months before the event ask for feedback from somebody you trust a coach, whomever, because you have time to make those adjustments two weeks or one week before your event. Let's say two weeks. I'd like to know if there's anything about this specific talk that you love week before. You're a warm body. I don't want you to say anything afterwards, except thank you for giving this talk. Right? So get really specific when you're asking for feedback so that you don't derail yourself a week or two before, you're about to deliver a talk that you have memorized and no longer have time to make adjustments. Speaker 2 (27:57): Yeah. And that is great advice. And it reminds me of advice that jazz, who we both know, lovely, lovely, jazz set on this podcast. She said, you know, cause we were talking about asking for feedback from people and she's like, you wouldn't leave your apartment to go get a cup of coffee and ask every person you passed on the street. What kind of coffee you should get? Because you're going to get a different answer. And it's just crazy-making. It is crazy-making and nobody needs crazy-making two weeks before they're set to give a Ted talk. No, that's the visualization making needs to be happening. You need to be visualizing what it looks like to walk out onto that stage. You need to be visualizing what it looks and feels like to be delivering perfect mandating, powerful idea, worth spreading. You need to be visualizing what it's going to feel like when they applaud and when they rise to their feet and give you a standing ovation, you need to be visualizing what it means to walk into an out of that red circle. Speaker 2 (29:01): And this is part of the deep preparation work that I do with my TEDx speakers and with my community and clients is it is a big deal to walk out onto that stage and deliver your powerful message. You can change and save lives by speaking, whether it's in the red circle or not. So taking the role of speaker seriously and understanding the magnitude of your responsibility requires you to go above and beyond. It's not just about memorizing and talk and going and doing performance. Think about how powerful it is when that person is going to be watching your video. And they're going to think differently. They're going to potentially behave in their lives and that ripple effect can reach every other person in their life. So it is a very big responsibility when you are speaking from any stage. So give yourself permission, set yourself up for success by going through the process. Speaker 2 (29:58): And that's why I say nine months, because you really want to give yourself enough time to identify that idea, cultivate that talk, frat that beautiful, powerful talk, memorize it in a way that is so solid. You, if the chandelier falls on your head, you could absolutely continue and then give yourself the success set up by visualizing, by knowing what you're going to eat. And at what time you're going to eat it before you take that stage so that your body is not using energy to digest, but it's using energy to support you as a performer. This is about being an athlete and any and everything that you can do. You want to shoot that ball into the, into that hoop over and over again so that your muscle memory is ready to go. It is game on and Kyrene did this so beautifully. We worked like an athlete, works repetition over and over mindset. Self-Sabotage we did every possible trick and, and practice in order to have her walk out onto that stage and own it. She got a standing ovation. Speaker 1 (31:06): Yeah, she's amazing. It was an amazing talk. And again, we'll have that in the show notes here as well. Well, you know, I was going to ask you, would you like to sort of wrap things up, but you already did it. That was a perfect way. Now, before we before we end the podcast where can people find you? And if you don't mind, can you talk about your new book? Speaker 2 (31:28): Oh my goodness. I would love to talk about my new book. I'm a new author and it is so exciting. It's all the influential voice saying what you mean for lasting legacy. And it is on presale now@theinfluentialvoicebook.com. And you can find me at Tricia, brooke.com. I'm on Instagram, LinkedIn, and the influential voice is really a book about how to be a good human being while also teaching you to effectively communicate on stage and off. And I wrote it in June of 2020 instead of going to Mexico for 10 days with my husband, because we were all quarantining inside. I decided to use that time to write a book about how to teach people, to communicate with dignity, respect, curiosity, and love. And it is my hope that it will teach people that their voice matters and how to use their voice for good in the world. Speaker 1 (32:25): Amazing. And what a great use of time during quarantine. Geez. I feel like I just like rearranged my apartment. You wrote a whole book. That's amazing. Amazing. Yeah. And so we'll have links to that as well. Now, Trisha, before we leave I've asked you this question a couple of times already, but you're going to get it again. At what advice would you give to your younger self knowing where you are in your life, Speaker 2 (32:51): In your career? You can not imagine what is waiting for you. So keep taking those forward steps, excellent Speaker 1 (32:59): And advice. And Tricia, thanks so much. This was fabulous. I think everyone here will be inspired. They will start looking up those TEDx stages and, and again, get your book, get Chris Anderson's book, Ted talks. I think there are two great resources to sort of set you up for success in your speaking career, regardless of you get on a Ted stage or not. So thank you so much for coming on. Thank you, Karen and everyone. Thanks so much for listening. Have a great week and stay healthy, wealthy and smart.  

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Jonas Sokolof, DO, a physician specializing in physical medicine and rehabilitation at NYU Langone’s Rusk Rehabilitation to talk about the importance of exercise therapy in cancer care.    In this episode we discuss:  What is Oncological Physiatry Use of exercise in improving function and quality of life  Lifestyle Medicine in Oncology Dr. Sokolof's baseball diamond analogy for rehab  The importance of collaboration in the treatment of patients live with and through cancer  Common side effects from cancer treatments And more!    Resources from this episode:  Round Table Talk: Cancer Rehab and Survivorship  More info on Dr. Sokolof NYU Langone Oncology Rehabilitation Summit: Optimizing Rehabilitation Outcomes Through Exercise   More About Dr. Sokolof:  I am a physician specializing in physical medicine and rehabilitation at NYU Langone’s Rusk Rehabilitation. After completing my residency training at Harvard Medical School, I subspecialized in musculoskeletal/sports medicine and interventional spine care. During this time, I acquired additional skills in the nonoperative treatment of various musculoskeletal conditions, including arthritis, lower back and neck pain, coccygodynia, neuropathy, dystonia, and tendinitis. As a physiatrist, my goal is to help my patients regain function through various nonoperative treatments, including rehabilitation, injections for spine and joint pain, and medication. Whenever possible, I try to avoid prescribing medications for long-term use and prefer a more holistic approach to patient care. For instance, I have expertise in osteopathic manipulative medicine treatment (OMT), also known as manual medicine. OMT is “hands-on care”; I use my hands to diagnose, treat, and prevent illness or injury, through stretching, applying gentle pressure, and using resistance. I often find this modality useful as a supplement to other treatments. If needed, I can also provide people with image-guided injections for the spine and peripheral joints. Additionally, I perform electrodiagnostic testing to diagnose and guide treatment of various neuromuscular disorders. A major focus of mine is the rehabilitation needs of cancer patients and survivors. My goal is to help individuals, from diagnosis to cure, improve overall function and quality of life. I have expertise in diagnosing and treating a variety of cancer treatment–related side effects, such as chemotherapy-induced peripheral neuropathy, radiation fibrosis, lymphedema, and post-mastectomy pain syndrome. As the need for physical rehabilitation grows in the field of oncology, I find it exciting and rewarding to help restore function in anyone who has experienced cancer. I’m also certified in sports medicine, so I’m experienced in treating sports-related injuries in cancer survivors and helping them return to sports and exercise routines. I am passionate about lifestyle medicine, an evolving field that focuses on lifestyle interventions, such as diet, exercise, stress reduction, and smoking cessation, to treat and prevent various chronic conditions and improve function. In my research, I explore lifestyle interventions to improve the lives of people who have had cancer. I also speak at the local and national level about rehabilitation programs for people with cancer. I am a co-chair of the lifestyle medicine counsel for the American Congress of Rehabilitation Medicine and a co-chair of the medical fitness working group for the American College of Lifestyle Medicine. Additionally, I sit on the executive committee for the American College of Sports Medicine’s Task Force on Exercise Oncology.   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: Speaker 1 (00:07): Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Hey everyone. Speaker 2 (00:36): Welcome back to the podcast. I am your host, Karen Litzy and this month, which is the month of April, 2021. We have focused our attention on cancer, survivorship, and oncological rehabilitation. To that end. I am thrilled to announce that on May 11th at 8:00 PM Eastern standard time, this is a Tuesday evening. We will have our round table talk focused on that subject. Oncological rehabbing cancer survivorship. All of the guests from this month will be on that round table talk. So that includes Kristin Carol Jillian Schmidt, Dr. Lisa van Hoose, and our guest today, Dr. Jonas Sokoloff. This is your chance to ask these four amazing experts, any question you want. And I know being a physical therapist going to conferences, I always want to try and get the person's attention to ask them a question. Sometimes you never get the chance. This is your chance. So if you have questions on oncological rehab on cancer survivorship, whether you're a physiotherapist, a healthcare professional fitness, professional, learning more about how to treat this population is imperative because a hundred percent of us are probably going to see someone who has cancer, who has lived through cancer in their lifetime. Speaker 2 (01:55): So how do you sign up? Go to podcast dot healthy, wealthy, smart.com click on the link that says round table talks, and you can sign up right there. And again, it's going to be Tuesday, May 11th, 8:00 PM, Eastern standard time. Now onto today's episode, like I said, today's guest is Dr. Jonas Sokoloff. He is a physician specializing in physical medicine and rehabilitation at NYU Langone Rusk rehabilitation. After completing his residency training at Harvard medical school, he sub-specialized in musculoskeletal sports medicine and interventional spine care as a physiatrist. His goal is to help his patients regain function through various non-operative treatments. And he also has expertise in osteopathic manipulative medicine treatment. Also known as manual medicine it's hands-on care. So he does use his hands to diagnose, treat and prevent injury or illness through stretching, applying gentle pressure and using resistance. A major focus of his is the rehabilitation needs of cancer and survivors is goals to help individuals from diagnosis to cure, improve overall function and quality of life. Speaker 2 (03:06): He has expertise in diagnosing and treating a variety of cancer treatment related side effects, such as chemotherapy induced, peripheral neuropathy, radiation, fibrosis, lymphedema, and post-mastectomy pain syndrome. As the need for physical rehab grows in the field of oncology, he finds it exciting and rewarding to help restore function in anyone who has experienced cancer is also sort of certified in sports medicine. So he's experienced in treating sports related injuries in cancer survivors and helping them to return to sport exercise and routines. And he is also passionate about lifestyle medicine as am I and ever evolving field that focuses on lifestyle intervention, such as diet, exercise, stress reduction, and smoking cessation to treat and prevent various chronic conditions and improve function. And we talk about that in the podcast today. What else do we talk about? Well, we talk about exactly what a physiatrist is and how they work in the field of oncology. Speaker 2 (04:06): We talk about some common side effects that people may experience from cancer related treatments. We also talk about the, his baseball analogy on rehabilitation and getting people back to their sport or back to life, which I love because I'm a softball player. So I had anything with a baseball analogy I'm all in. And he also talks about the importance of lifestyle medicine and why that's important, especially with cancer patients. And he lets us know exactly why that's so important. So a huge thank you to Dr. Socolow for coming on the podcast. And everyone don't forget to sign up for our round table on May 11th, by going to podcast at healthy, wealthy, smart.com and clicking on the round table tab. Enjoy everyone. Speaker 3 (04:59): Hi, Dr. Sokoloff welcome to the podcast. I'm happy to have you here this month, where we're talking all about cancer survivorship. So thank you so much for coming on. Oh, thank you very much for having me. It's really great to be with you. Yeah, this is really exciting. I'm definitely familiar listening to your podcast or floor gray while you're doing and you guys, my pleasure. Awesome. Well, thank you so much for that. And like I said, in your bio, you're a physiatrist and you're here at NYU. And we'll talk about that a little bit later, cause you guys have an oncology summit coming up and we'll talk about how people can sign up for that, but they have to listen to the whole, they have to listen to this whole podcast to get all the goods. So before we get into the meat of the discussion today, can you tell the listeners what oncological physiatry is? So uncle logical desires, you, maybe I should start by what is desire? Speaker 4 (05:58): You know, there's, I'm sure most of your listeners are well aware of what the field of desire tree is all about, but there may be a few that aren't so desire tree also known as physical medicine rehabilitation is a sub-specialty of medicine that involves essentially working with patients to enhance quality of life and physical function for patients that may be suffering from whether it's a an illness or an injury traumatic brain injury, spinal cord injury, or musculoskeletal injury. And it's a, it's a very multi-disciplinary field that overlaps a lot with orthopedics neurology, internal medicine rheumatology sports medicine, and, you know, several others. So you kind of have to know a little bit of everything, but basically the main goal of [inaudible] is to enhance quality of life and physical function. Now in oncological, physiatry is, is sub specialty. Speaker 4 (06:57): So we are experts in neuromuscular and musculoskeletal and other functional impairments that directly affect you know, people living with the beyond cancer, whether it's from the actual cancer itself or from the treatment of cancer. So surgery, radiation, systemic therapies, chemotherapies, immunotherapies, targeted therapies, et cetera. So in a nutshell, that's, that's, that's essentially what the field is about and what drew you to this subspecialty. So I am a sports medicine trained physiatrist. I did three years of a physical medicine rehabilitation residency. Before that you have to do a, a year of a general internship. And then I went on to do a three-year residency in PMNR. And then after that I did another year long fellowship and what's called spine and sports care or spine and sports medicine. So I received training in sports medicine care. So sort of like non-surgical orthopedics, interventional spine psychiatry, injections under fluoroscopy and under ultrasound. Speaker 4 (07:59): And, you know, I thought I was going to, you know, treat, you know, weekend warriors and, you know, athletes and, you know, yoga moms and so forth. And you know, essentially non-surgical orthopedics. But for me, I learned kind of early on in my fellowship year that, you know, I, I tend to kinda get bored doing the same thing, you know, over, over and over. And I, I really liked the variety and really like the challenge. And there was an opportunity to major cancer center in New York where they were looking to hire another physiatrist. They already had two physiatrists and they were looking at another physiatrist who actually had more of a sports medicine, interventional background. And I ended up applying for the position and it was, I was so impressed with the institution, but more importantly, I was, I was really impressed with this opportunity to really make a big impact in the field of oncology and really help like enhance the quality of life for people living with and beyond cancer. Speaker 4 (09:03): I just felt for me, that was more meaningful because there's such a huge need. Unfortunately, people who have the disease of cancer and go through treatment through the whole continuum, they have a lot, a lot of problems with, you know, getting back to the way, the level of functioning and quality of life that they had prior to their diagnosis. There's just a tremendous need, but we've gotten so much better at treating a variety of different types of cancers keeping people alive longer. Unfortunately a lot of these treatments do have a lot of sequelae that, you know, the oncology field, it's just not, they're just not well equipped to deal with these issues. And that's where we really shine as rehabilitation professionals because we are the experts in physical function and quality of life, and we really can make a difference. And I liked that feeling of really being able to make a big difference in the lives of these people. Speaker 3 (09:59): And you had mentioned in there that a couple of things that stood out to me, one that there are more people living after and beyond cancer than before, because of I'm assuming better treatments, better detection. Correct. And you also mentioned that there are side effects from some of these treatments and interventions. And I think oftentimes people think physical therapists alike think, Oh, someone had cancer, they survived it, they must be fine. So what do you see as the most common side effects and where can rehabilitation physical rehabilitation make a difference with those side effects? Speaker 4 (10:44): I would say probably amongst the most common side effects that I see, for example. So I see a lot of breast cancer patients and survivors in my practice and a lot of head and neck cancer survivors, a lot of prostate survivors. I'd say, you know, sequentially after surgery, for example, after mastectomy, or even in breast conservation, surgery, lumpectomy, and so forth. Whereas like you're, you're right. Patients, essentially in many, in many cases they're diagnosed early. They are, you know, very high success rate. The achieved cure is very often, but unfortunately a lot of these people, these individuals are left with a lot of pain and dysfunction, everybody heals at their own pace or rate. So their ICL, I see a great deal of patients who, whereas it it's expected that they're going to sail through their, their treatments. And men, many instances, they have achieved the events they have achieved you know, complete remission, but yet in some way, they're, they're left kind of broken and they're not able to get back to their baseline level of functioning. Speaker 4 (11:50): They have, they may have prolonged pain that lasts longer than what would be expected. They may have more scar tissue. And there's there. These factors may be, are usually multifactorial lifestyle factors come into play. Underlying premorbid conditions come into play you know, whole host of factors. And in many instances they are not, they don't recover as fast and they need a lot of help. So I'd say the biggest, you know, impact. I think the, in my practice, I would say in our breast cancer patients, we see a lot of patients with post-mastectomy pain syndrome pain that lingers way past the recovery period with scar tissue that often results in shoulder dysfunction adhesive capsulitis rotator, cuff dysfunction and impingement, bicipital tendonitis, various other factors that really adversely affect people's abilities to get back to like their life. That's one example that comes to mind, radiation fibrosis. Speaker 4 (12:55): So, you know, chemotherapy, radiation being the cornerstone of treatment for head and neck cancers, a great deal of morbidity there, you know a lot of scar tissue that forms after radiation, that impairs neck range of motion, ability to open your mouth trismus swelling, lymphedema in the head and neck population. Nobody, nobody knows how to handle these types of issues, but as rehabilitation professionals are really well equipped in you know, are able to really make a big impact in the lives of these folks. So I'd say those, those two populations really stand out to me and they are, they do make up a majority of my practice. Speaker 3 (13:37): And one thing that rehabilitation professionals are really proficient as in is exercise. So how can exercise help with these patients to improve their function and quality of life? Speaker 4 (13:49): Right? So we do have very robust data in the form of randomized controlled trials that exercise both aerobic training and resistance chaining can actually help improve several different cancer-related health outcomes. And that includes overall physical functioning lymphedema, anxiety, depression, overall, quality of life and wellbeing. And this comes from, you know, a tremendous amount of rigorous, you know well-designed clinical trials. So we do have, we now have really great evidence supporting this. We actually know that it, that it can be used as medicine, and we all know, I'm sure your listeners are well aware that exercise is medicine and really in oncology, this is actually even more apparent. Speaker 3 (14:39): And when we think about these patients living with and living beyond and through cancer, one of the things at least that I've seen with a lot of my patients that I have seen is that fatigue is an issue. And so when we're thinking about exercise, so as physical therapists, you're sending your patients to us, fatigue is a big issue. Do we center our treatment approach around a graded approach to exercise or to a paced approach to exercise? Or is it one of those answers that it depends. Speaker 4 (15:11): So it's all it's should be a personalized approach, right? It's really not a one size fits all. And that's why, again, it helps to be, you know, it helps for a patient to work with a highly skilled trained rehabilitation professional so that they can really hone in, do a full comprehensive assessment and really understand, you know, what exactly that particularly low patients struggling with with the impairments may lie what their history has been and order to come up with a real, you know, comprehensive, structured, personalized program. Oftentimes we use in rehabilitation, we're using a therapeutic exercise program. So for example, patient has, let's say rotator cuff dysfunction, right? They have imbalance of their scapular scapular stabilizing muscles, right? And they may have altered glenohumeral mechanics that are promoting this condition of impingement, let's say of the supraspinatus tendon and that leads to pain, loss of range of motion. Speaker 4 (16:14): And then that then progresses to let's say, adhesive capsulitis or frozen shoulder, for example. So we would, we would construct a therapeutic exercise program specifically honing in on that specific dysfunction, right. The shoulder. But we can also use, you may say generic exercise. We could use aerobic training and strength and conditioning on top of the therapeutic program, all from a personalized standpoint for what meets the needs of that specific patient in conjunction with a therapeutic exercise program. And that's where I think really where the field is headed is really being able to the goal should not just be, to get the patient out of pain, would get them back to, you know, being able to do some of their life specific activities, but also getting them to an exercise program that should be one of the main goals of ecological rehabilitation program. Speaker 3 (17:10): And I think that's great advice for all the physical therapists and physiotherapists out there listening is that when these patients are coming to you, like we'll take the example of shoulder pain post-mastectomy or post some sort of treatment that we don't want to just focus on. Let's just do exercises and rehab around the shoulder, but let's take it broader and try and make this into like a lifestyle change for the patient. Speaker 4 (17:40): Exactly, exactly. There's a there is a diagram that I often use on a lot of my talks when I lecture on this subject. And it's Speaker 5 (17:50): The baseball diamond approach to rehabilitation is a approach that is utilized in sports medicine. It was it was passed on to me by some folks some physiatrists at the Mayo clinic. It's very simple way to think about it, but essentially your goal is to get, get to home plate, get back to return, to play, you know, so to speak or return to life, do advance through all the bases to get the first space you have to restore range of motion from first base to second base. And you have to start to work on strength from second base, third base. Now you're starting to work on the neuromuscular kinetic chain on the pitcher's mound. You really want to put an exercise program that they should be able to be able to do for the rest of their lives. Because what it's going to do is actually going to, it's going to improve survival. Speaker 5 (18:32): It's going to improve cancer related you know health outcomes. Okay. So it's gonna help them to improve. It's going to help to improve anxiety, fatigue, physical functioning. And this is another thing that I really love about the field of oncological rehabilitation, because not only are we helping to restore quality of life and overall physical function, but we actually have the opportunity to make an impact on the disease itself. We actually can, as rehabilitation professionals can actually change the course of the disease by getting our patients back to a safe and effective exercise program. So it really needs to be incorporated into rehabilitation. It really should be all part of what we're doing as rehab professionals. Speaker 3 (19:14): I really liked that baseball diamond analogy. And, and oftentimes when we think of that return to play, I know the first thing that comes to my mind is as an athlete. So you're getting them back to their sport, whether whatever that sport may be, but you're absolutely right, that that same framework can be used for all of our patients. They have to get back to, it may not be back to the soccer pitch or the baseball field, but they are getting back to returning to play, which is their life Speaker 5 (19:49): That's correct. And even back to their familial roles, there's societal roles, there are vocational roles really getting them back to the things that they want to be doing, the things that they need to be doing to live out the rest of their life. Speaker 3 (20:06): Yeah. I love that baseball diamond going to be using it all the time. I love it. Especially as a former softball player and a former pitcher, I can definitely relate to that. Now we've been saying this word a couple of times throughout the interview, and that is lifestyle. So there is this lifestyle medicine, branch of medicine. So how does that fit into the oncology patient in the world of oncology? Speaker 5 (20:34): So two thirds of the world's cancers, according to the world health organization can actually directly be linked to lifestyle, right? So smoking alcohol dietary intake lack of physical activity, increased stress levels and so forth. So we have as rehabilitation professionals, the opportunity to intervene to provide lifestyle interventions and again, help restore physical function, but also have a major impact on the, the course of the disease itself. So I believe that lifestyle medicine actually should be, is a very important aspect of what we offer in rehabilitative care, especially in on-call oncological rehab. So I try to incorporate it into my practice counseling patients and educating patients on proper nutrition, certainly exercise. We do a lot of cancer counseling and exercise. We offer stress reduction techniques. Certainly when, when patients are smoking we, you know, get them as soon as we can plugged in with smoking cessation programs and so forth and so on. So because there is such a direct relationships to lifestyle and cancer it, it has to be a key component of the rehab plan as well. Speaker 3 (21:51): Yeah. And that, that is all in our lane. Speaker 5 (21:54): Exactly, exactly. Yeah, I mean, you know, the F really up until, you know, recently the thought process, you know, cancer essentially had a very strong genetic component. But right. The it's the way the, the environment or lifestyle is affecting those genes, which we know that, that poor lifestyle can actually turn on a lot of those oncagenes and promote you know, promote cancer growth. So yeah. Speaker 3 (22:26): Yeah. And so what is it coming from you from your position as a physiatrist? What are some things that you really want physical therapists to know when it comes to treating patients that have, or have lived through cancer, Speaker 5 (22:43): Physical therapists that it's, it's safe to put these folks through an exercise program it's safe to put them on a resistance training program as long as it's, you know supervise and as long as, you know, if you're working with a physical medicine rehabilitation physician or a physiatrist, it's really great to partner up so that you can learn, you know, what would be a safe way to approach, for example, a patient with metastatic disease in the spine or metastatic disease somewhere else. You know, in the, in the skeleton, for example, cause I think a lot of therapists may be apprehensive. They don't want to, you know, cause a fracture, for example, they may not want to injure a patient and they're not sure what would be safe. Just know that it is safe when it's done, you know, under the supervision of someone who's as skilled, as trained as yourself, but also helpful if you have members of your oncology community that you can communicate with and determine you know, what would be the great, the best plan for that patient and what would be the safest plan? Speaker 5 (23:57): I mean, therapists were, we, we were in constant communication about the patients programs in our, in our at our site as to what, how you can progress them through an exercise program safely based on, you know, review of imaging and based how, and then how they present clinically. So yeah, I mean, I, I would, I would just say, I think, you know, a lot of these patients can tolerate probably a little bit more than what's been previously done in the past. Speaker 3 (24:29): Awesome. Well, thanks so much for that. And hopefully all the physical therapists and physios and even other healthcare professionals listening or taking notes on all of this, cause this was great. Let's talk about the NYU Rusk rehab. They have an oncology summit coming up. Is it in October, Speaker 5 (24:49): October 1st, it's going to be Speaker 3 (24:51): Featuring our very own Nicole Stout as a keynote. We love her here. Love her, love her so much. So go ahead and talk a little bit more about that. Speaker 5 (25:00): So we are having our first you know, annual uncle logical rehabilitation summit Ruskin suit, NYU school of medicine on it's gonna be October 1st, it's going to be a hundred percent virtual. Eventually as we come out of the pandemic, we will hopefully transition to an in-person program. But this year we're going to starting off as virtual. And the theme of this year's symposium is going to be exercise oncology. So we are going to have oncologists lecturing, certainly physical therapists, speech therapists, occupational therapists Dr. Katie Schmidts, the CSM round table leader in luminary in the field of exercise oncology as well as Nicole Stout, excited to have them are two keynote speakers are really looking forward to providing a robust program for anyone interested in how to implement exercise into a rehabilitative care plan for oncology patients. Speaker 3 (25:58): Yeah. And it's like total coincidence. I got the email for that. Like a couple of days ago, I was like, Oh, this is perfect because here we are doing this interview. So this worked out very, very well. And now where can people find you, if they want to ask you questions, they want to connect with you? Where can they find you? Speaker 5 (26:17): My email probably is the best. I'll definitely find putting it out there. It's my first and last name, so that's Jonas, J O N a S dot SoCal off that's S like Sam. Okay. O L like Larry off, likeFrank@nyulango.org, one word, NYU llangollen.org. Speaker 3 (26:37): Perfect. And we will have all of this links to sign up for the summit and your email in the show notes for this episode at podcast at healthy, wealthy, smart.com. And last question that I ask everyone, is that knowing where you are now in your life and in your career, what advice would you give to yourself as let's say, fresh out of medical school? Speaker 5 (27:05): What would the advice would I give myself fresh out of medical school? I would say, you know, I would say, probably go with your gut. Right. You know, there's a lot of pressure. I think when you're, when you're going through medical training and medical school you know, pulling in different directions on planning your career you have a lot of different factors, financial and I think, you know, I always had wanted to, into going to have a medical career that was going to make a big impact. I think I got a little bit sidetracked along the way, and I, I kinda may have been chasing a different dream, but then when I finally realized what I think what I was meant to be doing, it really kind of brought me back in line on my path. So I'd say, you know, just really follow your gut, you know, pursue your dreams. You know, really go with what you feel is right deep down in your heart, and now you really can't go wrong. So Speaker 3 (28:06): I love it. Great advice. And, and frequently heard advice here on this podcast. So it must be a good one. So, Dr. Sokoloff thank you so much for coming on today and look forward to seeing you at our round table discussion in a couple of weeks. So thank you for that as well. So thank you. Thank you. Thank you. Speaker 5 (28:26): Thank you. I'll look forward to the round table. Speaker 3 (28:28): Yeah. As in everyone for listening everyone out there listening. Thanks so much. Have a great couple of days and stay healthy. Speaker 1 (28:34): Be wealthy and smart. Thank you for listening. And please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.  

In this episode, Associate Professor and Program Director in the Physical Therapy Department at the University of Louisiana Monroe, Dr. Lisa VanHoose, talks about the provider role in cancer survivorship. Today, Lisa talks about implicit provider bias, survivorship as a concept, social determinants and healthcare access, and provider trust. How can physical therapists help lessen the overload? How do you determine whether or not you’re a trustworthy provider? Hear about the effects of cancer on co-survivors, get some advice for screening when working with cancer survivors, and learn about the disease burden on marginalised communities, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways The definition of cancer survivor: “You become a survivor from the time of diagnosing.” “When we talk about survivorship, it really is a conversation about how well are you able to live your life.” “Cancer and its treatment is one of the top causes of bankruptcy in the US.” “Cancer and Alzheimer’s Disease are two chronic diseases where we’re seeing the caregivers die earlier than the survivor because of the caregiver burden.” “Medical access accounts for about 20% of someone’s health outcomes.” “Cancer survivors who have unmet social determinants of health are more likely to miss appointments.” “If you want to know if you’re a trustworthy provider, you should probably ask.” “You can condition yourself to have less bias, but you have to actively do it.” “100% of physical therapists are going to see someone who had cancer or has cancer.” “Everyone needs to be doing a self-assessment of where they’re at in regards to their own biases.” “African American women were dying at rates 3 to 4 times higher than those of their Caucasian peers.” “That difference in healthcare is avoidable if we would just stop and be intentional about the care and the way in which we deliver care to each other.” “We’re one decision away from someone having a different type of cancer survivorship journey.” “Although we know cancer survivors are recording these side-effects to cancer and its treatment, only about 20-30% get referred to a provider to address them.” “In our quest to provide care for others, we forget to refresh and replenish ourselves.”   More about Lisa VanHoose Dr. Lisa VanHoose is an Associate Professor and Program Director in the Physical Therapy Department at the University of Louisiana Monroe. Dr. VanHoose received her PhD in Rehabilitation Science and MPH from the University of Kansas Medical Center. She completed fellowships at the University of Arkansas Medical Sciences Donald W. Reynolds Institute on Aging and the National Institute of Heart, Lung, and Blood Institute PRIDE Summer Institute with an emphasis in Cardiovascular Genetic Epidemiology. Her Bachelor of Science in Health Science and Master of Science in Physical Therapy were completed at the University of Central Arkansas. Dr. VanHoose has practiced oncologic physical therapy since 1996. She is a Board-Certified Clinical Specialist in Oncologic Physical Therapy. As a NIH, PCORI, and industry funded researcher, Dr. VanHoose investigates socioecological models of cancer related side effects with an emphasis on minority and rural cancer survivorship. She has been an advocate for movement of all persons, including the elimination of social policies and practices that are barriers to movement friendly environments. Dr. VanHoose served as the 2012-2016 President of the Academy of Oncologic Physical Therapy of the American Physical Therapy Association. She currently provides oncology rehabilitation services through the Ujima Institute, PLLC, as the owner and service provider.   Suggested Keywords Physiotherapy, Research, PT, Health, Therapy, Healthcare, Cancer, Oncology, Survivorship, Rehabilitation, Mental Health, Providers, Biases, Movement, Wellness,   To learn more, follow Lisa at: Website:          https://www.ujimainstitute.com                         ULM - Lisa VanHoose Facebook:       Ujima Institute Instagram:       @ujima_institute Twitter:            @LisaVanHoosePT                         @UjimaInstitute LinkedIn:         Lisa VanHoose   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 Transcript:  Speaker 1 (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. Speaker 2 (00:35): Hey everybody. Welcome back to the podcast. This month is all about cancer survivorship. So if you missed the episode two weeks ago with Christine Carol and Jillian's Schmidt, make sure you go back and listen to that episode. Lots of great information, especially for providers on how to treat people with cancer currently, or cancer survivors. Now today's episode is brought to you by net health and tomorrow, which is Tuesday, April 20th, net health has a three-part mini webinars series bet with best-selling author, Stacy Fitzsimmons and Kelly Castillo of net health. They'll be talking about the three T's of creating revenue ownership beyond just billing beyond just the billing department, training tools and transparency. Stacy and Kelly have over 25 years of combined experience helping private practices give the best possible care while increasing their revenue head over to net health.com/litzy. To sign up as a bonus. If you put Litzy in the comment section and show up, they've arranged for net health to buy lunch for your office. Speaker 2 (01:44): Once again, that's net health.com forward slash L I T Z Y. So head over and sign up now and moving on to today's episode again, following in our theme of the month, which is cancer survivorship. I'm thrilled to have on the program, Dr. Lisa van hus. She is an assistant professor and program director in the physical therapy department at the university of Louisiana Monroe, Dr. Van who's received her PhD in rehab science and MPH from the university of Kansas medical center. She completed fellowships at the university of Arkansas medical sciences, Donald W. Reynolds Institute on aging and the national Institute of heart lung and blood Institute pride summer Institute with an emphasis in cardiovascular, genetic epidemiology, her bachelor of science in health science and master of science and physical therapy were completed at the university of central Arkansas, Dr. Van, who says practiced oncologic physical therapy since 1996. Speaker 2 (02:40): She is a board certified clinical specialist in oncologic physical therapy as an NIH, P C O R I and industry funded researcher, Dr. Van who's investigate socioecological models of cancer related side effects with an emphasis on minority and rural cancer survivorship. She has been an advocate for movement of all persons, including the elimination of social policies and practices that are barriers to movement friendly environments. She served as a 2012 to 2016, president of the Academy of oncologic physical therapy of the APGA. She currently provides oncology rehab services through the Ujima Institute PLLC as the owner and service provider. So on today's episode, what do we talk about? Well, it's all about the provider. So in today's episode, Lisa talks about implicit provider bias, survivorship as a concept social determinants of, and the healthcare and healthcare access and provider trust. So how can physical therapists help lessen the overload? How do you determine whether or not you're a trustworthy provider we'll hear about effects of cancer on coast survivors, get some advice for screening when working with cancer survivors and learn about the disease burden on marginalized communities. So there's lots to dive in. This is a long episode but it is well worth it. I highly encourage you to listen to the very end because everything is so good and you will get so much information from Dr. Van who, so I want to thank her and thank net health and thank you for listening. Speaker 3 (04:20): Hey, Lisa, welcome to the podcast. I am very happy and honored to have you on, so thank you. Thank you. Hi, everyone. Super excited to be with you today. And now all this month, we are talking about cancer survivorship. This is your research. This is your wheelhouse. This is what you teach. So let's get to it. What we're going to talk about today is provider bias in that lens of cancer survivorship. So can you tell us how that works and what that is? Yes. So I think most of us are now familiar with the term implicit bias because of all the things going on in the social environment, right? So implicit bias is basically those preferences, attitudes, stereotypes that we might have towards a person or towards a specific group of people. And so when you talk about provider bias, it's that implicit bias, but it's something that is hailed by a provider that might then potentially impact have a interact with that patient or client, and even the decision-making process for that client and the research to just that it, a lot of times occurs either subconsciously or unconsciously. And so we're not even realizing how we might be negatively impacting somebody's care. And how can that provider bias affect outcomes affect treatment and affect the survivorship of these cancer Speaker 4 (05:58): Or patients with cancer. I don't want to say cancer patients. I want to say patients, people with cancer almost, almost, almost set it wrong. Speaker 3 (06:09): No worries. So when you think about provider bias so the research should just that most of us have a bias towards people that are a bigger body size or what we call obese, right? And so if you were a PT, a nurse, a physician, and you were talking with someone that is of a larger size, and they're trying to articulate to you that maybe their knees hurt, or maybe they've got, you know, some type of discomfort provider bias might make you minimize their complaint. It might make you not do a full assessment because you're like, ah, it's just related to their weight. Or you might just go, well, you know, it's part of their lived experience because they chose to be fat. And so there are things that instead of us doing the standard care, we actually will deviate from it because of our bias. Speaker 3 (07:04): And so where we see that happen, where that has an influence on cancer survivorship is we know that every cancer survivor will have at least one physical impairment and most of the time it's fatigue, but let's say that cancer survivors, someone who identifies as as a sexual orientation, that's not heterosexual. And you as a provider, you may believe that, you know, there's a moral or religious issue with that. So then when that person's talking to you about their fatigue, as it relates to maybe their sexual activity, or maybe just how it relates to their everyday life, you may decide consciously or unconsciously to not listen. Or you may decide that, you know what, that that's, God's answer to, you know, their, their lifestyle choice. So, sorry, y'all just, somebody is having a healthcare emergency right now. Speaker 4 (08:06): That's okay. Normally it's on my end because I'm right on Broadway. So there's always a siren going off. The listeners are used to it, please continue. Speaker 3 (08:14): So I think when we think about, you know, someone's care, we're all talking about, you know, high quality care and standardized care and trying to minimize variations. But a lot of the variations we see are related to our biases. Speaker 4 (08:29): And so let's talk for a minute about, so we know outcomes may be different because of this provider bias. And, you know, we are talking about cancer survivorship, but there's a difference between you're alive. You lived, you survived and the concept of survivor ship. So can you talk a little bit about that and how again, where that bias may play a role? Speaker 3 (09:01): Yes. So the new definition for cancer survivor is that you become a survivor from the time of diagnosis. And so often we think of that as binary, right? Are you alive or not alive? When we talk about cancer survivorship, it really is this conversation about how well are you able to live your life? Right? So regardless of the cancer diagnosis are, do you have the resources that you need to live the life that you choose at the best level that you so choose? And so when we talk about survivorship, now we want to know about all of your physical wellness. We want to know about your emotional wellness. We even talk about financial wellness because one of the side effects to cancer is financial toxicity cancer and his treatment is one of the number one causes of bankruptcy in the United States. So survivorship is really about how well are you able to live your life? Speaker 4 (10:05): And I would also have to assume that within that survivorship is the environment in which you're surviving. So can you talk a little bit about that as well? Speaker 3 (10:14): Beautifully stated. So the hot topic everywhere right now is social determinants of health. And I think that is also just as true for cancer survivors. And I also want to say their caregivers because when we talk about cancer survivorship, we want to also talk about the coast survivors, right? So a lot of times we'll focus in on the cancer survivor. But the work that we did in Arkansas, a couple of years back, we went throughout the state talking with cancer survivors and caregivers. And the thing that cancer survivors told us over and over again, was I'm more concerned about my loved one. I'm more concerned about my coast survivor because everyone's focused on me as a person with cancer, but no one is thinking about the lived experience of my of my caregiver. And I was at a conference once and they were talking about how that cancer and Alzheimer's diseases, Alzheimer's disease are two chronic diseases where we're actually seeing the caregivers die earlier than the actual survivor, right. Because of the caregiver burden. And so that's a trend that people are watching in the data. So, yeah. Speaker 4 (11:29): Yeah. So it's, it's more of, it's more than just the patient, it's the caregiver and it can also be their community. Do they have access to their treatments? Do they have access to the things they need to help them survive and survive? Well, if you're living perhaps in an area that you don't have access to a lot, these things might Speaker 3 (11:54): That also be something that can cause a bias in the provider, almost definitely. So I think you have to think about all of the social determinants of health. So in the, the literature suggests that the medical access, like the healthcare access, a counselor, about 20% of someone's health outcomes. Now we do know that your ability to get to a provider of choice is important. And we also know that people typically don't want to travel more than a 20 minute drive to get to care, but there are some areas where people are driving hours. I remember when I was in Kansas practicing, I had clients that would drive three to four hours one way to see me. And so when you think about cancer survivorship, and we know one of the number one complaints is fatigue. If you're driving three to four hours to get to therapy, then the expectation is you're going to work with a therapist for an hour, hour and a half. Speaker 3 (12:58): It's just not a realistic journey. So we have to figure out a way to improve access. Most definitely. We also have to think about the fact that, that it's not just can someone access care, but can they access high quality care? So there is a time and a place for generalists. I totally love my generalist, right. Shout out to you. But then there also Toms for specialists. And so there are certain geographical areas where it would be really difficult to find a specialist in cancer, be it an oncologist, be it a PTB in an OT, be it a dentist. So we have to think about those issues when we talk about healthcare access. But then you talk about the 80% and the 80% are going to be the things like what is the environment that that person with cancer has to live in. Speaker 3 (13:50): So like I'm here in Louisiana and Louisiana has a stretch of highway that's known as the cancer corridor, right? Because we have hundreds of production, meals and industries that have a lot of waste products. And so because of that, we see this uptake in cancer prevalence, we see a different survivorship experience for those cancer survivors because they're constantly exposed to these environmental exposures. So I think, you know, that's one thing when you think about cancer, survivorship is what is the environment in which they're living right now? We're talking to everybody about, you know, physical activity, the, the APA has just launched a physical activity campaign, but then you have to think about, okay, what, what is their green space availability? Is it safe for them to be out and walking, right? Then you have to think about how are they going to fuel that movement. So are they close to grocery stores, right? Or, you know, community gardens. So I think when we think about cancer, survivorship, healthcare is one piece, but then we also have to think about all those other determinants of health as well. Speaker 4 (15:02): And it's does it not seem overwhelming? I mean, gosh, to me it sounds, seems so overwhelming. So how can as providers, let's say, as physical therapists, healthcare providers, what can we do to help lessen that? What that Speaker 3 (15:19): Overload? Yeah. So I think if we, number one, just all can agree that we have some level of implicit bias because we're all animals. So therefore we are slightly tribal in animalistic, which means that you're naturally going to have a preference towards people who look like you or people who act like you or think like you, so you have to engineer the system to combat that. And the best way to do that is with screening tools, right? So could you introduce a screening tool that asks that client about their cultural beliefs and their lived experience? Right. so then that way you can incorporate that into their care because I was pulling up some articles that looked at the lived experience of black or African-American and Hispanic or Latino X cancer survivors. And one of the things that they talk about is the fact that their provider, who is often, you know, someone who identifies as white, doesn't really ask them about their life. Speaker 3 (16:27): They might give them instructions, but doesn't ask them about the context right. In which they're supposed to implement this. And they're like, that's part of the reason why I don't follow those instructions and then they get dinged for noncompliance, right. Or, or non-adherence, and they're like, that person never asked me anything about me. So could you potentially introduce that as a screen in regards to kind of getting some information about their cultural values and beliefs, and then introduce a social determinant of health screen. So then you can find out kind of what their needs are because one of the articles I pulled up was talking about how that cancer survivors who have unmet social determinants of health are more likely to miss appointments. And so how often do we all get frustrated at that patient? That's a no show. Well, have you asked them about what's going on in their life and then help to align them or connect them with some community resources, because that might be the root of a no-show right. So I would say start off with some screening. Speaker 4 (17:37): Yeah, that's great. And you know, we had a conversation last night on clubhouse with a group of physical therapists and it was about the female athlete, but one of things that Speaker 2 (17:50): Was very clear is, are we asking the right questions? And I think that completely aligns with what you just said. So what is your food security? Like, what is your home security like, right. Do you have children? And this is another one, do you have pets? But if you have, what is your responsibility in your home life? If you have a dog, if you live alone or do you have to walk this dog? We just talked about fatigue being one of the major aspects. So what if they have to walk their dog three times a day and they have physical therapy that day? Well, which one do you think is not going to happen? Speaker 3 (18:28): Exactly great points. You know, Speaker 2 (18:31): These are all great questions to ask. So it's, we're asking questions, but are we asking the right questions? And I think that was a solid point that you just made. Speaker 3 (18:41): I love that. Are you asking the right questions and then are you living? Speaker 2 (18:47): Hmm, well, even more important because like you just said, implicit bias can make us our brains be like, blah, blah, blah, blah, blah, blah, blah. Oh, were you saying something or, or, you know, Speaker 3 (19:01): Often someone will say something, someone will tell us what they value and then, because we don't value that we'll minimize it and that might've actually been the secret sauce to them being able to achieve their healthcare goals. Speaker 2 (19:15): Yeah. Yeah. Another and again, gosh, another great question that was brought up yesterday is, well, what kind of successes are you having right now? And then, like you said, that might be it, that might be the secret sauce. So if we're not tuned in, are we going to miss it? Speaker 3 (19:33): Great points. And then I think often as providers, we tend to ask all the questions about the negatives. And especially when you add in your provider bias your implicit bias, because we've been conditioned to think so many negative things about different subgroups. So we automatically start asking them all these questions about all of these negative things that we think should be occurring in their life. So I love this concept of saying, well, what's going well, right? What are the successes? Because then it also changes the dynamic of the relationship, because then that helps you to understand what are the things that you could leverage. Right. And expand. So I, I really think, you know, the other hat I wear y'all is I'm an educator. And so when we talk about culturally responsive pedagogy, one of the core elements is are you coming into that exchange with the student from a positive lens? Speaker 3 (20:36): And I think we also have to think about that as a provider. Because anytime you interact with a human, it's an exchange of energy, and if the energy I'm putting to you as negative, that's going to impact you. So I think always kind of, you know, asking, you know, what's going on. Well also thinking the best of the person that's sitting in front of you. That's one thing that I've learned from the patients that I've been able to serve is they're like, there are some days that I just have to borrow the positivity from my providers. Right. And I think we have to recognize that that some days we are, we are that, that shining star, that good vibe for another human, but that requires us to actually believe in that other human and in their experience. So you got to see that human in front of you perfectly said, of course. And that leads me to the next topic. Is, is, are you a trustworthy provider? And how do you determine that? Because is, is trust normally determined by the person in front of you? They feel you're a trustworthy provider. If you feel you, are, are you biased towards yourself? Like, yeah, I'm awesome. Right. So can you expand on that? And on that note, we'll take a quick break to hear from our sponsor and be right back Speaker 2 (22:03): Tomorrow, April 20th, as part of net health, three part webinars series bestselling author, Stacy Fitzsimmons, and Kelly Casio of net health. We'll be talking about the three T's of creating revenue ownership beyond just the billing department, training tools and transparency, head over to net health.com/lindsey to sign up as a bonus. If you put Lindsey in the comment section in the registration page, sign up and show up net help, we'll buy lunch for your office. Once again, that's net health.com forward slash L I T Z Y. Sign up today. Speaker 3 (22:39): Oh, that's a good one. So there are two dynamics that occur in the therapeutic Alliance. There is the trust that the patient or the client, or maybe their caregiving unit, the stove's on us as providers, right? So that's the gift. And I think often as providers, we feel like we're entitled to trust and you're not, it's no different than any other relationship. It is something that someone is gifting to you, if they're dressed. And then for us as providers, we have to prove to be trustworthy and trustworthy is reliable and honest, right. And authentic. And so how do you know if you're trustworthy is that patient or client is actually the judge of that. It's not you. And so the definition of trustworthy may slightly vary for different patients, right. Because they are actually the judge and the jury in that. So if you want to know if you're a trustworthy provider you should ask, or maybe it should be part of your customer satisfaction survey, but I think, you know, when you think about provider bias or even implicit bias most of us can sense when the person that we're interacting with is not being authentic. Speaker 3 (24:03): Right? And so your bias thing can impact your ability to be, to be perceived as trustworthy as a provider or even just as a human. And so that's why it's really important for us to do the self work, to really kind of sit with ourselves, know what our triggers are. So, you know, who is it that we have these really negative perceptions of, or thoughts about, and then really questioning that. So Eckhart totally talks a lot about watching your mind. And so my challenge to providers is even in that interaction with the client or the patient in front of you, you know, always kind of paying attention to what are the voices in your head saying, you know, as you're doing that interview, listening to that client what, what is really S what else is going on? You know, like when that patient says, you know, no, I've not been able to, you know, take my blood pressure medicine, are you like, yeah, it's probably because, you know, you're doing X, Y, and Z with your money, or, you know, you're always telling a lie, but could you say to yourself, is that true? Speaker 3 (25:12): Cause Bernay Brown talks a lot about asking yourself is that the story is, you know, what's the story I'm telling myself. So could you really question that and then push back on, push back on that a little bit, cause you can condition yourself to have less bias, but you have to actively do it Speaker 4 (25:32): And it takes work and it can be uncomfortable. Yeah. Speaker 3 (25:35): It takes a lot of work, takes a lot of work. Because it's easier just to believe your own little echo chamber that you've created. Speaker 4 (25:44): My next question is what is your advice to providers when it comes to dealing with cancer survivors? Because as I spoke about in another podcast with Kristin is a hundred percent of physical therapists are going to see someone who had cancer or has cancer, the numbers are there. So what is your advice to providers when working with this population and kind of checking themselves? Quote unquote, Speaker 3 (26:15): Great question. So I'm, I'm going to say, first of all, we're going to go with your statement of ask the questions. Because I have actually seen therapists, physicians care for a client and never know that they had cancer because we didn't do a complete history. Right. and so you, you want to ask people that because the data says that one in two men will have cancer in their lifetime, one in three women. So just like you said, the odds are, is that you're going to care for someone that has had cancer or currently has cancer. So ask the question, number two is ask some details about it. So now the standard is, is most cancer survivors will have, what's known as a cancer survivorship plan that outlines the details of their tumor and also the treatment of it. And that's really beneficial to you as a provider because it'll help you be able to explain maybe some of the symptoms that they're reporting and also potentially anticipate some of the symptoms that they might have in the future. Speaker 3 (27:23): And there are things you could do to prevent that so that they have a better survivorship journey. Then number three, just listen and listen with a beginner's eye and beginner ears. Right? So be really curious about what that person is saying. Everything doesn't have to be judged because I always remind people, there are 8 billion people on the planet, so there are 8 billion ways of doing this thing. There's no rights or wrongs. And then the fourth thing is a screen, right? Because I have to recognize as a provider that I'm going to ask the questions, I'm going to do the things that are often comfortable for me because you get in this routine. And then, because this is a human sitting in front of me and everyone is diverse. I have to have some screening so that I don't miss anything. Right. Because often my pattern is based on what I like and the things that I do with the community that I'm, you know, most accustomed to. Speaker 3 (28:28): And so when I'm treating someone that might be different from me and everybody's different from me, then it's always good to have a screen that way you make sure you're not missing anything. And then I would say the last thing is ask that person what is important to them because often as providers will create a whole plan of care and never really asked people to rank or prioritize, what's really important to them. We often make judgements for people and that's not our jobs as providers, we're, we're part of their team. So those would be the things that I would say to remind people love. And then, you know, I think everyone needs to kind of be doing a self assessment of where they're at in regards to their own biases. And then just getting curious about it, be okay with talking with someone who doesn't think like you or who doesn't look like you. Speaker 4 (29:23): Yeah. Every point. Excellent. And hopefully people were taking notes on that. And now Lisa, where can people find you if they want to learn more about you and what you're up to and what you're doing. Speaker 3 (29:35): Awesome. so you can typically find me at the university of Louisiana Monroe. So I am the associate I'm associate professor and program director of the physical therapy program there. Or you can find me through Jima Institute. So the Ujima Institute is a grassroots organization that we started to primarily look at ways in which we could collectively come together to address the health and wellness of black communities. Because one of the things we didn't even talk about was health disparities as it relates to minority or marginalized communities. So when you think about black and Brown cancer survivors, when you think about cancer survivors from LGBTQ communities their disease burden is significantly different than the majority group. And even things like just their mortality rates are significantly different. That was some of the work that we did early on in Kansas city where we found that, you know, African-American women were dying at rates three to four times higher than those of their more of Caucasian peers. So yeah. Of white peers. Speaker 4 (30:47): And is that because of lack of access, was it because of lack of belief that they were ill or what, what did you, what did your findings Speaker 3 (30:59): So some of it was an access issue. So when you think about where the mammography centers located also the quality of the equipment at different sister centers varies as well. I think people often don't think about that. Then also the providers. So there's often a difference in which providers are available to which subgroups then also, and this is one thing that even, I think PTs and healthcare providers should think about in general is our typical office hours, right? So we tend to do eight to five. Well, if I'm a second or third shift worker that might not work for me, or if I work in an industry where I do a 12 hour shift that may not work for me. And those are often jobs that black and Brown community members are holding down. And so the very nature of how we deliver care often introduces some inequities. And I love that Def to my favorite definition of inequities talks about how they are avoidable, right? So that difference in healthcare is actually avoidable. If we would just stop and be intentional about the care and the way in which we deliver care to each other. Speaker 4 (32:18): Mm gosh, it's so multifactorial. But changeable Speaker 3 (32:25): Very changeable. I often say we're just one decision away. We're one decision away from someone having a different type of cancer survivorship journey because for your audience, fatigue is the thing that we often talk about, but the other things are like pain. Most cancer survivors are also experiencing a high level of anxiety. And in the United States, we're actually going the opposite direction in regards to our mental health resources, right. And cancer survivors need that support. Other things that bother them are things like neuropathy and even like itching. Like I cannot tell you how many cancer survivors are like, can you just make the itching stop? And people are like, well, who is it that big of a deal, but if I have a job and if my job is customer service and my receptionist is scratching, I'm like that impacts employment. So I'm like all of these things are, are part of the cancer journey where there are things we could do to prevent that or to attenuate it, even things like weight management, there are so many parts of this cancer sequella that we could adjust address early on. The other thing that has always been really interesting to me in the data is although we know cancer survivors are reporting these side effects to cancer and it's treatment only about 20 to 30% of them actually get referred to a provider to address them. So there are a lot of people live in a life that has less quality that really, that doesn't have to be right. And to me, that's not kind that is not con no. Speaker 4 (34:14): So you survived then what? Speaker 3 (34:19): Yes. Yeah. So, yeah. Yeah. So, and especially when we know that there are clinicians and providers out there that could be helping. Speaker 4 (34:30): Absolutely. And you know, I think don't you think that this is such an opportunity for the world of physical therapy? You know, we can be a conduit to other providers. Yeah. So, so if they, the cancer survivor is only spending 10 minutes with the doctor, but Hey, maybe they are coming to us maybe. Well, now it's like an automatic PT referral at the time of diagnosis. At least that's what the guidelines say. Am I correct in that Speaker 3 (34:59): Is the preferred guidelines. So that's kind of the pre rehab standards, right? That you get that diagnosis, you get a PT a Val, so we can get some baseline data. Speaker 4 (35:10): Right, right. Exactly. So might we also be the person to have the time to listen? And like I said, be that conduit and that super connector to people they need. So something to think about for the PT profession, you know, it's a huge opportunity for us to expand our reach, to be helpful and to make a difference in people's lives. And that's what we're supposed to be doing anyway. I totally agree. Because early Speaker 3 (35:38): On in my career I went through patient navigation certification and I remember people going, why would a PTB here? But it's a great place for us to be as a, as a rehab professional and especially as movement specialists, right? Because movement is the key to life. And so if I can help a cancer survivor, figure out the resources, they need to be able to keep their movement and function. That's a game changer in regards to health and wellness, even cancer outcomes. Some of the data even suggest in regards to mortality recurrence rate. So PT might, you know, often we talk about nurse navigation, but actually having a PTs, a navigator is not a bad idea. Speaker 4 (36:28): Absolutely. Well, I have to say, I thoroughly enjoyed this conversation, Lisa, and as always, and last question is knowing where you are now in your life and in your career, what advice would you give to your younger self, maybe that fresh face gal right out of PT school. Speaker 3 (36:47): Yeah. If I could talk to her, I would tell her to put herself first. Cause I think there is a reason why that the triple aim moved to the quadruped blame, right? To include burnout of providers because often in our quest to provide care for others, we forget that we need to refresh and replenish cash sales have. That is really, really important. We take better care of the equipment in our clinics and our hospitals that we do of our providers. Speaker 4 (37:20): And if it's, if we can't take care of ourselves, we are the most important piece of equipment. Speaker 3 (37:26): Yes we are. So we are the most important piece of equipment as it. If you wanted to talk about resources and I think also in regards to, when we think about our patient you know, client interactions, cause I often ask therapists nowadays, are you causing harm to the client that you're serving because of who you are. And maybe that's because you've not done yourself care, maybe it's due to your provider bias. Maybe it's due to, you need to re upskill in regards to your clinical skills. But I think it's always good for us to ask ourselves, are we doing somebody harm and why? Speaker 4 (38:04): Excellent. And on that we will end. So I will thank you so much for coming on, Lisa. Thank you. Speaker 3 (38:10): Thank you so much for having me. It's always a blessing to be in your space. Speaker 4 (38:15): Thank you so much mutual mutual and everyone. Thank you so much for listening. Have a great week and stay healthy. Well, the in smart, a huge thing. Speaker 2 (38:23): Thank you to Dr. Lisa van who's. And of course, to our sponsor for today's episode net health, again, sign up for their webinar, which is out tomorrow, April 20th, as part of their three-part mini webinars series, bestselling author, Stacy Fitzsimmons and Kelly Casio of net health. We'll be talking about the three T's of creating revenue ownership beyond just the billing department, training tools and transparency, head over to net health.com/lessee to sign up. And remember if you put Litzy in the registration page, sign up and show up net health. We'll buy lunch for your office once again. That's net health.com forward slash L I T. Speaker 1 (38:59): Why 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, Net Health's Daniel Folsom talks about how to use Google ads and how to boost your SEO to drive more potential clients to your business.  In this episode we discuss:  - How to use online directories to boost your SEO - The importance of online reviews  - The ins and outs of running a Google Ad - Are Facebook ads worth it?  - How to prepare to run an ad on either Google or facebook - and much more!    More about Daniel:  My Name is Daniel Folsom the account executive for the Digital Marketing Group at Net Health.  I have 20+ years’ experience in the healthcare world through sales and practice development. I live in the beautiful state of Georgia and have two kids (four-legged) Jon Jon and Oliver. I have a passion for helping private practices find ways to grow their brand and sustain a healthy level of consistent revenue through patient engagement.   Resources:  Rehab Therapy Outpatient Services 101: How to Expand into the Home or Assisted Living Facility. Free Market Scan Daniel's LinkedIn   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 Transcript: Speaker 1 (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. Speaker 2 (00:35): Hey everybody. Welcome back to the podcast. I'm your host. Karen Lindsay and today's episode is brought to you by net health. So net health has a great new webinar coming up tomorrow, April 13th at 2:00 PM. Eastern standard time with Ellen Strunk. She is a physical therapist, owner of rehab resources and consulting, and his net health guest panelists discussing rehab therapy, outpatient services. One-On-One how to expand into the home or assisted living facility. Ellen lectures nationally on the topics of pharmacology for rehab professionals, exercise and wellness for older adults, coding billing, documentation for therapy services, and the importance of functional outcomes to value based payment, head over to net health.com/litzy to sign up as a bonus. When you sign up for the webinar type, Litzy in the comments section of the registration show up to the webinar and net house. We'll buy lunch for your office. Once again, that's net health.com forward slash L I T Z Y. Speaker 2 (01:32): To sign up now on today's podcast, we are talking all about S E O for people who aren't familiar. That means search engine optimization. And my guest is Daniel Folsom. He is an account executive for the digital marketing group at net health. He has 20 plus years experience in the healthcare world through sales and practical development. He lives in the beautiful state of Georgia has two kids, four legged, John, John, and Oliver. And he has a passion for helping private practices, find ways to grow their brand and sustain a healthy level of consistent revenue through patient engagement, which is something we all want if we own our own practice. So today we talk about digital marketing. We talk about search engine optimization. What it is, is it dead? Is it alive? How can you make your website more SEO friendly? We talk about Google and Facebook ads and are they really worth the cost? Speaker 2 (02:30): And guys, this is a deep dive. This is really talking about Google ads and definitely Google ads more than Facebook ads. But boy did I learn a lot and Daniel is very generous. He is offering a free market scan, covering all online directories, which there's like, guys are so many. I had no idea all these online directories that will make a difference in where your podcast is ranked on Google. And so what the folks at net health are, is a free market scan, covering all those online directories to see if you're in there or not tedious work folks. You don't want to do this yourself. So Daniel talks about how you can get that free scan in today's podcast. So everyone enjoy, Speaker 3 (03:16): Hey Daniel, welcome to the podcast. I'm happy to have you on the show this week. Thank you very much. Happy to be here. Great. And today we're talking about, I think something that can affect every single physical therapist that has a website, every company, every individual therapist, and that is looking at SEO or search engine engine optimization. And we're also gonna touch on online ads, Facebook ads, Google ads, things like that, but let's start out with SEO. So here's the question is the title of the episode is SEO dead. Absolutely not. That's the biggest question that we have to answer today, right? How are you found online when you're found, what does that online reputation look like for your Google ads? So when I find you, what does it look like? Funny, kind of a funny story. I was working with a physical therapist group last week and we've looked at their Google listing and they actually had a picture of chilies. Speaker 3 (04:22): So what happens is, and I thought, well, Hey, if you're cracking backs in ribs, I think I want to make an appointment, right? That would be a win-win yet what Google does. If we don't actually create that directory and clean it up is they take the Google earth pictures that attached to your address and they put those images on. So if you haven't looked at it, definitely take a peek at that Google listing anyway, yes. With our SEO, try to get back to that. We want to know what you look like across these search directories. Can people find you with your address and they call you from your phone number. If they look at these directories, are these directories actually clean with reviews? Are you getting good reviews? Are you responding to the negative reviews? So all of this goes into making up that SEO. Speaker 3 (05:12): You know, I always say, if people ask me, you know, when, when should we start SEO? And, and as I mentioned, you should have started 20 years ago. And when you say looking at all these different directories how many directories are there? And can you give some examples? Because I just think, well, Google, what are the other directories? So there are 72 plus directories. And when we talk about directory management, we talk about 72 different directories. The reason we talk about 72 is those are what massage, Google analytics to make Google happy. So Google actually sends these small bots out across all of these different directories to make sure they're consistent across internet. And that affects your Google analytics. Of course. So these bots also work in tandem with Google because they want to be the next game on the net. They want to be the next big game on the street, right? So they're sending bots out to find information. So when we run what we call a business scan here at net help, we are running that business scan to look at how accurate all of these directories look for you. You will find if you've had a practice purchase, if you have gone by a different name, if you've moved locations, a lot of these directories are going to be out of line. So if anyone's using those, they're either going to go to the wrong address. They're going to see the wrong name so forth. Speaker 4 (06:37): And what, so aside from Google, what are some of these directories? Is that like Yelp or is it, is that one or no, Speaker 3 (06:46): We, we have Yelp, we have yellow pages. We have Google business, we have Facebook and using a service, you know, a service we'll actually go in and create those directories so that they're all consistent. More importantly, they go in after that and lock those directories for you, which means they can never be changed or modified unless we go in and actually change your modified those directories for you. You know, some of the other search directories, we talk about Yahoo four square city search MapQuest, local database, a few more just to add on. Speaker 4 (07:21): Yeah, that's a lot. Okay. So what you guys do is you scan all of these directories to make sure that it lines up with what your, what and where your business is, and then absolutely. And then you make it so that people can't hack into it, or can people still hack into it and kind of screw that up. Or Speaker 3 (07:45): Nope. Once these directories are locked, we actually claimed the directories. We clean up that directory management and cleaning up that directory management. We're going to make sure that we've got consistent pictures of the practice. We've got pictures of the team, maybe of the owner with a nice blurb there. So all of these directories are going to look consistent. And of course the goal here is to create a beautiful story, right? So if I search physical therapy near me, I go to your Google ad, your Google ads, beautiful with pictures and reviews and things that click on your website. It then translates the story over to your website. So it's a nice flow from the original organic search all the way to your website. Speaker 4 (08:26): When, what else goes into SEO, because I know people talk about SEO and we always just think, Oh, it's just maybe cleaning up these directories, but I know that what's on your website and maybe the backend of your website also counts for SEO. So can you talk a little bit about that? Speaker 3 (08:49): Sure. So when we talk about your website, we want to talk about keywords that drive to your website. So in using a vendor for your website, you want to make sure that you keep those keywords accurate and you also keep them fresh. For example, when microneedle and came out, we wanted to make sure that we added any of the search words for microneedling in, into those keywords to drive traffic. So we look at the meta tags, we look at the data tags, we look at the backend of what that website is there for, because again, that organic search with Google is the happiest that Google analytics, that it makes it the happiest there. So that's what we're really doing when we drive that traffic with those back keywords. You know, I think a lot of people too, when we talk about websites, miss the opportunity to blog and blogging is huge in having searchable content. You know, let's say you just came back from a wonderful conference and you learned all these cool new techniques or, or services that you can offer going in and creating a blog about that makes it searchable content. Again, we're driving that organic traffic directly over to your website. Speaker 4 (10:06): And if you can drive more organic traffic, does that bump you up in the Google search? Because everybody's like, Oh, you want to be on the first page of Google. Speaker 3 (10:15): Right. Right, right. Where do you hide a dead body, the second page of Google. Speaker 4 (10:20): Right. So how do we, how do we, so obviously adding a blog, making tree of these keywords, making sure all of these directories are up-to-date and locked in. Is there any other tips or tricks that can bump you up in the Google in the eyes of Google without having to pay for it? Cause we'll get into ads in a little, Speaker 3 (10:42): Right. You know, that Karen is a beautiful equation that deals with how old is your domain? Are you garnering reviews? Are your directories established and consistent? So there is a really long equation that goes into making that very, very happy. Of course, you know, running ads can potentially puts you on the first page. And when we talk about ads, we'll talk about what that looks like. But putting you on the first page, it's just a lot of consistency and it's a lot of work to check the right boxes as far as what SEO means and what makes Google happy for you. Okay. Speaker 4 (11:20): Right. So doing all these things that we just discussed, obviously very helpful. Right, right, right. And the more you update your website, does that help to boost it up? Speaker 3 (11:32): Absolutely pleased fresh content every month, whether it's an e-book, whether it's a newsletter, whether it's a blog post, whether you're just changing staff names, we want to keep that website fresh. You know, part of what we, we pride ourselves on at net health is every month and account manager is actually going to go with the customer. We're going to make sure that we're pushing out those blogs. We're pushing out those eBooks. We actually set up cadences for the month ahead of us just to make sure that we're tackling maybe seasonal issues as well. So let's say it's winter time, everybody's slipping and falling. How are we addressing that type of searchable content as well, pulling that organic traffic over to your site. Speaker 4 (12:17): So now let's move on to ads, right? So you've got Google ads, Facebook ads. The big question everyone wants to know is where can I get the most bang for my buck, Speaker 3 (12:30): Bang for your buck. Here's what we need to do everybody. Before we dive into ads, we need to make sure running an ad for you even makes sense. If you just take money and put it into a pay-per-click ad, it's probably not going to work. You know, one of the things that we do at net health with our customers is we do a forecasting call. That forecasting call looks at your geographic area, longitude latitude within 30 miles, because that's generally the driving distance. People are going to come to see your location. And then we type in keywords. I want to see if enough people are searching for those keywords. You know, you could put $2,000 into an ad, but if you have 20 people searching for the keywords that are relative to your services, it's probably not going to be a good return on your investment. Speaker 3 (13:17): So with that forecasting call, we look at those keywords and we also see how much they cost. You know, as we kind of spoke about earlier, those keywords could literally drive your ad budget way out of socket. I've seen people who have run ads in the past that it did make sense to run ads, but they had an ad budget of $400. When we look at that ad budget, we have to tie it into what does a conversion look like? And a conversion is when someone searches for your words goes over to your ad, clicks on that ad and fills it out. So that's somebody that converts over. Now we call that a lead. So this is someone that has engaged. They're looking for your services, they're in your target area, they're searching for your keywords. And they said, Hey, we are looking for you. Speaker 3 (14:12): Now, the other thing when we run these ads to care is which is very, very important is we need a really good call to action. And what does that call to action mean? You know, I think for everyone, this can be unique to the practice, with their call to action. It's something that's going to engage them to take the next step. You know, I have some people who use eBooks and toolkits and things that, you know, fill this out and get the free toolkit or ebook. We generally find that people generally just want the ebook. They really don't want an appointment. So when we really look at a conversion here, we really want to something unique. You know, the cool part of forecasting is we can actually look at what other ads are running, what their calls to action are. So we can really kind of create a unique structure to walk that practice through having an amazing call to action and filling out the form to have that conversion into the lead. I have to say some of the more successful physical therapy practices that are using any type of ads right now, last month, we had someone who ran a targeted ad that gave away a free 30 minute back massage. He had well over 50 participants fill out his lead form, which was huge. I didn't always, I mean, I didn't know that many people needed they're bankrupt, but obviously they do. Speaker 4 (15:36): Right. And what other call to actions have you seen that have been really successful? Like I know a lot of people will say, you know, a free, you know, 20 or 30 minutes call or, or screen or something like that. But what, what else have you seen that has really worked? Speaker 3 (15:59): Usually you want to tie it to something within your services that keeps the person engaged or will engage them. For example a physical therapist was really focused on their, their dry needling and they actually did this hot patch. It was almost a massage machine as well. So after the dry needling, you literally sat on this like hyperbaric type chamber chair and got this warm back massage. That was a part of it as well. Now that was after the third visit. So of course at that point they've got the patient engaged with it. Again, we usually find toolkits eBooks and things really aren't that effective, but something tangible that the patient can actually use or have you know, we've even had people tie them around Starbucks gift card with, we all have our Starbucks. Speaker 4 (16:56): Right, right, right. So really taking some Liberty here to be quite creative, correct? Correct. Okay. And you had mentioned something in talking about the ads about the price of keywords. Can you talk about that a little bit more? Because I know it's definitely something I don't understand. I'm sure it's a lot something, a lot of the listeners don't understand. So go ahead. Speaker 3 (17:20): Sure. So when we, when we look at the forecast, we actually look at the keywords of course, for the services that are offered there at the practice, those keywords, and what Google will tell us is, is what people were paying for those keywords. So the funny part about keywords is in certain areas, some lawyers may be bidding on those keywords as well. So we generally want to keep the costs, the cost per click below $3. If it's above dollars, we really want to see if it makes sense for our practice with their budget. And of course, what outcome they're looking for. Does it really make sense for you to run these ads? Sometimes it does. Sometimes we can have a great return conversion level. Other times we may want to look at some other keywords and other prices just to make sure that, you know, again, this is going to be affordable for the practice and we're going to bring the number of conversions that they need to make this profit. Speaker 4 (18:17): And so for example a keyword like low back pain might be worth, I'm just going to make this up here for $4. Whereas shoulder pain might be worth $3. Like, is that how that works? Speaker 3 (18:33): You got it. Yep. Yep. The biggest trend difference that you see right now is physical therapy. Of course, near me. Where, of course that's an extremely popular keyword search. I've seen it cost 58 cents in certain areas. Right now in Seattle, it's $58 for late work. Speaker 4 (18:56): Okay. So if you're running a Google ad and you have back pain in your ad, it costs $58 per day, Speaker 3 (19:06): $58 for someone to search for that in your area, click on your ad, just click on your ad. Speaker 4 (19:15): Wait. So if five people click on your ad in one day, it costs you like $300. Speaker 3 (19:24): Correct. Do you see what ads can fail for people who aren't doing proper form? Speaker 4 (19:28): I see. Yes I do. Now. Okay. Now this is making much more sense, much more sense. So you really want to know how much those keywords cost to see, like, if it's worth it or can you put in a different keyword and still get that demographic and okay. Speaker 3 (19:47): Absolutely. So some of the things and part of the service of net health that we provide is we provide weekly checks. So we actually go in and you can bid on words every week. So some of those higher dollar words for our customers, there's no guarantee that you're going to win, but if you're paying $10 for physical therapy near me and you bid three 50 on it, you win the bid. Guess what? For the week you actually get $3 and 50 cents. You save $7 for every click for that. We also go into the ad. We look at stale keywords. So if all of the keywords that we have, and you can have up to 50 plus keywords here that we're talking about in a plan we look at what words really are stale. We want to pull those words out because they're just kinda sitting there doing nothing in our, in our campaign. Speaker 3 (20:34): And then we want to put in those active words. So we want to look at what new words may have come up within the week. Also Google gives us a ad score. So if your ad is not running at a hundred percent, we want to make sure that it is running at a hundred percent. So we look at what Google tells us of why it isn't. And we go in and repair that for you. We also, every two weeks make sure that we have a call with our clients just to make sure the ads are running correctly. We're making sure that they understand the keywords because as you can envision, we're bringing the horse to water. It's up to them to teach them how to have that horse drink the water. So we really have to do a lot of sales training on, on what that conversion looks like. You know a few weeks ago we had our podcast on purpose, the profit, and you know, the big comp topic of conversation was, you know, how well trained is your, your front desk staff and answering the phone. So, you know, I really depend a lot on that when we talk about these, these ads, because of course these are hot leads, ready to schedule an appointment. What does that look like when they're actually called for that follow-up Speaker 4 (21:45): And where are these Google ads showing up? So are these the things like if I go onto a website and I see a banner ad or something, is that a Google ad? Or is it only like when you go into Google and you type in physical therapy near me and you see those ones above the fold, the T ad, is that the only place? Right? Speaker 3 (22:08): So, so, so it can be a banner ad. It can be the ladder, as you mentioned, that says, ad generally it's the ladder that says add there, it pushes it to the top, you know? And I think a lot of people get really confused with that because they think, Oh, if I run an ad, I'm going to be at the top of Google. What they don't understand is Google only a lot certain ad spaces on each page, you can have two to three at the top. You can have two to three at the bottom. And that is all based upon the number of people that you actually have in that search criteria. So you could easily pour $2,000 into an ad and be on the top of page two, which again, who's going to look for you there. So one of the things that we really dive into when we run these ads is where are you going to be on that page placement? And where are we going to be able to put you? Because of course it's very important. Speaker 4 (22:58): And in these ads, I mean, are, is, are there photos, are there videos or is it just texts? There is Speaker 3 (23:07): Absolutely. So when we talk about the Google ad, it actually is, it looks like a landing page. So when I click on physical therapy near me and I see Karen physical therapy, I'm going to click on that. It's going to take you to the landing page. Now that landing page again, as we go back to create this beautiful digital marketing story should look just like your website, which should look like your Google directory, which creates this beautiful flow over. Now, that landing page is going to have graphics on it. It could have videos on it. Of course this is where we were going to have your call to generally we ask for name, email address, phone number, and maybe some other information that you want to gather. For example, you know, tell us how we can help you. You know, when would you like to be contacted? Speaker 3 (24:00): Those types of things are important on there as well. The beautiful part of filling out that ad for us is that it actually goes into a lead database. So from that lead database, we can actually nurture that lead for our customers, with eBooks, with personal letters. I love the nurture campaigns to be very personal. You know, let's get to know who the physical therapist are there. Let's get to know who the front desk staff is. So let's send out some really good tailored, personal messages, say, Hey, thanks for clicking on our ad. We'd love to help you. This is Megan she's at the front desk. She can help with that. This is Dr. Smith. He's going to be able to help with it really puts the face and the name together, which creates again that beautiful story and a lot of familiar nurse with the ad. Yeah. Okay. All right. Well, this is so much more robust than I had originally thought. This is great. Now let's talk about Facebook ads because with this, I would think, well, if your ideal, customer's not on Facebook, obviously you're not going to be running a Facebook ad. So how effective are these Facebook ads? Speaker 2 (25:12): And on that note, we'll take a quick break and be right back, be sure to sign up for net health next webinar, which will be Tuesday, April 13th at 2:00 PM, entitled rehab therapy, outpatient services, one Oh one. How to expand into the home or assisted living facility. Their guest panelists will be Ellen Strunk, owner of rehab resources and consulting head over to net health.com/glitzy to sign up as a bonus. When you sign up for the webinar type Lindsay in the comment section or the registration show up with a webinar and net health, we'll buy lunch for your office. Once again, that's net health.com forward slash L I T Z Y Speaker 3 (25:54): Facebook ads can be really effective. You know, where we win with Facebook ads is target marketing. So with our ads that we're running they're actually going to be slow creep ads. So they're not kind of those, those strange ads over on the right that nobody hardly ever looks at. These are actually in the feed. So as you're looking at Sonia's wedding photo and Katie's baby picture, you're actually going to see the ad. Now, when we talk target marketing for Facebook, we're really talking about who you want to attract as your patient. So if you're looking to grow your 30 to 45 year old demographics within a certain zip code with Facebook, we can really, really target out who sees that ad to make sure that we're achieving your key goals are to grow the market within that targeted area. Speaker 4 (26:49): So yeah, you can really get like drill down to really your ideal patients. Speaker 3 (26:59): Absolutely, absolutely. You know, the good part about running Facebook ads is it's fairly inexpensive. I will say the rate, the return on Facebook ads, isn't near what it would be running Google ads. Big only because you've got to think with Google, we have 200,000 people searching for physical therapy near me with Facebook. We've taken that and we've really targeted down to kind of a small pocket of people that are going to be looking for that ad. Again, the Facebook ad is going to be like the Google ad. It's going to be beautiful pictures. It's going to be a nice call to action. It's going to be something that's going to engage them and want them to click on that ad to fill out that call to action form. Speaker 4 (27:41): Got it. And what are some big no-nos if you have big no-nos for, for Google ads or big no-nos for Facebook ads? Speaker 3 (27:51): You know, I think some of the big no-nos are over promising and under delivering on your ad. You know, when we talk about these ads, we really want to make sure that they don't go stale. So that's another big no-no that people don't really understand. So, and when we talk about an ad going stale, we actually talking about keeping some of those higher dollar keywords that aren't really searchable right now and taking them out if people really aren't looking for them, because as you pointed out in the example, if you've got a $58 per click and you've got 30 people or three people clicking on it, it's a stale keyword. It's still taking a lot of money from your ad dollars. So we really got, I think that's the biggest no-no here. And a lot of that is just us making sure that we're doing that for the customer. Speaker 4 (28:43): And what about Facebook ads? Any big no-nos there? Speaker 3 (28:47): You know, I think with Facebook ads, again, you just want to keep them simple. I think in this philosophy of life kiss, keep it simple. You know, with Facebook ads, a lot of our customers really want to get involved, almost tell a complete story in that Facebook ad. And you really, really want to use that ad as if I'm looking at this for two to three seconds, what am I going to get out of it? So I think a lot of people over-complicate their Facebook ads. And of course you lose your audience at that point, they should be able to in literally two seconds, scroll your ad, see your good call to action, who you are, what you're trying to accomplish and send that right over again, all of the aesthetics for either Google or Facebook should match your website. It should match your landing page. It should be that beautiful story that just carries over. Speaker 4 (29:38): Got it, got it. Well, this has been very, very informative and super helpful. Is there anything that we missed, anything that was on your list of, of talking points that we, Speaker 3 (29:53): I don't think so. You know, I think some of the things too, when people are looking at ads that I just wanted to mention here, because this is the biggest oversight I think is when we talk about running those Google ads, we talk about, of course, how much your cost per click is, how many conversions you're going to have a big number that people really overlook is what we call the impression. And the impression is people who actually went to your ad, but never filled out the ad form. And I think a lot of customers and, and, and practices overlook this number, but it's super important because this is part of your paid ads. That's pushing your brand. I've seen where I've been able to give for example, 10 leads, 10 plus leads to a particular practice, but they had 32,000 impressions. So if you could imagine 32,000 impressions of just looking at your ad or just looking at that Google directory that displays your ad, that's a huge number. So I think that's the biggest thing I just kind of wanted to touch on. When we look at running these ads, let's look at the impressions as well, because again, that's promoting your brand, Speaker 4 (31:07): Right? And like the way I look at it, and this may be completely wrong. Now that you said those well, 32,000 people looked at it, but only 10 people clicked. So do I have to change something? Is something not landing correctly? How do you, how do you interpret that? Speaker 3 (31:25): So we definitely want to, we, that's a great observation. So we definitely want to look generally their extra call to action. Was your call to action, not engaging enough. Was it not? I guess salesy that's, you know, I hate that word, but was it, was it not catchy enough that people were like, wait a minute, this is actually something that I want to look into. Speaker 4 (31:50): Got it. Okay. That makes sense. That makes sense. Cause I would think, Oh, why am I running these Google ads? Speaker 3 (31:56): Yeah. And of course we don't want to give up. Right, right. Yet the good thing is of course of the people that click on that ad, we then get to look at what that return on investment is. So of course, in physical therapy, you know, we look at, if we add five patients with 10 visits per patient, you've definitely reaped what you've paid for your ad service plus. So we definitely look at what that conversion rate is for you as well. Speaker 4 (32:27): What is this ad bringing back to us? So again, you're looking at how much you spent on the ad, how many people came in for initial eval and how many of those followed with their plan of care, whatever that plan of care may be. If it's, if you average six visits per patient, you know how much each visit costs, you can multiply that by however many patients you got from the ad. And if it made you profit great. If it didn't, I think you have to do some rejiggering there. Speaker 3 (33:00): Yep. Yep. We definitely need to either run a different campaign. We need to look at what, I guess why the wheel didn't spin properly here. One of the beautiful things of net health is that we tie certain KPIs. And if, if anyone isn't familiar key performance indicators to our ad module. So for example, Karen, if I told you, I'm going to bring you 10 patients every month and I don't meet that criteria for you, you're actually able to stop running ads with us. So we really put our feet to the fire to make sure that we're doing the right job. We're also doing what we said we were going to do in making sure that you're getting that return on investment for what you're giving us. Cause it's expensive, you know, act, I mean, add packages right now started a thousand dollars. So it's a lot of money. That's a lot of money. Are you getting that back? Speaker 4 (33:53): Absolutely. And that makes perfect sense. And now before we wrap things up, I have another question in a second, but I want people to find out where they can get more information on what you do, how they can get on board. So what is your call to action? Speaker 3 (34:12): Sure. So we're offering for anyone that's interested what we call that free business scan. So I'm going to go in for the practice. I'm going to run that free business scan. That's going to look at all of those search directories that we talked about earlier. I'm also going to look at, in that business scan, it shows how that practice compares to their competition. When we talk about reviews. So I'm offering a free business scan for anyone that is interested. I'd love to dive into that. Of course after that, I would definitely email that over. I would also love to offer a free forecasting call for any practices interested in running ads. Let's look at it, let's see if it even makes sense for you to run ads. I have to tell you, last month we walked away from three different practices where it just didn't make sense for us to run ads. So want to make sure that it's a good fit for both of us, Speaker 4 (35:03): Right? Well, that is awesome. And where can people get all of this? How can they yeah. Speaker 3 (35:09): Www.Net health.com and click on the digital marketing page. Perfect. Speaker 4 (35:16): Perfect. Well, that's great. I mean, yeah. Sign me up free. I would love that. So now last question is something that I ask everyone and knowing where you are now in your life and in your career, what advice would you give to your younger self? Speaker 3 (35:34): Oh, you know, Karen, that's such a good Speaker 4 (35:38): Question. I think it would just be slow down. Enjoy the martinis, enjoy the dog. Walks spend more time with your mom and dad. It's just literally just stopped going. And fifth years shifted down to second and learn how to live on cruise control for just a little while and be calm. Lovely advice. Thank you so, so much for coming on and talking to us about SEO and ads and for all of you PT entrepreneurs out there, head over to www.net health.com. Click on the marketing, digital marketing, digital marketing tab and get this free business scan free forecasting calling me. And that's huge for people to see, Hey, should I be, should I be running ads? Or if you are running ads, EEGs, are they working? Yikes. Well, Daniel, thank you so much. This was great. I really appreciate it. Thank you and everyone. Thanks so much for listening. Have a great week and stay healthy, wealthy and smart. Speaker 2 (36:43): Thanks to Daniel. And of course, things to net health for sponsoring today's episode again tomorrow, Tuesday, April 13th, 2:00 PM. Eastern standard time. Sign up for rehab therapy, outpatient services one Oh one. How to expand into home or assisted living facility with Ellen Strunk. And in order to do that head over to net health.com/lindsey to sign up type in Lindsay in the comment section net health, we'll buy lunch for your office once again. That's net health.com forward slash L I T Z Y. Sign up now. Speaker 1 (37:16): Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.    

In this episode, Associate Professor in the Doctoral Program of Physical Therapy at Rutgers, Dr. Ellen Anderson, talks to Dr. Stephanie Weyrauch about burnout in physical therapy. Today, Ellen talks about her dissertation on burnout, the distinction between normal stress and burnout, and how these markers of burnout fit into the anecdotal accounts of burnout seen in blogs and magazines. Why is data so limited on burnout in physical therapy? Which settings within physical therapy experience the highest rate of burnout? Hear about the many factors impacting the number of therapists affected by burnout, how Covid-19 has affected recent graduates and students, and the causes of burnout, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “When people work with people who are in crisis, there are a lot of demands placed on them - very different than in other kinds of work, for example.” There are 3 categories in burnout: Emotional exhaustion. Depersonalisation. Personal Accomplishment. “When we think about just being stressed out, it’s hard to know what that means because everyone’s stressors are different.” “If a physical therapist has high perceived stress, that’s correlated with emotional exhaustion, which is a part of burnout, but not the full definition of burnout.” Researchers have suggested that there’s 2 ways to look at burnout: The Personal Approach. Make the person resilient, and they will be able to handle any kind of environment. The Work Environment. Make a nurturing environment that’s conducive to good work, and supporting people who are in crisis, then you’re supporting the workers and you’ll have less burnout. “Younger physicians have higher rates of burnout than do older practitioners.” “When people in healthcare feel as though they don’t have control of the situation, or they cannot contribute to good patient care, effectiveness, and efficiencies, that the burnout rates are higher.” “There needs to be an understanding on how stressful and difficult it is to work with people who are at risk and people who are in crisis.” “We need to be thinking about ways in which physical therapists can have some participation in systems that supports everyone in that work environment.” “One of the things that’s very detrimental when people share thoughts and ideas, is that the first response they get is ‘we cant’ or ‘no’ without any kind of real honest investigation into the suggestion or recommendation.” “Breathing practices and meditation are two strategies which help people be able to manage their stress effectively. The idea is that you practice those things so that when you need it, you can use it.”   More about Stephanie Weyrauch Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.   More about Ellen Anderson [caption id="attachment_9555" align="alignleft" width="150"] Rutgers School of Health Professions in Newark. 11/7/16 Photo by John O’Boyle[/caption] Ellen Zambo Anderson, PT, PhD is an Associate Professor in the Doctoral Program of Physical Therapy at Rutgers, The State University of New Jersey where her primary teaching responsibilities are in Therapeutic Exercise, Development Across the Lifespan and Clinical Inquiry. Dr. Anderson, a Board Certified Geriatric Clinical Specialist, earned a BS in Physical Therapy from West Virginia University, an MA in Motor Learning and Control from Columbia University and a PhD in Health Sciences from Rutgers University. She is the Assistant Director of the Rutgers Community Participatory Physical Therapy Clinic, a student-run, pro-bono clinic in Newark, NJ, and serves as the Special Olympics Global Advisor for Young Athletes. Dr. Anderson is the co-author of the textbook, Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach and has spoken internationally on physical activity, mental health, and complementary health practices. She is also co-owner of YogiAnatomy, a company that provides continuing education for rehabilitation professions on topics related to complementary approaches for managing well-being, health and function.   Suggested Keywords Physiotherapy, Research, PT, Health, Therapy, Healthcare, Education, Training, Stress, Burnout, Wellbeing, Mental Health, Stressors, Support, Covid-19, Exhaustion, Depersonalisation, Accomplishment, Environment,   To learn more, follow Ellen and Stephanie at: Website:          https://stephaniesandvickweyrauch.academia.edu                         https://ptsmc.com/stephanie-weyrauch                         https://www.yogianatomy.com Facebook:       Stephanie Sandvick Weyrauch Instagram:       @thesteph21 Twitter:            @thesteph21 LinkedIn:         Stephanie Weyrauch                         YogiAnatomy   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:  Speaker 1 (00:07): Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Hey everybody. Speaker 2 (00:37): Welcome back to the podcast. I am your host, Karen Litzy and today's episode. We have our good friend of the podcast back, Dr. Stephanie Y rock, and she is interviewing Dr. Ellen Anderson all about burnout in the physical therapy profession. I'm not going to go into Dr. Anderson's bio because Stephanie reads that in the beginning of the podcast. We don't need to double up on that, but what you're about to hear, I'll give you some highlights is they talk about the three categories of burnout and does the research definition of burnout jive with the anecdotal accounts of burnout that we see on blogs and podcasts and things like that. They also talk about the difference between stress and burnout or perceived stress and burnout. The main causes of burnout in physical therapy, how COVID is affecting burnout. And Dr. Anderson talks about some things that perhaps you can do as an individual to help with your perceived stress. Speaker 2 (01:41): And she hypothesizes on some things that perhaps some businesses, some physical therapy businesses can do to help their employees with stress and burnout. So thanks to doctors why rock and Anderson and everyone enjoy today's episode. Hello everyone, and welcome to the healthy, wealthy and smart podcast. I'm your guest host today, Dr. Stephanie, why rock and, or once again, going to partner with the American physical therapy association, private practice section to discuss a topic that has been in the forefront in healthcare and that's burnout. This is an especially relevant topic. I think as COVID-19 pandemic continues to rage on, and I've actually been asked to write an article for PPS impact magazine on this. And so when I went to do some research on this topic, I of course found a lot of blog posts and opinion articles by physical therapists throughout the profession on this topic, but was really surprised to find that there's really not a lot of research in physical therapy on burnout. Speaker 2 (02:50): And I was surprised by that because it's so frequently discussed in our profession. So eventually my literature review led me to our guest today, Dr. Ellen Anderson. So Dr. Ellen Zombot Anderson is an associate professor in the doctoral program of physical therapy at Rutgers university in New Jersey where her primary teaching responsibilities are in therapeutic exercise development across the lifespan and clinical inquiry. Dr. Anderson is a board certified geriatric clinical specialist and earned a BS in physical therapy from West Virginia university, an ma in motor learning and control from Columbia university and a PhD in health sciences from Rutgers university. She is the assistant director of the Rutgers community participatory physical therapy clinic, which is a student run pro bono clinic in Newark, New Jersey, and serves as the special Olympics global advisor for young athletes. She's the coauthor of the textbook complimentary therapies for physical therapy, a clinical decision-making approach, and has spoken internationally on physical activity, mental health and complimentary health practices. She's co-owner of yoga, Yogi anatomy, a company that provides continuing education for rehabilitation professions on topics related to complimentary approaches for managing wellbeing, health, and function. So thank you so much Dr. Anderson for joining us today on our podcast. And again, I read your dissertation and I've, I found it really interesting that you decided to tackle burnout for your PhD dissertation. So maybe summarize your dissertation a little bit, tell our listeners a little bit about yourself and how you became interested in this area of research. Speaker 3 (04:38): Okay, great. Yes. It's a pleasure to be with you, Stephanie. Thank you very much. Initially I became very interested in complimentary therapies and through the work that I do with my colleague, Judy Deutsche, where we published a textbook in that area, I was interested in the application, the safety and the efficacy of complimentary therapies for patient populations. And that got me to realize, or helped me realize that there is a fair amount of data that suggests these complementary therapies can be useful for our patients, particularly in the areas of mood reduction of stress, as well as reduction of pain. And so that got me thinking about using approaches such as Reiki or yoga, meditation, breathing practices for self care as well as patient care from that point. However it was determined that we really didn't know what stress was in physical therapists or what burnout is in physical therapist, because as you've identified, a lot of people are talking about it, but there hasn't been a lot of research in that area. Speaker 3 (05:57): And so I started to embark on trying to get a handle on what is the stress and burnout in physical therapists. My focus took me to burn out. And the reason for that is because burnout was defined by fruit and burger back in 1975. And it was based on his observations in working with healthcare providers. And what he observed is that when people work with people who are in crisis, there are a lot of demands placed on them, very different than in other kinds of work, for example. And he began to categorize some behaviors that he saw in people who were becoming more and more stressed. And then it was Nass latch who developed the mass latch burnout inventory. And so what mass latch did was kind of support the observations of fruit and Berg by saying there are three categories that we need to look at in this thing called burnout, that there's emotional exhaustion, there's depersonalization and there's personal accomplishment. Speaker 3 (07:16): And so when we think about just being stressed out, it's hard to know what that means because everyone's stressors are different. So what stresses you out is different than what stresses me out, you know, when you kind of come to your work with a certain constitution about what keeps you even keel and what are your triggers? The burnout goes a little bit further because it's not just emotional responses. And in this case, emotional exhaustion is that sort of physical, mental exhaustion that many people might be feeling. That's just one part of burnout. So the next part of burnout is this deep personalization. And what that means is that you kind of begin to separate yourself out from your patients. And there's this phenomenon of, of I'm sick of thinking that the patient is to blame for their problems. You know, so they brought it on themselves and some psychologists and researchers suggest that perhaps this deep personalization is really kind of a protective mechanism because you're dealing with people in crisis all the time. And then you have the personal accomplishment and that's where you feel like your, a rat in a, in a maze or in a wheel. And you just keep going round and around and you ask yourself, finally, what am I doing this for? Am I really making a difference? So the, the, the curiosity for me is, was understanding the D the difference between just job stress and burnout, and that physical therapist in fact, would fall into a category of people working with people who are in crisis most of the time. Speaker 2 (09:28): I think that that's really interesting that, you know, we have a defined a true research definition of burnout. I'm wondering what your opinion is on how this definition fits with these anecdotal accounts of burnout that we're seeing in some of these blog posts that people post or that TA magazine has been posting about regularly. Speaker 3 (09:50): It doesn't really jive a very well, to be honest with you. So when, when I see comments about burnout, I just say to myself, well, people are stressed out and, and we should honor and respect the fact that people are very stressed out. That burnout technically from a research standpoint has a different definition. And what I found through my research is I did study and survey physical therapists, both using the mass latch burnout inventory, which has the three part, but I also included the perceived stress scale. And so the perceived stress scale, I think, is a very valuable tool because as I mentioned, previously, stressors for you are different than stressors for me. And the perceived stress scale has been used in thousands of studies. And it's looked to be sort of a gold standard if you will, to get a finger on the pulse of people's stress, because it is about perception of your stress. Speaker 3 (11:04): And, and so what I found in my, in my dissertation was that all, although physical therapist had better perceived stress scores than the national sample that I compared it to, there was a relationship between a high perceived stress score and burnout especially in the category of the emotional exhaustion piece. And so what we, what we saw was that if therapist had high emotional exhaustion, they were seven, seven times more likely to actually have burnout. So let me tell you what burnout is. According to those three parts is if you do the burnout scale, and you're very high where you're high in emotional exhaustion and you're high in deep personalization, and then you have low professional accomplishment, you fall into the category of burnout. And so what I found was that 29% of PTs are high in emotional exhaustion, and that is consistent with what people are talking about in the blogs related to being stressed. Speaker 3 (12:27): Okay. The other thing that I want to know is that in a lot of studies that are being done with physicians and nurses with burnout, sometimes the headline is 50% of physicians have burnout. And what they did was that they used the burnout scale, but they focus their, their headline on the fact that it was emotional exhaustion. And so there was recently a systematic review that looked at just that is the reporting of burnout and how it's a little bit of a mixed bag now where it traditionally had been the high score in exhaustion depersonalization on a low score in professional accomplishment. But now people are reporting even just on the emotional exhaustion. So when we think about PTs and what I found was that 29% had emotional exhaustion and then 12% had actual burnout. And so that's, that's really a concern because we're talking that we have a vulnerable PT workforce out there when it comes to stress and when it comes to burnout. Speaker 2 (13:56): So if somebody has, if a physical therapist has high perceived stress, that's correlated with this emotional exhaustion, which is a part of burnout, but not the full definition of burnout. Speaker 3 (14:09): You got it, it's perfectly stated. Speaker 2 (14:11): So do you think that we, that our research needs to maybe reassess the definition of burnout? Or do you think that people, that we just need to get the word out there about what burnout actually is and educate people that, you know, you're not quite burned out yet? You're, you're emotionally exhausted. Here are the steps that you can take to decrease this high emotional exhaustion to prevent burnout, or what, what's your kind of opinion on that? Speaker 3 (14:39): Well, it would be a wonderful thing if it was so simple. But the reason why it's not simple is because people have looked at well, what comes first is an emotional exhaustion, and that leads to depersonalization followed by lower professional accomplishment. And the answer is not clear. So there are different models that have been proposed and tested to show that it can be multi-directional. And so it's not easy to say that if we manage stress, as we know stress, the perceived stress that we will have made a dramatic effect on burnout, because if depersonalization is what drives emotional exhaustion or low self-efficacy kind of low personal accomplishment, low self-esteem that type of thing in your workplace, if that drives burnout, then managing stress may not have as dramatic effect on those areas. So I, I think it's, I think it is behooves us to think about the complexities of stress and that mirrors the complexities of burnout. Speaker 3 (16:04): But I think that the first step is to be thinking about what are those stressors in the workplace because researchers have suggested that there's two ways to look at burnout, and that is the personal approach, so that you're more resilient to that stress, to that emotional exhaustion. And then the other area of focus should be on the work environment and the, the experiences that a person has at work. So we see that there's both sort of schools of thought that you, you make a person resilient and they will be able to handle any kind of environment. And then the, and then the counter is that if you make a nurturing, caring environment, that's conducive to good work and supporting people who are in crisis, then by that you were supporting the workers and you'll have less burnout. Speaker 2 (17:14): I think that those are some very interesting points. You know, this is obviously a very popular topic in our profession. Why do you think there's then we had, we've talked about that. There's not a lot of data for this. And just so our listeners know, like there's maybe a few studies, including Al including Dr. Anderson's recent dissertation, which was published in 2014, there's a couple of articles that have been published since then, but most of the research has been, was done in like the eighties and the nineties. So it's like over 20 years old. Right. So why do you think that data regarding burnout is so limited in our profession? And is there really any research going on in this area right now in our profession today? Speaker 3 (18:00): Yeah, I I've thought about that quite a bit, and I'm not sure why there hasn't been much, much research in the area. You can imagine that when I was working on my dissertation, I was shocked that there wasn't anything that was substantial. Everything was very old, as you had mentioned. And it was done in very discrete populations. So one was in rehab inpatient facilities in Massachusetts. Another wasn't a head injury unit in the Pacific Northwest. So very specific, nothing quite as broad as a national sample. Why, I don't know. I, in general, though, the efforts in looking at burnout has been focused on nursing and in physicians and MDs. And the only thing that I could come up with is there's a difference in the way we think and do things if you're medicine versus when you're rehabilitation. And I think that in comparing some of my findings in, especially in the areas of deep personalization and personal accomplishment, is that PTs typically were scoring much lower than nurses and physicians in those two categories. Speaker 3 (19:24): And I speculate that perhaps it's because of the kind of relationships that we have with our patients, that because we spend more time with our patients, we get to know our patients, families, and a lot of instances that it's very hard for us to depersonalize when you really spend a lot of time with someone. And that may also contribute to the fact that PTs score better than people in medicine, in the area of personal accomplishment, because although things may be crazy in your, in your practice setting, the fact that you can see a difference in the individual clients and patients that you see may in fact be reinforcing for that personal accomplishment. Speaker 2 (20:16): So is your belief then based off of what you found in your research, that kind of the difference between say physical therapists and nurses and physicians, which are more studied than what our profession is that we have better really, you know, longer lasting relationships with our patients and get because of that, we get a lot more accomplishment. Whereas physicians and nurses are more short term relationships with their patients. And so kind of those better scores and deep personalization and in personal accomplishment kind of help us save us from being burnt out. Like maybe our physician and nursing colleagues is that a, Speaker 3 (20:57): That is my hypothesis, but I haven't tested it. But that in looking at some of the publications in physicians of, of all different practice settings they are scoring typically higher, interestingly, except for those in mental health fields. So that may be a situation, two fold. Number one, is that a person working in mental health may actually have more skills to deal with their own stress and burdens. But they also may be spending more time with their patients because of the kind of therapeutic relationship that would occur in, in mental health. Speaker 2 (21:44): I think that your hypothesis is a very logical one, because if you think about, so if we, if we look at those studies from 20 years ago, obviously our profession has changed a lot. I mean, healthcare in general is just always changing. So, you know, right now student loan is at an all student loan debt is at an all time high wages for physical therapists are basically the same as what they were in the nineties. And the two thousands, we continue to experience decreases in payment. We have rising productivity expectations in order to maintain that bottom line. And so a lot of these factors are kind of cutting into our ability to form these relationships, so to maintain those good scores and depersonalization, and to have that personal accomplishment. But I'm interested in potentially knowing your opinion on how you think these factors have impacted the number of physical therapists affected by burnout. Speaker 3 (22:43): Yeah, I think that it has one of the, one of the findings that I observed in my research and that others have observed in medical populations is that younger therapists, younger physicians have higher rates of burnout than do older practitioners. And it's speculated that it's because the more seasoned therapist or physician has learned how to manage, right. They've learned how to manage sort of the, the game, if you will. They've also learned strategies for self preservation. So that gets us into that twofold area again, right. The personal, you know, wellbeing, and then the institution as something separate, I think it be worth it to take a look now, even compared to five years ago, with all the things that you've described, they were occurring five years ago when I did my dissertation, but then along comes higher expectations for productivity. Speaker 3 (24:01): And now, you know, let's throw in a worldwide pandemic onto that. Right. And so I think that what we've, what we'll, what we will see is that institutional changes that people may not have been able to keep up with because it's happened so rapidly over time, or it's sorry, that's weird. It's happened so rapidly within a short period of time that I think it would be worth looking into what changes have occurred in perceived stress or burnout. Within the past couple of years in physical therapy, because I would predict that those numbers would be greater than they were back in 2014. Speaker 2 (24:51): Well, I mean, that leads me beautifully to my next question is how do you think COVID-19 has contributed to burnout in physical therapy amongst physical therapists? Speaker 3 (25:01): Right. So when, so, although I didn't ask the question in my survey about what's causing you to be burned out or, you know, identify things that are stressors in your life. What I know, what I know from the literature is that when people in healthcare feel as though they don't have control of the situation, or they cannot contribute to good patient care effectiveness and efficiencies that the burnout rates are higher. So there is something to be said about this time in COVID where in our physical therapy world, we went from non essential to essential. We went from, you know, not doing rehab to doing nursing care. I colleagues of mine who were sent to the Mork colleagues of mine who worked security desks because in order for them to keep their job, they needed to say I would do assigned duties. So if we know that having little say about your work environment, little, say about how much time you spend with patients or what your responsibilities are, or what responsibilities you can delegate to other people, we know that that's contributing to burnout then hello, because that's exactly what happened to the physical therapy profession during COVID. Speaker 2 (26:39): So you teach at Rutgers what types of what types of instances of burnout or stress have you experienced amongst your students who are now like fresh into our profession and the students that are maybe still in PT school? How have they reacted to this COVID-19 pandemic in relationship to burnout or perceived stress? Speaker 3 (27:04): Right. So I think that we, we probably have cooked two cohort of students, the ones that graduated in 2020, who did a big sigh of relief because, because of in our program, the amount of weeks and hours they had got in for clinical experiences was complete by the time that they started to be pulled out of their clinical rotations. So all of our students were able to reach a level of competency and entry level so that everyone graduated in 2020. So they were like, just so relieved the group that is scheduled to graduate in 2021 have been dealing with the stresses, the traumas that come with changing responsibilities and different expectations because of COVID. But I think that by and large, they've had excellent clinical instructors, so kudos to the physical therapy profession and that they have been able to take the challenges in stride in part, because of the support from the institutions and their clinical instructors. Speaker 3 (28:30): I think that the students that are engaged in academic work, their stressors come from the fact that they know that they are in a program that's delivering information very different than the previous year and their hands-on experience has been truncated. And, and that, despite the efforts of the faculty to give them all the experiences that they normally would have in person that we are limited by the COVID restrictions of our university. So what we've, what we've attempted to do is to speak about the virtues of tele-health. We have some testing opportunities for students to engage in tele-health and improve their skills with communication and observation. Also giving directions watching movement from like you and I are right now from across the screen. And I do think that that is something that many therapists are learning. There's many courses and, and many workshops that you can do for best practices in doing telemedicine. So I think some of our students will be better equipped coming out because they have had some work in that area. Speaker 2 (30:09): So we've talked a lot about some of the different stressors that potentially could lead to burnout, but do you think are the main causes of burnout amongst physical therapists? Speaker 3 (30:19): Yeah, I think number one, I think autonomy is, and, you know, we got out from under the physician prescription. But if you think about autonomy from many practices in which the productivity demands is so high that you feel as though you've lost some sense of autonomy, and that comes from not being able to perhaps schedule your patients based on their needs. So, you know, if 30 minutes session versus 45 versus an hour so that contributes to a decrease in, in autonomy, which we know is that, which is a stressor when it comes to burnout. The other thing that is a big factor is redundancy. And it can be primarily in documentation where, you know, we've all experienced that you fill out one form, then you fill out another, then you have to do this chart and so on and so forth. Speaker 3 (31:20): You have this information in four or five different places, and that contributes to burnout because what happens is you feel as though you've imparted your professional opinion and you've made your professional observations, and that should be good enough. And you know what, Stephanie, it probably should be good enough. The fact that we have to, you know, regurgitate it in three different ways for different purposes is, you know, sucking the life out of people. All right. So the other thing that happens is that acknowledgement of credentials and continuing education and bettering yourself when that is not honored and respected by an employer or by a setting that contributes to burnout. And so in the physician world, they talk about having their board certifications. And we could also think about that in physical therapy as well. So even if you've got staff that have qualified or are now OCS is, or sports, clinical specialists is they need time to maintain that expertise. Speaker 3 (32:35): They need to do continuing education. They need to see the right patient caseload. They need time to do some outcome measures so that they can maintain that level, that high level of expertise, and that needs to be respected and time needs to be given to those professionals. Otherwise you can see an erosion of professional accomplishment. So it, it's not from my, my work, but from the readings that I've done in other professions, you know, predominantly medicine and nursing, these are the institutional things that contribute to burnout. And I can see that how that can they can have a big role in physical therapy as well. Speaker 2 (33:23): So I recently did a very unreliable and bias social media study pool on this topic asking you know, what, which physical therapy setting is burnout most prevalent. And I had 147, a sample size of 147 on, and I was kind of surprised by the results, but here were the results. 48% said private practice, 23% said, hospitals, 24% said skilled nursing facilities, and 5% said home health agencies. Do you think based on kind of what your research showed and based off of what you've read and potentially what your alumni have said, do you think that there is a higher rate of burnout amongst physical therapists in certain settings? And if so, what settings do you hypothesize put people most at risk for burnout and how can leaders within those settings decrease the rate of burnout amongst their employees? Speaker 3 (34:25): Okay. So I don't have to hypothesize because I actually have the data that was not part of my dissertation. So I will share that with you now. All right. So the winner in the burnout rate is skilled nursing facilities at 24%. Okay. followed by home a home care at 14% closely followed by the hospital outpatient department at 13% and private outpatient at 12%. So 12, 13, 14%, you know, sort of in the ballpark, but the standard, our skilled nursing facilities. And in, in a statistical analysis that I even still don't remember or can explain the one that stands out is truly statistically significant difference are those people who practice in skilled nursing facilities. And I mean, I would have to say that that number is probably in a higher, I mean, look what our colleagues in skilled nursing facilities had to deal with with COVID. Speaker 3 (35:39): You know, people were not being able to have visitation by family members, right. Trainings for going home sometimes were done via zoom sometimes in person for maybe five minutes. But think about that, think about all of the subacute rehab, people who didn't have family support when they're, you know, they're following surgery. They've never been in that kind of situation before, and they had to do that totally alone. And the demands that were placed on the rehabilitation staff and the nursing staff to keep moving forward with subacute care, nevermind all of those residents in long-term care that needed attention. So it, it back several years ago, it was still ranking pretty high as a stressful burnout written place to be long-term care. And I think it's still gonna sort of be at that level if not higher, what can they do? Speaker 3 (36:50): I still, I still have to go back to having compassionate supervisory support that there needs to be an understanding on how stressful and difficult it is to work with people who are at risk and people who are in crisis. And with that compassionate understanding supervisor comes a system that optimizes the physical therapist clinical decision-making professional opinion and allows therapists to continue to impact people's lives as positively as we do and not be burdened or, you know block or have a blockade set up through unreasonable demands and expectations. I think that the other the other idea that I didn't speak about earlier also is this sense of fairness and justice, and that comes from also the supervisor and, and the institution, and that it appears that when there's good transparency by knowing what everyone's case load is by knowing what the expectations are and that everyone is contributing to a a great unit or a great facility and that there's rewards and acknowledgements. Speaker 3 (38:37): And sometimes it doesn't have to be an actual bonus or reward. Those are nice, but sometimes it's just the acknowledgement. And at the same time that there shouldn't be any kind of punitive action on people who are not able to accomplish the same benchmarks. So I'll give you an example of something that happens in medicine quite a bit is that physicians who work in clinics are, have their appointments, you know, done by a scheduler, and they will have an income based on bonus based on how many people that they see. But what happens is when people cancel, they don't see anyone and there's no one there to fill in that spot. So physicians are, who are in that situation, feel like I'm not pulling my weight, but it's no fault of my own. And now I'm also being penalized because I don't have that slots filled. So I can't generate a ticket if you will, in order for a charge to go in, and yet it's by no fault of their own. And so we need to be thinking about ways in which physical therapists can have some participation in systems that supports everyone in that work environment. Speaker 2 (40:17): Do you have any advice on any of those systems or any thoughts behind developing those systems? Speaker 3 (40:24): I don't actually, I think that those are for, for different minds than mine right now. And I bet that there's plenty of people in the private practice section who have looked into different types of systems that include participatory type management strategies. Speaker 2 (40:48): I think you're probably correct on that statement, Dr. Anderson and, you know, most physical therapy facilities, including private practice, we're moving towards using data to make decisions. So how, what advice would you give to private practice owners? How can they use data to measure burnout amongst their employees? Speaker 3 (41:09): Yeah, I mean, I think, I think one of the the easiest tools to use is actually the perceived stress scale. It's by Cohen, it's free, you know, there's plenty of places where you can find it online and know how to score it. And one of the reasons why I, this is because I've done the perceived stress scale with groups of therapists who take continuing education courses with my partner and me and they are often surprised at what their score is. So some who thought they would score really high on this perceived stress scale, realize that no, they really didn't. And those who thought, you know, they were getting along pretty okay. When they went through those questions, they're like, Oh, I didn't think I would score that high. And so it, it leads to a conversation about that personal side, right? So what are you think that your stress, but your perceived stress scale kind of comes out a little bit low. Speaker 3 (42:22): So what are you doing in your life? How do you approach your day? What are the things that you do to manage your health and wellbeing? And I think that facilities that make that part of the culture will do really well with being able to use some of that information from the perceived stress scale, not where they're collecting the data, but they're increasing the awareness of their employees and the people that work together. And it opens up the opportunity to have a conversation about the stressors at work, the stressors at home, and how people can support each other and how people are coping with their stressors. Speaker 2 (43:09): What advice or solutions do you have for private practice owners or any, or organizational leadership on managing burnout amongst their employees once they kind of figure out some of the data points that you mentioned previously? Speaker 3 (43:23): Yeah, I, I think that one of the things that has come out in some of the literature is the fact that when you're working with highly intelligent people. And so remember that burnout came from people who were working in healthcare, right? They, they are licensed healthcare providers. They often have advanced degrees. They often have specialties. One of the keys is to give people a voice regularly. And then what is also been found is that when people are given a voice and suggestions are made for changing in the environment or something that could help greater efficiency, that the response from the administration is that I will look into that and then come back with information to either support that idea or to say at this time, and in this situation, that idea won't work. And here are the reasons why, but one of the things that's very detrimental is when people share thoughts and ideas, is that the first response they get is we can't, or no, without any kind of real honest investigation into the suggestion or recommendation. And so I think that that's a very sound place to start and trying to have a clinic or a facility that is going to be resilient against all of these forces that are going on in healthcare and have a happy and healthier staff. Speaker 2 (45:23): What about employees? What type of advice do you have for employees who are maybe close to, or are experiencing burnout? Speaker 3 (45:32): Yeah. institutional change takes a very long time, and sometimes it can be really frustrating, particularly if you don't have those empathic caring supervisors who are going to sort of beat the drum for you. And so you have the chance to turn to yourself. And what we know from some work site studies that have focused on healthcare providers is that breathing practices and meditation are two strategies, which help people be able to manage their stress effectively. And the idea is that you practice those things so that when you need it, you can use it. So, you know, you could always think, well, like when I get really anxious or whatever, I just stop and I take some deep breaths. Oh, okay. That's great. But when do you, do you always have an opportunity to like, just stop, pause and like take your deep breaths? No, you, you have to anticipate that this is happening and you have to be really good at pulling that up very quickly. And that comes from a regular practice. And I think that in general, we know those practices are really good for managing the balance of the sympathetic and parasympathetic nervous system. We know that those practices help increase heart rate variability, decreased blood pressure, decreased heart rate. And so it's not, those are strategies that are not just great for managing stress, but they're also great for managing your overall health. Speaker 2 (47:27): Well, Dr. Anderson, this been a great conversation. I know that I have learned a lot and I'm really looking forward to using some of this information to write my article. One last question that I want to ask you, that we ask everybody on this podcast is knowing where you are now in your life and in your career. What advice would you give to your younger self? Speaker 3 (47:53): Huh. I think, I think to my younger self, well, Hmm. Okay. There's two, there's two sides to this sword. One is that if I wanted to be more accomplished, I would say in my career I would have focused earlier on, on a line of inquiry or a line of research. However, not having done that. I can't say that I have a lot of regrets and I have dabbled in a lot of things so that you, you saw from my bio, that I have a lot of different interests and I don't do anything with a half effort. So, you know, a lot of research went into the book. A lot of research went into my being the advisor for young athletes for special Olympics. You know, there's, there's, I haven't really ever fallen into anything. I feel as though I've put a lot of effort into that and, and all of those parts of who I am. I enjoy immensely and I wouldn't want to give anything up. So my advice is if I had a clear career trajectory, I should have focused more on one area. But I don't know if that was really me to begin with. Speaker 2 (49:34): Yeah, don't we all want to have one area that we want to focus on and have a very clear trajectory. I think of 2020 has taught me anything. It is, that is not something that's going to happen most of the time. Well, I want to thank you so much, Dr. Anderson for joining us today on the podcast, and thank you so much for your time. Thank you to our, thank you to our listeners for listening to another episode of healthy, wealthy, and smart, and hopefully you will stay healthy, wealthy, and smart. Speaker 1 (50:10): Thank you for listening. And please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.

In this episode, Co-Founders of Survivorship Solutions, Jillian Schmitt and Kristin Carroll, talk about Cancer Survivorship and the need for Caner Rehab Education. Today, Jillian and Kristin talk about the prevalence of cancer, the importance of competency in cancer rehabilitation for all rehab clinicians, and compiling educational courses from leaders in the field. When should cancer rehabilitation start? Jillian and Kristin tell us that learning is not enough, hear about the value of mentorship, and Jillian and Kristin’s community of clinicians, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Cancer is not just one type of cancer. Cancer is not just what you’re seeing on the outside, there are physical changes on the inside as well.” “One thing that physical therapists have to keep in mind is that 100% of physical therapists, at some point in their physical therapy career, will see someone with cancer.” “If you want to stay on the bus, get competent and elevate your skillset to everything, not just cancer rehabilitation, but add that as another skill in your pocket.” “If you are a clinician or a therapist, it really is your ethical responsibility to take care of every patient that comes through the door, regardless of what their past medical history is. If you are not confident and competent in taking care of oncology patients, get that way. There’s a solution for you. Educate yourself, feel comfortable, feel confident, take care of your patient the way you should.” “For administrators and leadership teams, you really want to know that your team can take care of this population. If you do not have something in place that is ensuring that your clinicians and rehabilitation teams are really competent at taking care of these patients, you need to get that way, and you need to get that way pretty quick because the regulations and requirements from the very top levels are requiring that you do that.” “If your oncologist is not talking to you about function and what’s happening to you during your cancer journey and how that is going to be mitigated, or how you’re going to have a rehabilitation therapist of some sort as part of your team, ask for it. It needs to have this bottom-up push as well.” “Think big, be brave, and just go for it.” “Keep being a sponge. Keep learning. Don’t be afraid to try new things. When you’re starting to get burned out, try something else. Keep learning and keep growing, and eventually you’re going to find something that just wows you and really makes you change not only your career, but your personal growth as well.”   More about Kristin Kristin has been in clinical care and leadership roles within the Boston and Hartford healthcare systems for over 30 years. For over a decade she has focused on elevating her oncology specific practice with Klose coursework in lymphedema, oncology and breast cancer rehabilitation specialty courses through Julia Osborne and the American Physical Therapy Association (APTA); Academy of Oncologic Physical Therapy, and earned completion certificates in Chemotherapy/ Biotherapy Agents and Radiation Therapy from the Oncology Nursing Society. She is planning to sit for the 2021 Oncologic Certified Specialist Examination. Kristin has been a mentor, clinical coordinator, and educator at both the system and collegiate level. She continues to serve as an educator through her role as an instructor within Survivorship Solutions ’clinical education course: Core Competencies in Interdisciplinary Cancer Rehabilitation, contributing to guest podcasts on Breast Friends Cancer Support Radio, Mama Bear Cancer Support Radio Talk Show, and The OncoPT Podcast, contributing to Alene Nitzky’ s book “Navigating the C: A Nurse Charts the Course for Cancer Survivorship Care”, and as invited speaker at the International Breast Cancer and Wellness Summit, and the American Congress of Rehabilitation Medicine National Conference 2020. She actively supports and is involved in the oncology community as a member of the American Congress of Rehabilitation Medicine Integrative Cancer Rehabilitation Task Force, Connecticut Lymphedema Consortium, local and national chapters of the American Physical Therapy Association (APTA); APTA Academy of Oncologic Physical Therapy, Hospice and Palliative Care Special Interest Group, and serves on the board of the APTA Connecticut Oncology Special Interest Group as Program Coordinator. Kristin received her Bachelor of Science in Physical Therapy from Northeastern University. More About Jillian: Jillian is a licensed physical therapist with over 20 years of experience in patient care, clinic development, management, and consulting within the fields of oncology, orthopedics, pediatrics, ergonomics, and corporate health. She studied biochemistry and business management at the University of Texas at Austin, and received a Bachelor of Science degree in Healthcare Sciences and a Master's degree in Physical Therapy from the University of Texas Medical Branch in 2001. Much of Jillian's early career focused on orthopedic and pediatric physical therapy intervention, specializing in complex, limb-salvage rehabilitation programs, spinal dysfunction, and sports medicine. Later, she turned her attention to program development, clinic start-ups, and management within the corporate healthcare industry. For the past six years, she has consulted in the implementation and optimization of survivorship services and cancer rehabilitation programs within national healthcare organizations. Jillian maintains professional licensure in physical therapy and participates in continuing education programs and certifications within oncology and other specialties. She serves as a contributing and presenting team member for the American Congress of Rehabilitative Medicine (ACRM)'s Integrative Cancer Rehab Taskforce and is a member of both the Education Section and Oncology Section of the American Physical Therapy Association (APTA). She also participates as a member of the Hospice and Palliative Care Special Interest Group (SIG). Jillian regularly contributes to podcasts, journals, and other professional publications related to oncology, healthcare, and business, and she participates and contributes regularly within the entrepreneur and small-business community of the Chicago-land area, including SCORE mentorship and women-led business groups. In 2016, Kristin and Jillian founded Survivorship Solutions, LLC., an education and consultancy firm dedicated to supporting clinicians and healthcare organizations in implementing high-quality cancer rehabilitation and survivorship services. The company collaborates with national and global experts in oncology, survivorship, and rehabilitation to grow team safety and competencies in oncology knowledge and evidence-based care.     Suggested Keywords Physiotherapy, Learning, Cancer, Research, PT, Health, Therapy, Oncology, Survivorship, Healthcare, Education, Training,   Recommended viewing https://vimeo.com/485402119 https://survivorshipsolutions.com/p/core-competencies-in-interdisciplinary-cancer-rehabilitation-2-0   To learn more, follow Jillian and Kristin at: Website:          https://survivorshipsolutions.com Vimeo:             https://vimeo.com/survivorshipsolutions Facebook:       Survivorship Solutions Instagram:       @survivorshipsolutions Twitter:            @survivorshipsol                         @KCarrollPT                         @JSchmittPT LinkedIn:         Kristin Carroll                         Jillian Schmitt                         Survivorship Solutions LLC NetHealth Webinar:  Rehab Therapy Outpatient Services 101: How to Expand into the Home or Assisted Living Facility. 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: Speaker 1 (00:00): Hey, Kristin and Jillian, welcome to the podcast. I'm so happy to have you guys on Speaker 2 (00:07): Or happy to be here. Speaker 3 (00:09): Thank you so much for having us on today. Speaker 1 (00:11): So today we're going to talk about cancer, survivorship. This is something that I've spoken to, one of your colleagues, Dr. Nicole Stout with, but before we get talking about that, what I would love to know is how the two of you came together to create survivorship solutions, the how, and the why behind it. Speaker 2 (00:31): So, Kristen and I knew each other before we started the company together for a couple of years, we, we previously worked for another organization and had similar roles and that was to implement cancer rehabilitation, service lines within healthcare systems. And Kristen and I really connected during that time. And we really enjoyed working with each other. We valued a lot of the same things. And so once we left that situation or once that situation of our, our, you know, once that's working together no longer happened for that particular company, we decided that we were great together and that we would we needed to continue the work. And so we started survivorship solutions together Speaker 3 (01:21): And Julia and I are both physical therapists and I have a special, I've been working with oncology patients for over 12 years. And even though we're both PTs, we both kind of had different soap boxes and what we were so passionate about. And Jillian has a love and just a savvy for business and growth. And you know, I just love to educate and things like that. So together, you know, just our, our strengths and our passions just forged us forward to create this, this company to, to continue to help healthcare organizations, but also individual commissions that, that really just needed to get more information on how to take care of people with cancer. Speaker 1 (01:59): Yeah. And that was my next question is where, where was the gap that, what was the gap that you guys saw that you were like, Hey, if we can put our heads together and create this, we're really going to help fill that gap? Speaker 2 (02:11): Right. Well, you know, for me personally, it was I was not a cancer rehabilitation therapist for most of my, my clinical career. I was in orthopedics and I th the opportunity to begin working in cancer rehabilitation actually came about it was pretty unexpected. I received a phone call from a very good friend of mine and also therapists I would school with. And I've been in practice for 15 years and she said, you know, I think that this would be a really good opportunity for you, you know, you, you've married sort of this business. And I, because I had opened clinics and I had done a lot of the, the business part of it. And but I really loved clinical practice. And I also had a very personal situation occurring in my life, or one of my loved ones was experiencing the cancer journey and really having a lot of issues and a lot of problems that I was really familiar with. But I, you know, like weakness and numbness and things like the things that physical symptoms, but I was just kind of watching through this lens and like, all right, well, that's like what I do every day, but why isn't somebody helping him? So it was all these three things that kind of came together and took me out of my orthopedic world pretty quickly and thrust me into the cancer rehabilitation world, which I had thought, I mean, admittedly been very naive of until that happened. Speaker 3 (03:43): Yeah. And I was working in an outpatient center and had surgeons come to ask if I would become competent to learn how to take care of breast cancer patients. Cause they were breast cancer surgeons. So I went to Olympia DEMA course and I learned all about lymphedema. And then I came back and I saw a breast cancer patient and I was all excited to use my new education that I just learned and she didn't have lymphedema, but I was like, Oh my God, what do I do with her? I mean, I learned all about lymphedema isn't that cancer rehab isn't. And so Julie and I learned quickly that in order to really become competent, to take care of people with cancer, you have to travel around the country at your conferences and online and, and do all sorts of things to get there. But a lot of it was just disease specific, like just breast cancer. So how do you learn how to take care of everybody that has all different kinds of cancers and all the different problems? So we felt that it really was our ethical responsibility as we were working with healthcare organizations to make sure that if we were going to implement a program, we had to make sure the team really was confident and competent to do that. So how we created education to go along with that implementation. Speaker 1 (04:54): Yeah. Excellent. And, and I will say that people who, like, I know people who've been diagnosed with cancer and as of yet only like two of them have gone to physical therapy. One of which was because I said, you have to go to physical therapy, she had a double mastectomy. And I said, tell your doctor that you want to go to PT afterwards. And she was like, but the doctor gave me this list of exercises. And I said, no, no, no, no, no. Tell your doctor, you want to go to see a physical therapist after this and, and sh afterwards she was like, yeah, I I definitely needed a PT. And so I think the issue here, and we'll get into that, we'll get into this conversation in a little bit, but you know, the issue here is that cancer is not just one type of cancer. Cancer is not just a, what you're seeing on the outside, but there are physical changes on the inside as well. And that's where being a knowledgeable physical therapist on, on the rehab of people diagnosed with cancer is so important, but let's talk about cancer in particular. So cancer itself can affect anyone true or false. That's absolutely right. Yeah, definitely. And so let's talk a little bit about the, this sort of prevalence of cancer and what that means for us right now, Speaker 3 (06:31): Almost 17 million cancer survivors in the country. And so that is all different ages, you know, doesn't matter which sex, all different kinds of cancers, definitely cancer is not discriminant. And so you talk about the gap in care. And Andrew Chevelle is, is kind of huge in our cancer rehab world and does research. And you know, she talks about the 83% of general cancer survivors have problems that really require rehabilitation and take it to the other end where women sorry, excuse me, general cancer metastatic or stage four, they have up to 92% of problems. So obviously somebody that has a chronic cancer condition is going to have more and more problems because they are receiving more and more treatments. And so the percentage of people that actually get rehabilitation is only about 30% according to, to her study. So that's, you know, that's a huge gap in care wizards. Speaker 3 (07:25): It's 83% of general cancer survivors or the 92% of our metastatic breast cancer patients. That's a huge gap with 30%. So when we're looking at that, if you're young and you're diagnosed with cancer and you have treatment, you're going to grow up to have perhaps problems, you know, as you get older. And so, you know, these people are inside our clinics already. And sometimes it's a little tiny past medical history. That's checked, you know, on their, on their form and we see cancer, but yet we're a little bit afraid sometimes to ask a little bit about what that is. And, and even I do that when I'm in a private room with my cancer patients that I'm treating them, I have no problem talking about what they went through, but on an open clinic. And I see that little word cancer, sometimes I, I will say, Oh, well, you had cancer. What kind did you have? And you know, but we really have to have these conversations. What kind of cancer did you have? What kind of treatment did you have because it really can impact the treatment that you are providing your patient, whether they're a pediatric patient, you know, an inpatient and outpatient adult really doesn't matter what the setting is. It really could depend on what your care plan is going to be. Speaker 1 (08:41): And Karen, you, you had mentioned that you said you asked, can anybody get cancer and can this affect everybody? And absolutely. And I think what's, what's really interesting is that healthcare professionals, you, myself Speaker 2 (08:56): Included, we don't necessarily automatically think about like the, the functional consequences of having cancer, even though we see it. We're so we have this new normal instilled in us that we sort of expect cancer patients to not have normal function or not be doing well. And it just really to be part of what the expectation is once you get that diagnosis. And even me, even somebody that has worked in therapy for a long time and having a person very close to me, experiencing physical symptoms, I still, it was almost like a, it was just sort of like an out of, Oh, you know, like I didn't really make sense to me why he wasn't getting it, but it wasn't sort of this, well, this is a person that needs to have therapy. That connection wasn't, wasn't quite there yet. And I think that that's true for a lot of clinicians. Speaker 2 (09:49): They say, well, we, we don't see cancer patients, but but w w what Christina likes to say, well, yes, you actually, you have, and you do you see them probably every day on your schedule, there's such a high percentage of people that cancer at this point, that if you're seeing any population in ortho population or a neuro population or whatever in your clinic, you have seen patients that have either current or a previous diagnosis of cancer. And so you are, these patients are coming into our clinics already, and people are just not really making that connection. Speaker 1 (10:23): Yeah. I remember when I spoke to Nicole, she said, one thing that all physical therapists have to keep in mind is a hundred percent of physical therapists in, at some point in their physical therapy career will see someone with Speaker 2 (10:36): Absolutely, absolutely. Probably this week. Yeah. And like, you know, it's, it's not, it's not when, or, or it's, I mean, like it's very, very soon because patients also don't necessarily think about the fact that they have a cancer diagnosis and it's something that they really need to kind of put, put front and center when they are going to rehab. So maybe they've had a knee replacement or they've had some other traditional rehabilitation problem, like a BA like back pain or whatever they go to PT for. And they had that pesky, you know, cancer diagnosis 10 years ago that colorectal cancer, but they, they got it and they got the third, but so they don't really, but you know what, those things that happened 10 years ago with that diagnosis and the medications that that patient had and the treatments that that patient had are actually going to impact the way that they heal in, in physical therapy. And so I think the patient doesn't understand the significance of it. And then the clinician doesn't really understand the significance of it. And it makes a huge impact in how well that patient is gonna, you know, do and how, and in the course of their therapy, it really should kind of direct the course of their therapy and and predict how well they're going to be able to, you know, certain, certain things that should be in therapy and certain things that should really not be done in therapy should be based on that. Speaker 1 (11:57): And something that as you're saying, all of this, that kind of struck me is that in physical therapy, you know, we are expected to have the competency to treat people with a total knee replacement, low back pain post-stroke Ms. But you guys have traveled around the country. You've spoken to many physical therapists, is that clinical competency in cancer rehab there amongst the physical therapy profession. And this is a silly question, but is it essential? Speaker 3 (12:35): I do. I think it was definitely not there. I mean, there are therapists that are very skilled at providing lymphedema treatments, and there are therapists that are very skilled in targeting certain kinds of breast cancer. But I think one of the things that we think, what I think about is that the things that people going through cancer treatment, it's kind of like an anticipated decline, right? Like we kind of know that they're going to feel like crap when they're going through chemotherapy. And I think that maybe, and I had this assumption that once their chemotherapy is over, they're going to be fine. And I think a lot of the providers think that as well, we kind of know that they're not going to do well during treatment, but I don't think that a lot of people know is that they don't do well even after treatment and that six months and years later, they have these effects. Speaker 3 (13:24): And because there are one in eight women that get breast cancer, and there are so many men that get prostate and other lung cancers are, are breast cancer women, and are prostate men have to take medications sometimes for five and 10 years, that affects their musculoskeletal system that affects every ortho therapist. If they're treating these people that are in their clinics. So there may be a general awareness, but I think there is kind of pick and choose, like you make it a lung cancer patients that you're treating for weakness. You don't have to treat weakness, you don't to treat balance issues, but you may not really understand what the chemo regimen did to the patient, why they're having those. So I think explain the why around it helps to decrease the fear that some therapists have of treating, because I sure was afraid when I saw my frail bald patients walking in, I was really afraid I was going to hurt them. And I didn't feel safe to take care of them because I had one month of DEMA course, and I wasn't. So we kind of wing it, right. Because there's not really many resources out there. Right, right. Speaker 2 (14:36): Back into my schoolwork and looked and to see what oncology criteria like curriculum that we had gone through when I was a student. And yeah, I mean, it was so minimal. It was less than a week was one core, like within one class that wasn't oncology focused. It was, I mean, the amount of information that clinicians were getting in school and professional programs was very, very minimal. And of course that's more than 20 years ago when I was in school. But even now even now I would say that there was a huge percentage of of clinicians that take our course who are new grads. They just got out of school. So we know, and we've communicated with them. Talk to them. This is not in their curriculum. They are not learning this in school. Otherwise they would not be seeking out some of this information that they know is really important anyway. And that's physical therapists, occupational therapists, anybody that's in allied health or are seeing patients really needs that they need to have this foundational, basic knowledge that makes them safe and makes them competent to care for these patients. And so it is a little, I I'm sure the education, maybe at some point we'll catch up, but it hasn't yet. Speaker 1 (15:56): Yeah. And, and I'm sure it also depends on what's on the MPTE, but that's a whole other thing and let's, we won't get into that, but we know that certainly exists when it comes to educational curriculum in schools. Yes. At any rate I digress. Let's talk about, let's talk about when should rehab physical therapy, occupational therapy start. So someone is diagnosed with cancer. When do they start their rehab? Speaker 3 (16:27): The rehabilitation starts at diagnosis and that's when the American cancer society. And so many of our, our industry regulators recommend that it started and it start from diagnosis all the way from end of life or end of care. And, you know, we compare this to kind of our other service lines, but, you know, somebody is having a knee replacement they're coming in for prehab, right. They're coming in for education, they're coming in for strengthening before they do that. And it's, it's no different for a patient with cancer. They need to be armed with what they are going to go through. Not only the education to help decrease their fear, but also the problems that they are going to incur, understanding that we have the skillset and the tools to be able to support them throughout that journey. And I think the other thing that rehab teams don't realize is that general clinicians that don't have specialties really can treat the scope of most of the impairments that people have. Just like we all can you know, balance and numbness and tingling and strength issues and fatigue, and just, you know, the list goes on and on, but if you have a pelvic health issue or if you have lymphedema, then we triaged to our, to our specialists Speaker 2 (17:35): And, and best practice really dictates that when you're going to begin any type of a treatment or any type of incur, any type of or undergo any type of surgery or anything like that, it's really to establish a baseline. And in cancer, there's really, it's, it's very important to establish a baseline because we know pretty, pretty well that cancer treatments are going to cause problems. They're going to exacerbate existing problems. And so if we can add diagnosis, capture what that baseline is for that patient and monitor and survey that patient and make sure that that patient is not there, that their existing, their preconditions or existing deficits or impairments are not getting worse or that new ones are not popping up. That really is best practice because we know that if we can see something pop up, you know, and catch it immediately, it's going to be a lot easier to take care of and to recover from or to prevent even then, if it's something that we don't, you know, that we don't look for until after treatment is over, maybe, you know, the patient is having a lot of functional problems that are really obvious. Speaker 2 (18:50): If you just wait until then it's going to be a lot harder to intervene and it's going to, I mean, and this is it's gonna be a lot more expensive. I mean, something that may take just an education and maybe one visit and rehabilitation from the very onset and the very beginning even something, you know, just as you're going to have this, you're going to have a lumpectomy you're going to guard you. You know, let's make sure that when this happens, you're going to continue to do range of motion within a certain, you know, limitation, but that the patient knows that that can later prevent like three months of a frozen shoulder. Right? I mean, like we know that this, these things happen all the time and it's easy to just kind of get in there from the beginning. So best practice is, is at the very beginning at diagnosis, patients should definitely be at least screened for impairments and informed that rehabilitation is part of their medical care. They should expect it, their patient should walk in knowing that rehabilitation is part of their medical team. Yeah, absolutely. Speaker 3 (19:52): And this is, and this is something that Nicole Stout talks a lot about in her research has called the process perspective surveillance model. And that is, you know, screening patients before each intervention. So we know kind of what we call each medical touch point. So whether they're having surgery or chemotherapy or radiation really being screened before each of those interventions. So like Jillian said, we can kind of pick up on those impairments when they're acute in nature, that's really important. Speaker 1 (20:19): And so let's talk about cancer rehabilitation education. I think we've already established that physical therapists do not get an adequate amount of cancer rehabilitation education in school, and you may not get it on the job either, depending on where you work. So couple that with millions and millions of people getting diagnosed with cancer every year rehab should start at the point of diagnosis. So let's talk about the education around it, because if that is the case, and now it is recommended rehab start at the time of diagnosis. And there are tons of PTs in this country and not many know how to deal with this. How do we educate physical therapists in a robust manner so they can help with these patients? Speaker 2 (21:15): Well, I think that things are kind of catching up here. It's been established that cancer rehabilitation is important and it needs to be part of cancer patients cancer care. And we have national regulatory agencies and different sort of top level drivers that are encouraging and really requiring organizations to provide cancer rehabilitation. So we have a lot of these companies that are starting to recognize, all right, are people that are in house already need to be doing this. And then from the clinician's perspective. And, and I can say this as a, as a physical therapist, if, if my boss had come to me in my outpatient clinic and said, okay, we're going to have a bunch of oncology patients come in the doors now. Because there's these guidelines and we're going to see this influx of patients and you guys are gonna be treating these patients. Speaker 2 (22:15): I would have been like, okay, like I would have been really nervous about it. And so we, we still sort of were getting that response as organizations are starting to implement some of these policies that are requiring that their organizations provide these services. So we're also getting this sort of searching from these clinicians, like, all right, I'm going to see cancer patients. And when I go online, I see like a billion, different CU courses for different types of, I mean, I can be different specialists in this or a specialist in that, or I can take this or I can take that. What I really want to know is how can I be safe to see these patients coming through the door. I don't, but maybe cancer is not there. And you know, what, what they're interested in, they don't want to specialize in it. Speaker 2 (23:03): That's fine. And so they don't want to spend thousands of dollars on specialties and weekends, but they do want to be safe and they want to know. And so Chris and I kind of came at it from that perspective, like, all right, we're gonna, we're gonna say, we're going to get more referrals in your clinics because of these guidelines, because it's the right thing to do because research says that cancer patients need it. But what's really important to us is that your clinicians feel competent. They feel safe. How can we create the education that your, your clinicians are gonna feel like they can have anybody land on their schedule and that's going to be fine because that's going to make them feel comfortable. And what that's going to do is going to make their bosses feel comfortable there. The leadership is going to know that their entire Rhea team has a competency and anybody can kind of come through there and that their service is going to be very similar from facility and location location. Speaker 2 (23:48): So we, that's kind of where we started with. We weren't, we didn't, we didn't want to make a course that was going to make somebody a specialist. Those are out there and they're awesome. And we work with all those people that make those courses. So we know they're awesome. We wanted to create something that was respectful of somebody's time and their money, and, and really want to just pull the most excellent parts of all those specialties into one spot so that a therapist could go through it and be pretty confident in their leadership can be pretty confident that they were that they were gonna be able to take care of these patients as they come through the doors. Speaker 3 (24:23): Yeah, Kristen, and then I, I was live and then I was living in the cancer rehabilitation world. So I knew a lot of the experts and the leaders in the field from just attending their courses and conferences like Nicole, Nicole Stout, and Julia Osborne. And, you know, just all of these amazing people that really aligned with the same mission and vision that Jillian and I both had to spread this education. And, but what was missing was a comprehensive online platform. And, you know, I I'm sitting for the specialty exam in February, but I'm an expert in certain things, but I certainly not the expert on everything. And so Joanie and I said, you know, when we're learning, we want to learn from our role models, right? Our peers and our colleagues who respect in the field. So we went out and we asked them, you know, will you help us create this education? Speaker 3 (25:18): And they all said, absolutely it's really important. And why it's important is because we have to get it in the hands of people quickly. I, it took me 12 years to kind of get all this information. We don't have that kind of time because we have almost 17 million people that need this care right now. And these patients are in the clinics and, and they need it. You know, they're, they're just people that want to do marathons and, you know, raise their children and go to school and do all the things that everybody else does. So how do we get it into the hands of people? So we went out and they created this, this education, and then we went and got it approved recently for continuing education credits. So it really is an amazing compilation of education that spreads a blanket over all different kinds of cancer, disease types and all the impairments. But it isn't just for somebody that wants to be competent and confident. Cause I went through it myself and I learned a lot of information and I've been doing this for over 12 years. So it really is also for clinicians that are interested in cancer rehabilitation that work in cancer rehabilitation, but are also experts because they will learn about a lot of things that there are no courses for like pharmacology. There are no courses for pharmacology, right. They're out there right now for to learn from Speaker 2 (26:39): It's really for the whole team. Yeah. And so when, so let's Speaker 1 (26:44): As a physical therapist I go through, through this chorus, I'm confident, I'm competent. And is it like, okay, thanks. I guess I'm, I'm, I'm good now. I don't need anything else. So what happens after this sort of ed, you have this experience with you guys and you're, you know, relatively confident and competent is, is that where the learning ends? Speaker 2 (27:12): No, I, I, I really love that you asked that question actually, because this is what I, this is my soap box. You know, we all, all of our presenters for our course, they all have their soap boxes. They're all specialists about what they think is the most important. That's why our education is awesome. We, you know, we went to the specialist, we said, give us 30 minutes, you know, or, or whatever that you think is the most important part of your specialty that you think all general people should know, and then they bring it in and that's, what's in the core. So you kind of get the best of everything and what the specialist actually think the general therapists really need to know about certain things. But we did recognize absolutely that once you have, this is acumen or you, this information about, you know, cancer rehabilitation and you have got to be able to communicate with others that have the same information that, that are there in the same world. Speaker 2 (28:02): Because even though there are going to be a lot of patients that are starting to come in in the future right now, it's a little bit of a small world. It's kind of a, a small world in regards to who is in cancer rehabilitation. And we know this because we go to the conferences and we see the people that come to the different lectures and the presenters. And we know that this is kind of a small world because we see that a lot of the same people over and over again. And, and so the education is really important, obviously for Kristin and I, we have it updated constantly by the presenters. Each one of them is responsible for their segment so that we know if legislation changes, if there's evidence that comes out, something happens where their presentation or their part of our education needs to be updated. Speaker 2 (28:42): That's going to happen in pretty, pretty much in real time. But how do we answer our students' questions later? How do we grow their interest or their confidence beyond just an online course and the way that Chris and I have been doing that, as you know, we've worked with clients and we've sort of built this community within our own clients, that they reach out to each other all the time and communicate in that way. They know they've got other people that are doing the same thing, implementing the same types of interventions or screenings or things like education. And so they can connect with each other. And that's great for those clients. But we've really recognized that there is there is a need for a community where people could really discuss their patients, discuss their experiences, discuss their education and grow from there. Speaker 2 (29:32): And so that's actually something that we're working on right now really hard. And we, we already, you know, it's rolled out for our clients right now. So it's just a matter of being able to make it more of a public forum where people can, they they've got this, they've had the education. So they kind of were speaking the same language, at least at a bare minimum. And then they can discuss and communicate. And what's nice about it is that we've got all of our partners who have created our course, like Nicole Stout and Mary Lou Valentino. And some of these others who are very reputable, well-known that created part of our course for us. And they're all in there like, heck yeah, we're going to be part of this conversation. We want to be part of this community. And so our vision of course, is that we can have discussion groups and different opportunities where people can get their questions answered about either about the education or applying that application, that education to real life scenarios. How can they get that feedback and that comradery that they're going to need to feel even more confident in this industry. That's why we have, that's why we have great relationships is that they all want to do this. They all know this community is important and it's not a big ask. It's not like, Hey, can you talk to a bunch of therapists that really think this is important? They're I mean, they're, they're all in it. They're all in. So Speaker 3 (30:51): Being an Island is, is kind of scary. And like you said, you take that education and then you go back into your clinic or your place. And for people that are working in rural communities, they may be the only person that is taking this education. And we're all really busy people in our work lives and our home lives. And I think one of the hardest things for me as a clinician and a business owner is what do I need to know right now? You know, there's so much research that comes out. And so that's how we also wanted to support with, with workshops. And you know, what is the need to know research that you need to know that's coming out today? You know, you can't afford to fly all over the country and go to all these conferences. Well, guess what, we've tidbit from all the conferences that now that's out there, that's pertinent to you so that you understand what's going on out there in the world without having to do that. Speaker 3 (31:43): And so it's you know, it has meant so much to Gillian and I to work with all of the partners that we have. All of the organizations that we work with are so passionate. We've met clinicians that are passionate. I've never met anyone that has not been exposed to cancer in some way, whether it's personally a friend, family, somebody, so everyone is connected by it. Nobody doesn't want to take care of somebody that's going through this. So it's really, how do we all kind of work together to support each other? That if you have questions kind of there in a non-threatening way. Certainly, you know, when Julia and I first met Nicole Stout, we were, you know, at, at, in section meeting and she was standing over there and, and, you know, Julie was like, I'm going to go over there and meet her. I'm like, no, no, it's Nicole Stone. You know? And I was so intimidated by her and because she was a big wig. Well, yeah, but when you meet her, you go, you meet her and you learn that she has the same passion and mission and commitment to people that you do. And, and she's so accepting and welcoming that, that really went away. And I felt like we had to really offer that to everybody else so that they could acknowledge that these people are, are very willing and receptive to helping. Speaker 1 (32:58): Yeah. Yeah. She's fabulous. Plus, I mean the shoe collection, I mean, I mean, can we just be envious of her shoe collection? And so, but yeah, she's, she's fabulous and what she does for the, for the physical therapy world oncology in particular. But I think the PT world as a whole is, is huge. As a student, she might, people might be intimidated by, by that. I mean, we were, but I think that that's what we're trying to do is as we're breaking down those, those barriers for our students, and we're saying, Hey, look, you know what your course is awesome as taught by an awesome person. And here's an awesome person that you can ask that question too. Yeah. Yeah. What a wonderful opportunity to give to your students to, to have to have those collaborations and those relationships, which in, in my, in my eyes, relationships are everything they're key. And, and that's the thing for me that keeps pushing this profession forward. As we wrap things up, I'm going to ask each of you. So what would be your big takeaway that you want the listeners to come away with from the talk today? Speaker 3 (34:09): I think one of the biggest things that I learned was actually back at CSM. And somebody said that as physical therapists, we are medical coordinators of care and is our ethical responsibility to really be able to take care of everybody that comes into our care. And he said, you know, what, if you're not competent to treat everybody get off the bus because you're bringing our profession down. You know, we have autonomy. Now we can have people coming into our clinics without physician referrals. So we have to know this many, many PTs can order x-rays and things like that. So my take home message is if you want to stay on the bus, get competent and elevate your skillset to everything, not just cancer rehabilitation, but add that as yet another skill in your pocket so that when that patient comes in, you can either treat them or you can triage them. A stroke patient comes into my clinic. I can evaluate them and educate them, but I might triage them somewhere else so that they get more targeted care. So that's, you know, I just want everybody to get on the bus. Yeah. Speaker 1 (35:20): Awesome. Jillian. Well I think my takeaway that I would provide it really depends on the audience on who is listening. So if you are a clinician or a therapist like Kristen, it really is Speaker 2 (35:38): Your ethical responsibility to take care of every therapy. Every patient that comes through the door, regardless of what their past medical history is you should be able to provide the highest level of care for that patient and as therapists. And we all know you have the heart of a therapist, you want to do the best for your patients. So if you are not confident and competent in taking care of oncology patients, my takeaway to you is get that way. There's a solution for you, educate yourself, feel comfortable, feel confident. You take care of your patients, where you said there's a solution for you. I'm an action girl, but my takeaway for administrators and for leadership teams of your organizations is you really want to know that your team can take care of this population. And when you do something, when you do something and you want to be sure that your team is competent, you put forth these standards and people have to meet these standards. Speaker 2 (36:31): And so my, my takeaway for then is that if you do not have something in place that is ensuring that your, your clinicians, that your rehabilitation teams are really competent in taking care of these patients you need to get that way and you need to get that way pretty quick because the regulations and the the requirements that are coming down from the very top levels nationally are requiring that you do that. So it's not just an ethical thing on the clinician side. It really, and, and also this is a new patient population or not, not a new patient population, but this is a patient population that is going to expand. We're going to see a lot more on ecology patients. And so that is an opportunity to reach out to sort of almost a new I don't want to call it a market cause I don't like to call people a market, but it is, it's a new, it's a new market for, for those administrators and most leaders. Speaker 2 (37:28): And then the takeaway, of course, if we have patients listening or, or relative caregivers coast survivors is what we call people that are in the lives of, of a person with a diagnosis of cancer. Ask for it. My takeaway is that this is part of your medical care. You should be, if you're not, if you're, if you're on ecologists, your provider is not talking to you about function and what's happening to you during your cancer journey and how that is going to be mitigated or how you're going to have a rehabilitation therapist of support as part of your team. If somebody has not said that to you yet ask for it because it needs to have this bottom up push as well. And it seems so logical when you talk about it. But again, you know, you gotta look, you gotta understand your audience and who are you talking to? What language are you speaking? Yeah. Speaker 1 (38:16): Excellent. All right. So before we get to where everyone can find you, I have last question, it's the question I ask everyone. And that is knowing where you are now in your life and in your career. What advice would you give to yourself as a new grad? Speaker 2 (38:33): I would tell my younger self or anybody that is kind of starting out in their career and they know they're doing what they love to think big, think big and be brave and just go, just go for it. Speaker 1 (38:48): Excellent. Kristen, Speaker 3 (38:50): I think that I would tell my younger self to just keep being a sponge, keep learning. Don't be afraid to try new things, you know, when you're starting to get burned out, try something else, which is what I did. I kind of kept jumping around and I found I was passionate about each of those things and just keep learning and keep growing. And eventually you're going to find something that really wows you and really makes you change not only your career, but your, you know, your personal growth as, as well. Speaker 1 (39:23): Excellent. Very good advice all around. So now where can people find you? Where can they find the course? What's the name of the course? Give me all the details. Speaker 2 (39:31): Great. but you can find us@survivorshipsolutions.com. That's our website and our courses on our homepage. So they can just click, click on the link, they'll see the education and they'll see some of the other, you know, consulting services and things like that that we also provide. But and certainly there's contact page. They can reach out to us. We're happy to, to have conversation with anybody. Speaker 1 (39:59): Perfect. And what about social media? Where can people find you follow you, et cetera? Speaker 3 (40:03): We are all over social media. We're on LinkedIn. We're on Twitter, on Instagram and I forgetting what's the other one, Facebook both personally and professionally where we're both on there. So maybe you can find us there. Speaker 1 (40:17): What are your handles? Speaker 3 (40:19): Our business handle is survivorship solutions for LinkedIn and for Twitter. It's survivorship Sol. Speaker 1 (40:26): Perfect. Excellent. And we will have the links to all of this at the show notes for this episode at podcast on healthy, wealthy, smart.com. So if you want to get more information on the course, follow them on social media become if you're a physical therapist out there listening, and you want to become competent and safe to treat patients, cancer patients, which we now know, we all will at some point then definitely check them out. So Kristin and Jillian, thank you so much for coming on. I appreciate your time. Speaker 2 (41:03): Thanks so much for having us. It's been our pleasure. Speaker 3 (41:06): Thanks, Cara. It's been fun. Thanks so much. Speaker 1 (41:08): And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.  

In this episode, Founder of Science PT, Dr. Erik Meira, PT, DPT, talks about his campaign platform as the President-Elect of the American Academy of Sports Physical Therapy, and the many components of this platform. Today, Erik talks about his roles within the academy over the past 15 years, his formal 5-year strategic plan, creating an executive board separate from the executive committee, and creating a research agenda. What is the overarching vision for the academy? Who is on the executive committee, and how is the executive board chosen? Erik elaborates on organisational structures and boundaries, and embracing the tenets of Diversity, Equity, and Inclusion, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “If you look at any 1 or 2 year period, it’ll look like things are getting done, but when you look over a longer period of time, you’ll see a lot of what gets published kind of has a circular nature to it.” “You have to build the boundaries of your sandbox, and then let the person play in the sandbox.” “Not every great presenter is a great leader, and not every great leader is a great presenter.” “Not everybody wants to keep progressing and keep pursuing, and somebody stepping back should not be slighted and that should not be seen as a negative.” “Somebody turning something down today does not mean that you shouldn’t offer it to them tomorrow.” “Nobody can be you better than you. Remember that. And that goes two ways - remember that the person that you’re talking to is also not you. They don’t have a brain that works like you, thinks like you, and sees things like you, and they’re trying to be the best person that they are as well.” “We all have different perspectives, and that’s okay.”   More about Erik Meira Erik Meira is a consultant physical therapist in Portland, Oregon. He is a Board Certified Sports Clinical Specialist and an NSCA Certified Strength and Conditioning Specialist with extensive experience in the management of sports injuries at many different levels. He also created and oversees the PT Podcast Network. The son of an engineer and a school teacher, he developed a love of science at a young age often running home experiments comparing/contrasting the effectiveness of products such as detergents and preservatives. Before beginning physical therapy school he studied philosophy and psychology while geeking out on chemistry and physics courses. Although he follows medical science professionally, he is a fan of all fields of science, particularly particle physics and astrophysics. He began his rehab training at the University of Florida where he had the opportunity to be a student athletic trainer with Gator Football. After finishing his physical therapy degree, he moved on to The George Washington University Hospital in Washington, DC where he overhauled the patient education program and became a physical therapy adviser to the GWU Medical School. After moving to Portland, OR he started his own private practice Elite Physical Therapy & Sports Medicine now called Black Diamond Physical Therapy. He also founded and directed the Northwest Society for Sports Medicine, a group of regional sports medicine providers who provided continuing education, professional support, and community outreach in the Pacific Northwest. Erik is extremely active in the American Academy of Sports Physical Therapy (AASPT), currently serving as the Representative at Large on the Executive Committee. In 2008 he helped initiate, organize, and then chair the Hip Special Interest Group. From 2012-2019, he was the Sports Section Program Chair for Combined Sections Meeting (CSM) for AASPT. He has authored several articles and textbook chapters, and has lectured at conferences around the world sponsored through the National Strength and Conditioning Association, American Physical Therapy Association, and the National Athletic Trainers’ Association, covering topics such as the hip, knee, shoulder, exercise prescription, returning athletes to sport, science application, and ethics in practice. He is a frequent consultant to professional and collegiate sports teams and individual professional athletes.   Suggested Keywords AACPT, Campaign, Opportunities, Strategy, Learning, Sports, Physiotherapy, Research, PT, Health, Therapy, Architecture, DEI, Diversity, Equity, Inclusion, Problem-Solving,   To learn more, follow Erik at: Website:          https://thesciencept.com Podcast:          https://ptinquest.com                         https://ptpodcast.com Instagram:       @erikmeirapt Twitter:            @erikmeira   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:  Speaker 1 (00:01): Hey, Eric, welcome to the podcast. I am happy to have you on. Speaker 2 (00:06): Thank you so much, Karen. It's a, an honor to be here. Speaker 1 (00:10): I know it's so nice to see you, even though we're not in person, hopefully one of these one of these years, maybe next year fingers crossed. We'll be able to see each other in person. Speaker 2 (00:20): Yep. Fingers crossed for sure. Yeah. I'm looking forward to it. It's I can only do so much zoom. I so much prefer being in person with people to do to do conversations and to do a teaching as well. Speaker 1 (00:32): Oh yeah. Teaching is, I mean, what a, it's just a whole different ball game when you're on zoom or whatever platform you're using. So Eric, today, you're on the podcast to talk about your campaign platform. So for people who don't know, Eric is a present elect candidate for the American Academy of sports physical therapy, which is part of the American physical therapy association. Did I get all that right? Speaker 2 (01:05): Yes, that's right. We're one of the academies, one of the components of the AP TA. Speaker 1 (01:09): Right? So you are here to talk about your campaign platform. So I'm going to hand the mic over to you and I want you to let the listeners know what are the components of your campaign platform? Speaker 2 (01:24): Sure. I, I, I really appreciate that. Yeah. So first to clarify, some people have the question, what's the difference between a president and a president elect and for the for the American Academy of sports, physical therapy, the AAS PT our president is elected to serve one term as the president elect. So kind of the president and waiting under the current president for one year, so that the transition is smoother when that happens and then they serve a three-year term after that. And so a little bit of my background is I've, I've been involved in I've been involved with the Academy for, for, you know, well, over a decade, I've been in leadership positions within the Academy continuously for the last 15 years. And so that's everything from just being a member of a, of a committee moving up to, I founded a special interest group. Speaker 2 (02:17): I then was the chair of a special interest group moved on to be the, the section programming chair. So I was involved with all of the the academies program at combined sections meeting did that for about six years. And then the last two years I'd been serving on the executive committee as a representative at large. So I have a, I have a huge history with this Academy and a lot of the things that a lot of the changes that have been made over those last 15 years, I've been very involved with and really trying to move things forward. And so one of the reasons I'm running for, for president elect at this point point is to try to kind of complete the mission, so to speak and, and really help set the Academy up for, for the future. We're, we're coming up on 50 years of, of existing as an Academy. Speaker 2 (03:08): Or as a component, we used to be a section like most of the other components. And now what I'm looking for is, you know, what's the next 50 years look like, are we set up for, for that future? So the first thing that I'd like to, I actually have five points that I'm highlighting for my campaign. The first one is I would like to create a formal five-year strategic plan that systematically, it gives us something to systematically work towards for our goals over time. And, and so, you know, the Academy has traditionally had strategic planning as a component of what it does, but it has never actually put forward a formal announcement to the members to say in five years, this is where we would like to be as, as a target. And that's something that I think can be really useful for, for a component to have to give a little bit of guidance to. Speaker 1 (04:05): And if, if you are elected, how will you go about implementing that? Speaker 2 (04:10): Yeah, so a five-year strategic plan. So currently the executive committee does a strategic planning meeting once a year to set basically the agenda for the next year. And so what this would be is actually sitting down and going over where would we want to be in the next five years? And that would be a process of, of actually first, you know, surveying the members, talking to members, trying to get that information of where are we going to go, want to go pitching ideas to the members, to get some feedback from that and then putting it together and setting it forward. And, and again, you'll notice it's a five-year plan. Our terms are only three years. And so that's kind of the point is something that outlives any one executive committee and is something that really is looking to kind of go past that one. Speaker 2 (04:57): One of the other points that I'm kind of looking at exploring is creating a separate executive board separate from the executive committee, which is an organizational strategy that a couple of other components have used as well, but it's also very common in associations in general. And so the idea there would be you know, I, I see this in the future as being something that the executive committee would work to create a five-year strategic plan. And then that would be reviewed by an executive board who would then have potentially have voting power to to approve such a plan and, and look at going through implementing the strategy. Speaker 1 (05:36): And so can you tell the listeners what, what is made up of the executive committee, who is on that executive committee within the organization, and then how would that executive board be chosen? Speaker 2 (05:52): So right now the Academy just has an executive committee and a lot of times within the Academy, they use the term executive board and executive committee interchangeably. And that's not always the case necessarily. So our current executive committee is made up of five elected positions. They are the main elected positions of the Academy. The other elected positions are our nominating committee. And so these are the elected officials. There's five of them and they, they make all, they do all the decision-making for the Academy. And that's, I mean, that's great. You want people who are voted in to be making the decisions you don't want, just, you know, all appointments across the board like that. And so the problem that that sometimes can create is, you know, they get into, they can get into the weeds of dealing with the nuance and the details and all of these things. Speaker 2 (06:44): And a lot of times decisions, especially in a large component like ours sometimes they're very nuanced, complex, challenging. They're not easy to kind of educate out on a sound so to speak. And so what an executive board would do first off that would be made up of all of the members of the executive committee would also serve on the board. But then you add additional members that are representative of the rest of the Academy to allow additional conversations that would happen like once a year, for example, of all right, we've been working on a bunch of stuff for the last year. Here's what we're going to bring forward. And again, this would be, this is how it's working towards our five-year plan. This is the, these are the issues. Here's a really tough decision that we're up against that we've had lots of conversations we brought in outside consultants. Speaker 2 (07:35): We've, we've had again, conversations after conversations, and now we need to convince the board that this decision is the right decision. And the example here would be well, if that board disagrees, this is where again, these are things that would have to be figured out in designing a board. Would they have the authority to block an executive committee or would it just be, Hey, we're just going to go on down on record that we don't think this is a good idea. And the board, you know, is, is doing this alone. And again, just, just being a little more transparent with that. So those other members, you would want it to, you know, you think of all the different components of a, of an Academy. And, you know, we have, like, we have practice, we have research, we have education within our Academy, we also have early career professionals. Speaker 2 (08:26): We also have diversity equity and inclusion as its own part of it. And then we have our SIGs as well. So I could see a representative from, from, you know, all those different committees. So, you know, practice research these could be, the chairs would sit on that and, and there could be a conversation about whether or not those would become elected right now, they're appointed positions and then and DEI and early career professional. So we get all of those voices having a strong voice and then maybe a, an at-large position, which could be a SIG chair, or a couple of SIG chairs could serve in that role there. And, and then, you know, they kind of get that opportunity to be heard, but again, it's still kind of behind closed doors, but it expands that ability to have those conversations out and, and get more advising for an executive committee. Speaker 1 (09:18): Got it. And, and because the you've got the, these people on an executive board that are part of these different sections within the Academy, I would then imagine that you can get some more input and feedback from the members. So it sounds like, and you can correct me if I'm wrong. You're trying to allow the members of the Academy have a bigger voice in the decisions made by the, by the executive board. Speaker 2 (09:43): Exactly. Cause one of the issues we have is, you know, we have an Academy that's, you know, seven between seven and 8,000 members in any given time during the year, there are definitely fluctuations and all being represented by five people and five people that, you know, yes, they were elected their position and they do know a lot of people within the Academy. They can go talk to those people, but then you have a tendency of just talking to the friends of the executive committee, for example. And so the more, the more kind of diverse voices you can get into the conversation the better. And, and again, if you have an executive board that has a very unified voice, well, that's a very strong position that you would be taking as opposed to a more divisive type position than these would be things that would probably have to have more of a conversation. Speaker 1 (10:28): Okay. All right. I like it. Let's move on to, you've got, you said you had a, a couple of things within your plan. So we talked about a five year strategic plan and executive board. What else? Speaker 2 (10:40): So the other thing I'd love to see is creating a research agenda and that would be to kind of lay a roadmap for the research needs of our members and explore our ability to drive this research potentially through some Academy funding as well. And so, you know, research and science, that's something that I hold very dear. I it's, it's you know, pretty much everything that I kind of geek out about, you know, in particular. And I hear a lot from, especially our early career researchers, but then other researchers as well, especially the ones that are running smaller labs of of how a lot of times, it's hard to know what is kind of useful information from clinicians or what the true path is to get to what we want to know. And then I hear from the clinicians on the other side, you know, I've been practicing over 20 years and there's a lot of things that I don't feel like we've made much progress much real progress over my career and, and it can get kind of frustrating. Speaker 2 (11:35): And, and what I mean by that is if you look at any one, like, like one or two year period, it'll look like things are getting done, but then when you look over a longer period of time, you'll see that a lot of what gets published kind of has a circular nature to it. So they, they're kind of revisiting some of the same questions, not really doing a very thorough job of answering that. And what I mean by that is a lot of times, you know, a group will have, it's like, look, we only have one study that we can do. We're going to try to answer as many questions with this one study as we can. And what ends up happening is it's so diluted that they don't really answer any question really thoroughly for the future. And again, this is looking for where are we going to be 20 years from now with this information? Speaker 2 (12:20): I understand that small steps are frustratingly slow, but that's where we actually make a difference long-term. And so creating a research agenda would basically take clinicians X are some of our researchers. And then ideally also methodologist that they're, they're what we call meta scientists. So people who study this study the science of studying information. And so making sure studies are designed appropriately making sure that replication is being set up, making sure that a study isn't biting off more than it can chew. And so in a research agenda can lay out here are the next five steps that we need to see to go towards what we're trying to get done. And then researchers can look at that. It can be published publicly, and they can look at that and say, Oh, I can actually step in right here. And the thinking here is if you have a large Academy kind of endorsing that these are studies we'd like to see done, that should increase the value again from the publishing side where journals would look at it and say, Oh, well, you know, this is a study that was very well executed. Speaker 2 (13:24): That answers the question specifically that was asked by an Academy. This is going to be cited in future studies. This is something we'd want to publish. So kind of putting those incentives kind of on both ends of it. Speaker 1 (13:36): Got it. So kind of using the Academy as maybe a jumping off point for ideas for future studies, given the input from the members and what they're seeing clinically and what they would like to see, continue on in the research. Speaker 2 (13:49): Yeah, exactly. And so part of that too, is, you know as a clinician, you might say, you know what, I would just love to have an answer to this right here. And it may seem really simple to the clinician of, I don't see why that's a hard thing to answer. And that's where the research community can go, come in and say, all right, well, if you want to answer that, you actually have to start with this very simple question way over here that you're not even thinking about. And so we're going to start there and lay the path so that clinicians can also see where are we on this path to see what do we know and how does this actually develop over time? And I think that that's a huge value both for, for the practitioner and for the researcher, Speaker 1 (14:27): Right? And, and on the research side. So obviously the clinician side. Great. Cause we're getting some of what we're seeing every day put into the research from the researchers side. It's Hey this is what we're seeing. You get an endorsement from the from the Academy and maybe it will maybe it will allow you to have a greater chance of being published. I don't know. That's not that I'm not phrasing that in the best way. You could probably phrase it better. Speaker 2 (15:01): Put it is, I would say that it makes their research more translational. So it's showing that. And, and so, and I think this is something that researchers sometimes struggle with where they're, they're trying to kind of dress up the clinical application side of things to make it more clinically applicable. So it gets that, that, that, that translation, but by doing that, it actually kind of dilutes their, the quality of the study, so to speak because there's certain looking at too many things. And so by getting that opportunity for the research community to say, Hey, it may not look clinically relevant yet, but it's going to be. And so then they're part of that clinical relevance as a package. So instead of one study trying to answer everything, you would have a suite of studies that actually lays your foundation for, for gives you a good foundation for knowledge. Speaker 2 (15:57): And, and I'd like to stress. I mean, there are plenty of, of research labs in our profession that are doing this themselves and doing a phenomenal job of that. And this wouldn't necessarily be for them. It's just, we have a lot of questions to answer. And there's a lot of, of again, some of these smaller labs and early career researchers that are looking to jump in and, and, and even some, you know, research clinicians who are like, Oh, I can, I can do a 10 person study that answers this one little, very finely asked question. If it's laid out for me, I can then take that and run with it, or simply just do a replication of it. Speaker 1 (16:36): And how does this look practically running through the Academy? How does this happen Speaker 2 (16:44): Here would be, you know, somebody would bring it forward an idea, for example, and there would be, you know, we do have a research committee they would start organizing around a couple of research questions and right off the bat. And, you know, I posted this on my blog this idea around a research agenda and I did get some people actually contacted me through my contact form saying, Hey, this sounds really awesome. Are you thinking about, you know, a return to play after ACL? It's like, well, sure. Are you thinking about Achilles repairs? Sure. Again, it's we lay out the agenda and the idea here would be that they would also be living, breathing documents, so to speak that would be revisited every year or every two years. And Hey, where are we? The idea, you know, you lay it all out and then as things get done, you know, you things get checked off the list, so to speak it just gives us a way to have kind of a repository for, for thoroughness that I think is often beyond the scope of a, of a large lab. Speaker 2 (17:42): And this is where, you know, even large labs can step in and say, wow, there's a ton of basic science work that got done by lots of little entities. Now we're going to swoop in and we're going to collect 500 subjects and we're going to now do an effectiveness study based off of all of the solid foundation that was laid out for us. So we didn't have to do year after year of sequential studies. We have a base of studies that we can now just move forward. Speaker 1 (18:11): Got it, got it. So you're looking at this from the Academy standpoint as being a repository of ideas that early career researchers, clinician researchers, smaller labs can go in and say, Hmm, I think I can, I think I can handle this. I'm going to pull this out and I'm going to see what I can do. I'm going to try and create a study. Speaker 2 (18:30): Exactly. And this is also one of, some of our really, you know, big, big names. So to speak. Researchers can look down and go, no, no, no, no, no. That's, that's not how you design that study for something I can use. I would need you to also do this here. And then our research committee and our methodologists might even kick back to them and say, Oh, I understand that what you're actually doing is adding another study in between not necessarily trying to do too much with one study. And so again, this is where it's creating a sounding board that all these people can have these conversations. Speaker 1 (19:01): Got it. Okay. All right. I think I understand it now. Thank you. Sorry for asking so many questions. Speaker 2 (19:07): No, no, of course. And then ultimately, you know, the name of the game is almost always funding. So if, if we can then set up some, some grants, for example, to say, you know, we want to, we have money set aside to pay for this next step. And then, you know, people can pitch the ideas to us. We can do like a register report process where we would review the study before it was even starting to collect data to say, Oh, this looks beautiful. We're going to, we're going to give you money to complete this. Speaker 1 (19:35): Got it. All right. Sounds like a plan. Okay. So what else is on your platform? Speaker 2 (19:42): So another thing I'd like to see is creating more structure to our organization. So something that, you know, as I mentioned, we just had the four, you know, executive committee members, and then we've had other we've had committees over the years, as I've said, I've served on a lot of those. But a lot of times what ends up happening is that everything ends up having to go through the executive committee for final approval for every single step. And, and I understand the need for that. I mean, these are the elected officials, these are the ones making the decisions, but when you get to a Academy, as large as ours, it kind of can start to smack a little bit of micromanagement and making it that if you've ever been in a, in an environment where you're feeling micromanaged, it really feels like your hands are tied, your creativity is stifled and you can't really give to the, to the institution if you're in that situation like that. Speaker 2 (20:33): And so the way that that gets solved is actually to have better defined roles that people are stepping into. So our, we have a new membership engagement director, Jamie little, who's just absolutely phenomenal. And he's been with us for the last year. And one of the things that he likes to point out is you have to create, you have to build the boundaries of your sandbox and then let the person play in the sandbox. But you, you give them a lane to be in so that they feel confident in what they're doing and feel supported in what they're doing, not just giving them like a very vague instruction and then say, then come back to me and show me what you got. And then I'm going to change everything anyway, but really empower them to say, Hey, here's, here's the goal. Speaker 2 (21:23): Here's generally what, you know, what your role is to say, like the chair of the practice committee or the chair of the education committee. And, you know, let's see what you can do. And you know, as long as it's not too far out in left field, we're going to support, support that all the way through. And so since I've been on the executive committee, we've expanded the leadership opportunities for our SIG members. So SIGs used to just have a chair in a, in a vice chair, and now they also have a practice lead and education league, a membership league, and a communication lead, all opportunities for people to step in and take leadership roles and allows us to to let people demonstrate what they can do in the Academy. And I mean, the beauty of it is I, these people, when they step into these roles, I don't know who half of them are. I've never heard of them. And I think that is awesome. That's not me trying to think of somebody to fill this role. That's somebody who stepped up and said, I want to do this role. And of course, some of them are not going to do very well, but a lot of them are really going to demonstrate who they are and what they can do. And it's an opportunity to to let our members really kind of, kind of contribute to the Academy. Speaker 1 (22:35): Yeah. And it also sounds like you're developing a bit of like a leadership development pipeline. Speaker 2 (22:40): That's exactly right. Yeah. And that's where, you know, and that, that gets to the final. One of my points is and embracing the tenants of diversity, equity and inclusion, and make sure that that applies to all of our members and our future members. And that's going to ultimately make our Academy a better overall. And again, this is the thing that, you know, people get, they get hung up on. And again, diversity equity inclusion typically noted as DEI is kind of the popular initialism that's used now. People get hung up on, Oh, well, that's referring to minorities. Oh, that's referring to gender. It's like that also refers to early young professionals, older professionals people who otherwise don't, you know, quote unquote fit into the to the, the, the club, the cliques, so to speak. And we just want to make sure that we're embracing of all the different voices that are within our Academy and make sure that they, they feel they feel represented and they feel seen. Speaker 2 (23:45): And so, you know, you mentioned leadership development. That's definitely one part of it. And a lot of components, a lot of times leadership and, and presentation. So like getting up at a conference and speaking a lot of times they're kind of shoved together as the same thing and not every great presenter is a great leader and not every great leader is a great presenter. So we don't want to fault people for being really strong on one, but not so great on the other. And so we want to create two opportunities for the, the face of our Academy, which is our leadership and our presenters to develop as, as again, as leaders. And then as people who are getting into more of the education side. Speaker 1 (24:29): Right. And like you said, they don't have to be the same person that's right. So you can speak on behalf of the Academy, let's say it's at CSM, or maybe even an international conference, something like that as, as a representative. But it doesn't mean that you're the president of the Academy, nor does it mean because you're on the executive board, you get to speak at these different places. It has to be something that is earned, not just given for the position that you're in. Speaker 2 (24:59): Yeah. And so that's, that's another definition of diversity is playing to your strengths. So not trying to make one person do everything, but try to find the best person for that job regardless of who they are. And it may be that they're really good at one thing, and they're not so great at other things, instead of trying to shoe horn them into things that, that they're not gonna Excel at, let them really shine where they, where they can shine. And, and again, you know, we're an Academy between seven and 8,000 members. We don't need to have one person doing everything. It's really an opportunity that lots of people can step up and fill different roles. And, and I think that's just, it's just great for all of us. Speaker 1 (25:37): Absolutely. And it also makes people feel like they're wanted. Yes. Yeah. And that's important because there's nothing worse than not feeling wanted. Speaker 2 (25:47): The other thing too is, you know, I'm a, I'm a big data guy, big analytics guy. And so one of the things that we used DEI in particular for, and this was a little over a year ago when we put together a task force to look at it. And that, that was the mission of the task force was to see what do our demographics, how do our demographics break down along gender and along race race identity. And the simple thing is you can just look at those numbers of the membership and then how do our leaders break down by gender and by racial identity. And then how do our presenters break down in the same way? And so in some respects, we had very, very good matches you know, specifically CSM presenters were pretty well representative specifically in gender, not quite so much when it came to race. Speaker 2 (26:50): So we're able to say gender is pretty well addressed from the CSM side. Now that doesn't mean there's, there's not future issues or not some issues still to be solved, but it looked much better for example. But then when we looked at leadership and we looked at some of our other, other events, we had some bigger issues around that specifically. And so, you know, a lot of people will say, Oh, so, you know, are you saying that you know, some of your leaders are racist or massage? Monistic, it's like, no, that's not how this works. What it means is that there's something at play here that is restricting equity and inclusion because of all things being equal, it should balance itself out in that way. And, and, and again, looking at the way CSM programming was selected it was intentionally set up to try to increase the number of submissions in and then trying to go strictly based off of the merit of the submissions and the quality of the speakers and not trying to read into it anymore. Speaker 2 (27:52): And it kind of organically started to sort itself out. And so this is where, you know, when we look from leadership, well, if you have an Academy of 7,000 plus people, and you only have five elected positions, a couple of nominating committee, a couple SIG chairs, there's just not a lot of opportunity for people to step up and have a path to leadership. And so that's why we expanded the leadership opportunities within our SIGs. Again, a little more low risks low stakes opportunities for people to step in demonstrate their, their abilities. And then if they want to pursue further, they have an opportunity. And that's the other thing to remember is not everybody wants to keep progressing and keep pursuing. And somebody stepping back and saying, I don't want to do that, is that should not be slighted. And that should not be seen as a negative either. Speaker 1 (28:40): You, I was just going to say that, darn it. I was just going to say, then that person can make the decision if they want to continue further, is this for them? Is it not? But it at least gives people the opportunity to make that decision for themselves. Speaker 2 (28:57): Yeah. And not only that, when, when talking from a leadership perspective, what leaders have to understand is that somebody turning something down today does not mean that you shouldn't offer it to them tomorrow. And so you may offer somebody an opportunity. They'll say, you know what? I just don't have time for that right now, I'm going to have to pass. And, you know, a lot of times people are advised, you know, never say no, because you never know what it's going to lead to. It's like, okay, well then it's, you're just encouraging people to take on way more than they should be doing. And then you end up with a handful of people doing everything. And so a good, a good developing leader is someone who recognizes, you know, I'm not in a good spot right now to take that on, to do it justice. Speaker 2 (29:37): So I'm going to pass for now. But then when another opportunity comes around, you know, bring it back to them and, and keep, keep asking. That's cause a lot of times, you know, especially when we talk you know, women in the workforce in particular, a lot of times they may be, you know, stepping back a little bit with you know, child-rearing and things like that. Which, which honestly, I don't understand why men wouldn't be doing the same thing, but this is where they may not want to be engaged in that way for a year or two, but then they need the opportunity to step back into it. It's not a matter of, Oh, well they just say no to stuff. So we don't ask them anymore. That's not really fair to people. Speaker 1 (30:17): No. And that's, I think it's so important is to remember that you have to ask because a lot of people feel like maybe they're not smart enough. They don't know enough people, but boy, they really want to try and get involved, but no one really asked them. Yep. So if you don't ask someone, you may be missing out on some great opportunities that that person can bring to the table. Great ideas. So I'm a huge fan of just asking and then if they say no, then you circle back and you ask again, and if they say, no, you keep circling back and circling back. That's what I did as part of the nominating committee for the private practice section. It was just a lot of circling back, a lot of conversations and sometimes long conversations, you know, because it's not like if someone says, Oh, no, I don't want to. I'm always like, okay, tell me why. Tell me, you know, tell me more, tell me what the barriers are now and what might that look like in a year or two, just so that we have, you know, a good also repository of people who we know want to serve this Academy or the section or component or whatever you want to call them. Speaker 2 (31:34): Yeah. And that's where and I like how you, how you put that at the asking the question of, okay, well, you know, can you explain why not now, again, assuming it's not a personal issue. And they may say, you know, I'm, I'm just not really good with this one part of that job. And it might be, Oh, we can get somebody else to do that. You know, that that's not a problem. As a matter of fact, there's another opportunity for another person to step up into a role. And so, you know, hearing them out from that perspective. I remember when I took over as programming chair for CSM, we greatly expanded, you know, we went from, I think it was eight or nine sessions that we offered at CSM. And then I took over and it was like 36. So it was like full, you know, big explosion. Speaker 2 (32:19): And it was more, a matter of APA had always offered us that, those number of slots and we just turned them down. We just wanted to do one every, every block and not program against ourselves. And I was like, Hey, if they're going to get us a spot, I'm going to throw people up there. And it was difficult the first year because we didn't have enough submissions to support that, but I wanted to set the precedent. No, no, no, we are going to do this. And so I then had to get on the phone and walk around at conferences and say, Hey, can you submit something on this, this or that? Or why aren't you submitting something on this, this and that. And the most common answer I got back was, Oh, I didn't, I didn't know that, that anybody wanted me to submit something like that. I didn't know that you guys were interested in that. It's like, no, yes, we are definitely interested in that and pleased and trying to lay things out. And then of course stressing that. There's a difference between me asking and me accepting, you know, a lot of times it's just, Hey, give me some missions so that we have something to work with here. And we don't have to accept, you know, necessarily the same speakers over and over, but because of that opportunity to do that. Speaker 1 (33:24): Yeah. Amazing. And now, Eric, what would you say when looking at this platform? So we have five-year strategic plan, creating research agendas, expanding organizational structure, creating an executive board and embracing the, and progressing the tenants of DEI. What is sort of the over arching vision in your mind for the Academy? Speaker 2 (33:49): So what I'm trying to do is really set things up for and the term that I've been using since I came on as, as representative at large, as well as my big thing is, is architecture. So I'm trying to set up kind of a scaffolding for our members to inhabit and to, and that is set up in such a way that the Academy can move forward into the future with the ability to be adaptable as things are changing, but also to be strong at the same time. And, and that's something that I think having things laid out, you know, I mentioned five-year strategic plan. That's where I would start. And then I would love to see, you know, a 10 what's the 10 year strategic plan. What's the 20 year strategic plan. I mean, that was something that, you know, we just passed a 2020 which, which turned out to be a different year than I think we were anticipating. Speaker 2 (34:38): But back in 2000, that was vision 2020. That was the APA made a strategic plan of where we want to be in 20 years. And I think people forget how important strategic planning is. You know, there's a lot of decisions that happen in the course of a year within any organization. And a lot of times there could be three or four perfectly acceptable, you know, courses that could be taken you know, decision courses that can be taken on one of those, you know, big decisions that need to be made, but one of them may support the strategic plan down the road better so that when you're making that next decision, it's going to build off of the previous one, as opposed to just solving the problem that's in front of you. And so making sure again, kind of like that research agenda, making sure that what you're doing today is something that can be built upon tomorrow. Speaker 2 (35:33): We're never finished. It's never the end. It's never, we've just solved it. It's how does this set us up for the next thing that we're going to be doing, you know, down the line and, and intentionally laying that out. And, and so some people will ask, well, w w so, so how locked in is this five-year plan? It's like, no, it's, it can be amended as we go. I mean, that's, that's kind of the whole point of it. It's just that we have some sort of a vision going forward with that. And so again, it's more trying to set things up, not for me, not even for the, our, our younger members, but for the members that haven't even joined yet that they have a path through their career, through our Academy, that our Academy supports them every step of that way. And they feel like they're involved as they go through. Speaker 1 (36:22): Yeah. And if 2020 taught us anything, it's that amendments are probably needed on any five-year plan. So if it's locked in, it's locked in and it can't be changed, then we're all in a lot of trouble. Speaker 2 (36:33): Exactly. Right. Yeah. Everything has to be flexible. Speaker 1 (36:36): Yeah. Everything needs some fluidity to it these days. That's for sure. Well, Eric what, what are the things that you want the listeners to take away from this and to think about the possibilities of you being president of the Academy? Speaker 2 (36:53): Well, what I would say is you know, I was elected as a representative at large a couple of years ago because I'm, I'm a regular old member. I don't have a PhD. I'm not a, you know, I have not taught in a S you know, as a school or anything like that. Not academic, not a researcher. I owned a private practice for almost 20 years. Just sold it. I work with patients day in and day out. I'm not, again, I'm not conducting research, I'm not doing these things. I do continuing education. I talk to a lot of physical therapists. I do a lot of mentoring across across the country and across the world with other sports physical therapists. I know this world inside and out, and what I'm trying to do is bring forward an entity that supports that. Speaker 2 (37:50): Ultimately, it's not that it supports the researchers. It does support the researchers, but that's not the mission. It's not supporting the clinicians either. It does support the clinicians, but that's not the mission it's to support our patients, to make sure that they get the best service possible by supporting our researchers and our clinicians and doing it in such a way that it's integrated in such a way that makes our members feel like they are getting a back and forth conversation with the Academy, which is made up of all the other members. So it's everybody talking across each other. Everybody communicate communicating everybody working together towards some common goals, trying to make their careers, what they want it to be setting it up so they can hand it off to the next generation to make it what they want to be as well. Speaker 1 (38:40): Excellent. Sounds wonderful. And now it does, it sounds great. Now, Eric, where can people find you if they have questions or comments or they just want to say hello? Speaker 2 (38:52): So probably the easiest way is well, the, the, the most comprehensive one is just going to the website that I run, which is called the science, pt.com, all one word, the science PT, make sure you put the at the beginning. And that's got links to my Twitter account. My, I have an Instagram account although I'm terrible at it. If you want to see an old man hitting something with a rock, that's pretty much what I do on Instagram. But definitely available for the most part on, on Twitter. But there is also a contact form on my website that if you have any questions, you can click on that, right on the homepage. There's a, a button that's, that's a link to my campaign page. And so you can go there and, and everything that we've talked about, I have a blog post and individual blog posts for each point that I highlighted going into more detail. Speaker 2 (39:41): And also as I, you know pointed out in this conversation, there are things I don't have answers for. I'm just talking about where I'm thinking of pointing things and then getting information and seeing is this something we can work towards, and maybe it's something we need to revise or change and do differently. But these are just my thinking from what I've seen from all my years of service, things that I think are very doable, very possible within our current means within our current support, within our current structure to really set us up, to grow into the future. And so just that website probably is, is the the most comprehensive spot. Speaker 1 (40:18): Perfect. And then before we go, last question, which I didn't tell you about, I probably should have done that. I think you'll be fine. I think you can handle it. So knowing where you are now in your life and your career, what advice would you give yourself as the new grad as that, you know, young, young, professional, Speaker 2 (40:37): You know being flexible, being adaptable is, is always the biggest thing be patient for probably the best lesson that I've learned is that nobody can be you better than you. And remember that. And that's, that goes two ways. Remember that the person you're talking to is also not you, they don't have a brain that works like you and thinks like you and sees things like you, and they're trying to be the best person that they are as well. And so the more that we can support each other to both be better at all times, I think is huge. And I think that's something that you can carry in with your patients when you're working with them of being compassionate, to understand that, you know, it might be easy for you to get up every morning and do a 30 minute run, but that might be like torture to the person you're talking to. And it's not their fault. They're not lazy, they're not wired wrong or whatever. It's just the way they, and we have to be supportive of, of that. But then that's also with our colleagues when we're trying to have conversations around things as well, to, to understand that you know, we all have different perspectives and, and that's okay. Speaker 1 (41:47): Absolutely. And what wonderful advice. So Eric, thank you so much for coming on and sharing your platform. I'm sure myself and the listeners really appreciate it. So thank you Speaker 2 (41:58): So much for having me. I really appreciate it. You're doing a great job with all of this. Speaker 1 (42:02): Aw, well, thank you. That's very kind and everyone, thank you so much for listening for tuning in, have a great couple of days and stay healthy, wealthy and smart.  

In this episode, Co-Owner of Champion Physical Therapy and Performance, Dr. Mike Reinold, PT, DPT, talks about his platform in the running for President-Elect of the AASPT. Today, Mike talks about the ‘why’ behind his campaign, what he’s going to focus on as president, and how to make the academy more accessible and inclusive. What is Mike’s vision for the academy? Hear his thoughts on adding value to the academy members, his plans to provide networking and mentorship opportunities, and his advice for his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “I’m going to judge my success of leading the academy, if in the end of my term, you clearly asked the members ‘why are you a member of the AASPT?’ And they have a very clear and distinct answer.“ “The most important thing we need to do right now is to re-brainstorm the mission and the vision of the academy to make sure that we’re doing one thing: we’re focused on the goals and objectives of the members.” “I’m pretty certain at this point that everything I’ve accomplished in my career is because I specialised. You need to start general, but if there’s something you’re passionate about, every second of down time you have, learn how to be the best at that. Just be absolutely amazing at something.”   More about Mike Reinold Mike Reinold, PT, DPT, SCS, ATC, CSCS, C-PS is a world renowned and award-winning clinician, researcher, and educator. As a physical therapist, athletic training, and strength and conditioning coach, he specializes in all aspects of sports performance and rehabilitation. Mike is currently the Co-Founder of Champion PT and Performance, in Boston, MA, and Senior Medical Advisor for the Chicago White Sox after years of working at prestigious institutions like the American Sports Medicine Institute, Massachusetts General Hospital, and as Head Athletic Trainer and Physical Therapist for the Boston Red Sox. He has authored dozens of publications, lectured at national conferences, and has an educational website and podcast at MikeReinold.com.   Suggested Keywords AASPT, Physiotherapy, Research, PT, Health, Therapy, Healthcare, Education, Mentoring, Training, Networking, Sport, Athletics, Election,   To learn more, follow Mike at: Website:          https://mikereinold.com Facebook:       Mike Reinold Instagram:       @mikereinold Twitter:            @mikereinold YouTube:        Mike Reinold LinkedIn:         Mike Reinold   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:  Speaker 1 (00:01): Hey, Mike, welcome to the podcast. Happy to have you on. Speaker 2 (00:04): Hey, Karen, how's it going? Thanks again for for having me on your amazing podcast. I F I F I, I remember being on in the past Speaker 1 (00:13): So long ago. Yes. It has been a long time, but here we are. We're back. Speaker 2 (00:18): That's what happens when we, when we're, we're both veterans we'll, we'll call it. We're both veterans. We, we, we did this in the past, but, but yeah, no, honestly, like big kudos to you for keeping this going and doing such an amazing job with it. Thanks for having Speaker 1 (00:31): Any time. And we'll talk about your podcast a little later, but now, you know what it's like to be cranking out episodes on a weekly basis, right. Speaker 2 (00:39): And staying up with it, right. It's like, it's a way of life now for us. Speaker 1 (00:43): It is, it is. That's why there's like a hashtag podcast life, I think on Instagram or something. It's, it's a thing. It's a thing. So today you're here because you are running for the president elect position for the American Academy of sports, physical therapy. So I wanted to have you on to talk about why you're running and what your platform is and what you hope to do if elected. So let's start with, what is the why behind your running. Speaker 2 (01:13): And I love that. That's how you started this off, because that's how I start everything off. Right. If we don't establish our why, right. Like what's the point of even coming out. But a lot of people, they, they, they don't focus on the end. Right. They focus on just doing the day to day. So I love that you started off with a Y so I'll, I'll be honest with you. This is something I've been thinking about probably for the last, I don't know, several years or so. I never felt that it was the right time for me. I've had a lot of my mentors pushing me to, to run in the past and the past elections. And yeah, I mean, trust me, it's really humbling to know that the majority of past presidents of the Academy are all pushing me to run and, and kind of, you know, it's really an honor to be nominated by them, right. Speaker 2 (02:03): Like, you know, Mike boy, Kevin Willett, George Davies, Tim Tyler. I mean, it's Melissa gigantic of past presidents that were kind of nudging me to do it, but I was resistant for awhile. And I think that was a good thing because at that point in my career, I don't think I was ready. And I don't think I would've, I would've done the Academy justice for what it needed. Right. So I was kind of resistant for awhile. You know, I, I started a private practice. I have like four jobs, right? Like we all do, right. Like to an extent, you know, I'm flying, you know, to, to work with the white Sox. I, you know, private practice doing all these things with the educational stuff. So for me, it was always like, it wasn't the right time, but things have changed a little bit. Speaker 2 (02:44): And I humbly say this now. And I, I really came to this conclusion the last couple of years of my career. I, I really believe I'm on the descent. Right. And don't you think at some point in time, it's, it's all it's about, okay. I am now on the decent portion of my career and I've completely changed my focus on trying to help others succeed. And I can't wait to see the people that I work with surpassing me. Right. Leapfrog me just like we did, like when we were 20 years ago in our career. Right. And that, that kind of point. So I got, so my why right now is that I am completely shifted towards more of a leader right. In a leadership type position with my career. So both educational, both with my, my companies and with the organizations I worked for that, I thought it was a great time to do this so awesome that I've been getting nudged by, you know, such, such amazing people, but I didn't feel it was right until, until now. And I think now I have the time I have the energy, I have a little bit of the head space to now be able to, to focus on this and it's time to give back and it's time to help the next generation. So that's my why. Speaker 1 (03:56): Yeah. And that's, I think it's really important for anyone listening. If you are thinking about being of service, whether that be to something, to a section or whatever you want to call them Academy of the AP TA that, you know, you have the head space and the time. Right. Because you just don't want to be saying, yeah, sure, sure. I'll do this. I'll do that. And then guess what, what happens if you get elected and you don't have this space, you don't have the time. Well, that's just not the way to, to enter into, be of service to others. And like you said, you're at that point in your career, at least it sounds like what I got from what you said, that you really want to be of service to others, that you've kind of, you're, you're content, you're happy within your career and probably the time of your life and everything else that you can now do this for others. Speaker 2 (04:48): Right. And, and I'm, I'm very eager. Right. I had a lot of good mentors in my career that helped open doors for me, but don't get me wrong. Like we need to be the one stepping through those doors. You have to have the energy and the effort to do that. Right. But for me, it's about opening doors for others. Right. And I saw how much the Academy helped me early in my career, and I really kind of want to do that. Right. And you know, it's funny, Mike Delaney and I were just talking about those. So Mike's running for vice-president right now as well. So I'm myself for president him for vice-president. And we are so similar with our, our beliefs and everything that we have, that we were like, let's team up to try to, to do this. So that way we can really give back and help. Speaker 2 (05:29): And we both said this. We said, if, if we don't get elected at this point in time, we actually think that our time, our window will pass. Right. At that point in time, we'll probably be in our fifties. Right. And I am not sure that we would be the right people to lead the Academy at that time, because we want to still be relevant. We still have students. We still work with like clinicians and educate all, all around the country, the world, right. Where we still are in touch with them. I'm not sure if I would be the right leader six years from now or seven years from now, it was probably one of the next election. We would be open if I would be the right leader for that. I, I, I'm not sure. Maybe I would be more out of touch. So Mike and I both said, I think this is our window. If we're going to do it, it's probably now or never. Speaker 1 (06:14): Okay. So let's talk about your platform. What do you hope to accomplish as, as president, what are things that you really want to focus on? Speaker 2 (06:24): So I, again, I love, I love how you start with the why, and then, and then you talk about, you know, what you want to accomplish. I love that because to me, it's not, it's not about coming up with like a list of things I want to do. What I want to do is I want to flash forward six years or whatever it may be. Right. I hopefully would get reelected if I get elected the first time. Right? So we'll say three years to be conservative maybe, but flash forward. And what I want, what I want to know is I'm going to judge my success of leading the Academy. If in the end of my term, you clearly asked the members, why are you a member of the American Academy of sports, physical therapy? And they have a very clear and distinct answer, right? Speaker 2 (07:10): That to me is going to define my success. Because right now, the number one thing I'm hearing from people, both veterans in this field, people in the middle of their career, early career professionals, students, they, they ask, why should I join the Academy? They don't know what they get out of it. Right? And it's, it's one thing to just be a part of a group. But the question always is, what's the value? What am I going to get out of that? So that's how I'm going to judge our success as an executive committee at the end of this, is, is it very clear that we achieve the objective that you know, why? And I think the most important thing we need to do right now is I think we need to rebrand storm the mission and the vision of the Academy to make sure that we're doing one thing we're focused on the goals and objectives of the members. Speaker 2 (08:00): It's not about me, right? It's not about my ideas, my initiatives, what I want to get. It's not about me or my legacy to me, it's about what the members get out of it. And I think it's actually pretty simple. I, I looked on the website, I'm just trying to like dig out like the mission statement. Right. And it's very like corporate, right? Very like, like very about like, you know, advocacy and like, you know, making, you know, sports, physical therapy like prominent, right? I actually want to see the mission statement changed the simply the American Academy of sports, physical therapies here to help you specialize in sports, physical therapy, right? You are going to become a specialist now because we're not learning stuff like this in school, we shouldn't be learning stuff like this at school. It was very hard to be, to graduate as a new grad and be a very well-rounded proficient physical therapist. Speaker 2 (08:44): Right. But if you want to specialize, if you want the best education to learn everything you need about to become a sports physical therapist, if you want to stay cutting edge, right. If you want opportunities and networking, to be able to become part of this group. And more importantly, if you want mentorship with some of the best people out there, that is why you joined the Academy. And I know right now, a lot of people say that all the time is I'm not sure what the benefit of my membership is, and that's why people drop off. And that's why people don't renew is they're not getting enough out of the Academy. So that's what, that's what I want to achieve. And that's how I am going to grade our executive committee. If, if we do get elected is at the end of this, if it's very clear, have we achieved our mission, that the members know that our whole goal is to help them specialize in sports and to get a job in sports. Right. I think that's what people want in sports. That's a big, big things is an advanced orthopedics. This is sports it's different, right? So that that's, that's kinda, that's kind of what, what we hope to accomplish. Speaker 1 (09:47): And how, how would you go about doing that? What changes do you think need to happen to number one, help more people join the section? Cause I know it, it is hard, you know, I'm part of, I'm part of the sports section I joined a couple of years ago. I let my orthopedic one last. So I left the orthopedic and I joined sports. And I'm also involved in the private practice section. And I know it's something that we're always trying to think about in the private practice section is how can we get more people to join? What are we missing here? You know, how can we be more inclusive? So how can the sports section be more inclusive to get those people in, to get them from what it sounds like you're saying, mentorship, education, jobs and just fulfillment within your career. It sounds like Speaker 2 (10:40): Here, and this is what I think it is. The past leadership has been amazing. Right? And the stuff that even the current board has done in this last few years is really evolved, right? So there's tarnished take the next step with technology and all these other things. They're doing a really good job with that sort of thing. To me though, I, I really think we need to refresh just the vision a little bit. And I want to reevaluate all of our decisions in all of the things we provide. And just answer that simple question. Does this help you become either become or become a better sports physical therapist. Right. And I think, I think we need to take a step back. Sometimes it's not about what we think is cool or what we think is a list of objectives. It's about how do the memberships actually get value out of the Academy. Speaker 2 (11:26): And I think that's, that's the biggest thing we're going to do. So that's a little bit of the vision, but we're going to reevaluate everything, right. There's, you know, one of the big ones is education, right? One of the big ones education and staying current with, with research, right. So recently just in the last year or so the Academy got rid of one of the free benefits of being a member was access to the international journal of sports, physical therapy. And I think that was one of the biggest reasons why a lot of people were members, right. They got, they get access to a free, very well like established journal. Right. So they took that away from the membership a little bit. And again, I just wonder why, I mean, if the reason you join is to, to learn and stay current about being a sport, physical therapist, I don't want to take away benefits. Speaker 2 (12:11): Right? Like there's, there's gotta be a way we do that. Right. so I, I, you know, there's, there's, there's a ton of different avenues, right? Like you said, it's hard to go over this and just like a quick like kind of podcast, but I think it's about like networking opportunities. Cause it's all about who, you know, in this world. Right. But for me, it's about education and mentorship, right? We have some amazing clinicians that are part of this Academy that we need to learn from and that we need to go work with. Right. So we have residencies, we have fellowships. Those are great well-established things. Those are large, those are daunting, right? Like, like that's a big commitment, both time and finance for you to go do one of those things. We need to have more accessible opportunities, either online or shorter term, those types of things. Speaker 2 (12:56): I think we need to leverage, remember sports, physical therapy. That's where my background comes in. That's all I've done. My whole career is work with pro athletes and stuff. Right. Is how do you get a job in pro sports? How do you get a job in the MLB or the NBA or the NFL? Right. We need to leverage our, our connections. Like I'm friends with people in all these leagues, the PTs and all these leagues. And I've reached out to all of them. And I said, we need to start collaborating more. What if we have joint education sessions? What if we have mentorship opportunities where you come to spring training with me for eight weeks. Right. And who do you think is going to get a job when a physical therapy job opens up now in major league baseball, somebody that's just off the street with a good resume or somebody that's actually done a mentorship program with somebody already established. Speaker 2 (13:40): So that's part of the things that I think that's what I bring to the table is these connections and sports. And these are the things I've done. Like I, to me, I feel like I am I'm representative of the membership. I'm a clinician, you know, we treat our butts off. Right, right. And we're still working with people, you know, all the time we published clinical research, right. Impactful clinical research that have great implications that everybody wants to learn from. Right. We teach this to everybody after we publish it. Right. So we're on the trenches. We're working with the pro athletes. We're working with the collegiate athletes. Like I want to give people the opportunities that I've been fortunate to have. And I think that's a big part through networking, mentorship, education. I think those are the three big areas that are really push. Speaker 1 (14:24): And I really loved the mentoring aspect or Avenue of that. Especially like you said, maybe some online options and things like that. Obviously during COVID these things have become more and more prevalent, but I think it also does well for members who may be don't have, don't have the finances. They don't have the resources to let's say, even travel to a continuing education moment or even go to CSM. So I think to make things more accessible to all members or to people who want to become a member, right. Cause you may have someone out there is like, I'd really like, want to be part of the sports section. But man, I don't know if I can, like you said, do a residency or fellowship, which can be very expensive and time consuming or maybe they're a later in life PT and they have a family that they have to care for and they can't go off for 12 weeks or something like that. So I think to have those virtual options would be really great. And, and for me, I think it would be something that would really generate some interest in the section. Speaker 2 (15:38): Yeah. And that's my wheelhouse. Right. And that's what, that's what we did. I mean, it's funny. Like I stumbled into online education. Like I don't even like 12 years ago now. Right. Remember where the we're the old ones again, Karen. Right. I stumbled into that and have all these online courses now. And I did it for one simple reason. I was unable to travel around and teach. Right. Because I, I was now in getting a new baby. Yeah. Well, no, I was, no, that was before that I was in professional baseball. Right. So meaning like I worked 24 hours a day, seven days a week. I can't take a weekend off and be like, Hey, I know you guys have a game tonight, but I'm going to go teach a course in Louisiana. Right. Like they couldn't do that. So I got in that, but then yes, then you get you, and now you add family on top of that, right? Speaker 2 (16:23): Like, yeah, that's a big deal. So, so I started teaching online to kind of scratch that itch for myself, to keep giving back right. And sharing and educating and men that it's amazing how many people around the world you can touch by, by doing it online. And again, we need to catch up with that and just shows again, like, like, you know, the current state of even like the AP team totally. That they don't, they don't even have a way to a good, solid way to be able to offer continuing education credit for people with online courses. It's a mess. It just shows you how, like it's a, we're, we're getting a little outdated. I think we just need to refresh the vision for modern day, you know, this next generation of VCPS and people that want to get further along in their career, we need to meet them where they are. Speaker 2 (17:06): And not just assume that like some of the old standards that they've done. Right. And I think that's why bringing some new vision to the board is helpful. Right. I mean, the board has been pretty consistent for a long time. Right. The board has been quite academic for a long time right now. Right. There's not a lot of clinical leaders that are in the trenches, like working with athletes every day. I think there should be both, right. Like, don't get me wrong. I think we need both. We need clinical and academic in there, but I think we need to collaborate on that because I do think there's different perspectives if you know, depending on what you do all day. So I'm pretty excited for those things. Cause I actually think that's going to make a big impact. And, and again, I just think like the benefit of being a member is going to skyrocket. You have all these opportunities. Speaker 1 (17:51): Absolutely. I agree. And now before we kind of wrap things up, is there what would you like the listeners to kind of take away from the discussion? What is your main point? Speaker 2 (18:05): Yeah. vote for me now. I'm just getting abs. No, in all honesty, I'm like, I, I'm pretty humble about it. Like if, if, if I'm not elected, like I, it's not a big deal to me. I CA I can't wait to continue to continue to contribute to the Academy and help people. Right. For me, it was like, this is the right time to kind of give back and to be able to do that. I think my experience, I think I've done what a lot of people join the Academy to try to also accomplish. I've been there. I've done that. I understand what they're going through. And I'm, I want to get the Academy back to helping exactly, exactly. Achieve your goals. And that's it, it's about the member. It's not about me. It's about the membership. So yeah, and I think that's it. Speaker 2 (18:47): And you know, again, just just you know, also throw up Mike Malaney again, as vice-president, because I humbly, I can't do this by myself. Right. We're all busy. Like you're busy, I'm busy, we're all busy, right. This is a team effort. And I think in some fresh vision of people that have this clinical background, like Mike and I, and I've been, I've been big sports PTs our whole career, like adding that to the current board that's already in place, I think is going to be quite a nice dynamic that is going to really help lead this Academy in the future. Speaker 1 (19:19): Excellent. And now let's talk a little bit more about you. Where can people find you, your, your podcast website, anything you want to share? Speaker 2 (19:29): Awesome. I'm easy to find, right? So I'm just Mike ronald.com. If you want to learn a little bit more about this election and the process with that, you can go to microsoft.com/vote, and there's some info on there that you can, you can get I have a podcast, I have a blog, you know, kind of blot for over 10 years. So there's like a thousand articles on there. So people always ask like, where should I, where should I get started? I'm like, well, you got a lot to catch up on. Right. There's a lot of articles out there, but yeah, no, I'm easy. I'm on social media. Like I just, I really am at the point in my career where I want to help others. So I, you know, we try to hit every, every channel we can to, to have the most impact. So, so yeah, just head to my website, there's a lot to learn on there. And and like I said, Mike reynolds.com/boat, and you get a little bit more info about this election. Speaker 1 (20:14): Excellent. And last question. What advice would you give to your younger self knowing where you are now in your life and in your career? What advice would you give yourself as that fresh face? New grad? Speaker 2 (20:28): You know, this is, this is actually funny because I, I just wrote this to my, to my newsletter last week. Right. It was kind of funny that I literally, I just wrote this last week and I just wrote like the next one for this weekend, that's going out this weekend. But I, there was one thing I accidentally did in my career that I stumbled into that I, I it's become clear now that that is what we should do. And I said, like, I am pretty certain at this point, everything I've accomplished in my career is because I specialized ready. And in this week's newsletter, I actually talk about like how to, how to arc your career path that way to do that. But like, I remember early in my career, like I got, I got some heat from some other physical therapists that I was too specialized. Speaker 2 (21:13): Right. And you were like, no, you need to be generally, like, you're not good with neurologic injuries or something. And I'm like, all right. But like, for me, like getting really good at one thing helped me achieve all the goals that I wanted to get to, to get a job in professional baseball, right. To win a world series, right. To, to open my own clinic, to open my own gym and sports performance center. Right. It was all because I specialize in something. So we need to be general, you need to start general, but if there's some your passionate about say, it's like soccer, football, whatever sport it may be. Right. You just, every second of downtime, you have learn how to be the best at that. Just be absolutely amazing at something. And I think that was the biggest key to my career is overhead athletes and shoulders, like in baseball. Speaker 2 (21:58): Like I just, I got super lucky that I engulfed myself in that environment and became a specialist in that. Right. And again, just, that's another thing that the Academy needs to do, and it needs to help people that want to get super specialized in one thing to be able to do that. So I think that would be my biggest thing right now. You know, it keeps evolving as we, as, you know, as we get older, but I think right now is for an early career professional is master the basics, but follow your passion and make sure you are just, you're putting your extra grind and hustle into like, become the best you can at that side. And then it'll grow, you know, grow over time. And then when you're lucky like us, Karen, and you're a little bit older, you, you go to work one day and you're like, gosh, I just have, I have six baseball players today. That's all that's on my schedule. It's like, it's pretty cool. You know, I played catch three times yesterday. Right. Like that's kind of cool. I got, I got paid to play catch. Right. That's kind of cool. So, yeah. So I think that would be my biggest advice really for the early career professionals. That would be good. Speaker 1 (22:58): Well, what, great advice. Thank you so much. I don't think I've heard that one yet. And I think that's a great, I think that's great. And hopefully that will help some of our students and younger clinicians as they try and figure out and navigate their career. So thank you so much and thanks for taking the time out and coming on today. I really appreciate it. Speaker 2 (23:15): Thanks for having me, Karen. You're the best. This is awesome. And I appreciate it. The LC in the future, I'm sure fingers crossed Speaker 3 (23:22): One day. We'll actually be able to see each other in person, right. Speaker 1 (23:26): And everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, CEO of Julie Wiebe Physical Therapy, Inc., Dr. Julie Wiebe, PT, DPT, talks about running and pregnancy. Today, Julie talks about running/exercise and pregnancy, creating baselines, the research around female running form, and she busts some pregnancy myths. When can you return to running after pregnancy? What is Julie’s definition of ‘postpartum women’? She tells us about structuring exercises around their daily exercises and goals, pelvic health education, and she gives some advice to clinicians working with postpartum runners, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Landing mechanics are affected by what’s happening north.” “Let’s understand what they looked like beforehand so that we have a better idea of how to help them find their way back.” “Just because you had a baby doesn’t mean you should be in pain and weak for the rest of your life.” “Listen to what’s happening, but learn to interpret it.” “If your 10 minutes is spent running and that’s your goal, you’ll do it. But if I say you’ve got to lay down on the ground and do rehab exercises that make no connection for you, you’re not going to be motivated to do that.” “Pelvic health does not mean that you have to be clinically prepared to do internal work. It just means that you’re treating the musculoskeletal of someone who happens to have a pelvis, which, last I checked, is everyone. You don’t have to be certified as a women’s health specialist, but you can get information, read books, watch videos, take courses so that you are competent in treating a woman postpartum that wants to get back to running.” “The pelvic floor is not the only gatekeeper that creates pelvic health. It is a component of multiple body systems, and we need to understand that those systems affect the way the pelvic floor acts and behaves. The pelvic floor itself needs to have attention directed at it, but when we talk about just the pelvic floor, it isolates it away from relevance to other areas of care.” “Learn to ask questions, and ask questions that make you uncomfortable. You will get more comfortable with it, and understand that what you’re trying to do is open a door of communication.” “When you read the conclusion in research, is there any other explanation that could’ve come to that same conclusion based on what you’re seeing?” “We need to start broadening our lense, and I think we’re broadening it to look at females as not just little men.” “Instead of thinking of learning as this linear thing, include and transcend. Instead of it being a linear line, let it be concentric circles.”   More about Julie Wiebe Julie Wiebe, PT, DPT has over twenty-four years of clinical experience in Sports Medicine and Pelvic Health, specializing in pelvic/abdominal, pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness and sport after injury and pregnancy, and equip pros to do the same. She has pioneered an integrative approach to promote women’s health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations (ortho/sports medicine, pelvic health, neurology, and pediatrics). A published author, Julie is a sought after speaker to provide continuing education and lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes through telehealth and her clinical practice in Los Angeles, California.   Suggested Keywords Physiotherapy, Pregnancy, Research, PT, Health, Therapy, Healthcare, Education, Training, Postpartum, Running, Exercise, Pelvic Health, Conversation,   Use the code: LITZY for 20% off the following courses from Dr. Wiebe:   Treating and Training the Female Runner (or Any Female Athlete) Foundations + Running Bundle A Foundations + Running Bundle B   Running Rehab Roundtable Live Broadcast https://www.crowdcast.io/e/runningrehab   To learn more, follow Julie at: Website:          https://www.juliewiebept.com Instagram:       @juliewiebept Twitter:            @JulieWiebePT YouTube:        Julie Wiebe LinkedIn:         Julie Wiebe   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:  Speaker 1 (00:07): Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Hey everybody. Welcome back to the podcast. I am your, Speaker 2 (00:39): The host, Karen Litzy and today's episode. I'm really excited to round out our month all about running injuries and running rehab with Dr. Julie Wiebe. She has over 24 years of clinical experience in sports medicine and pelvic health specializing in pelvic abdominal pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness in sport, after injury in pregnancy and equip pros to do the same. She has pioneered an integrative approach to promote women's health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations, or at those sports medicine, pelvic health neurology, pediatrics, a published author. Julie is a sought after speaker to provide continuing education lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes to through tele-health and her clinical practice in Los Angeles, California. Speaker 2 (01:48): So Julie's amazing. And in this episode, we talk about some myths about running while pregnant and in the postpartum. And of course, the question that everyone always asks Julie is how can we return to run after pregnancy? So Julie answers that question and cause a lot of really helpful hints for practitioners to look for when evaluating postpartum women and those postpartum women, those runners can be anywhere from six weeks to six years, 16 years, 20 years after having a child. And she also encourages clinicians to think critically, to look deeper, to have a framework for evaluation, to try and, and, and get a baseline to ask your patients to film themselves while they're running or exercising so that you can understand what they look like when they're doing what they do. There's a lot of variables to post to running post-pregnancy and Julie really runs through all of them. Speaker 2 (03:01): So I want to give a big, huge thanks to Julie for coming on the podcast today and sharing all of this knowledge. And she also has a discount on the course. So she has a course on running a postpartum running. So she has a course for the listeners. So all you have to do is enter the promo code Litzy that's L I T Z Y my last name for 20% off treating and training the female runner. And just to be clear, this is for professionals, not for individuals. So this is for clinicians. So a huge thanks to Julie for that. We'll have all of the information, including links to everything in the podcast at podcast dot healthy, wealthy, smart.com. And tomorrow you can catch Julie live along with Dr. Ellie summers, Dr. Chris Johnson and Tom goom for our live round table discussion. That's tomorrow, March 30th at 2:00 PM Eastern standard time. Speaker 2 (04:10): If you can't make it still sign up because you'll still have a chance to get your question answered by the panel, and you will still get to watch the replay any time you want. And listen, this is a deal. It is $25 for four of, in my opinion, some of the best minds when it comes to running injury and rehab. So sign up today. If you're listening to this today, sign up today because you have until probably, I don't know, it starts maybe until like quarter to two tomorrow, which is March 30th to sign up for our live round table discussion. Again, that's with all four guests from this month, Ellie summers, Chris Johnson, Tom goon, and Julie Wiebe. So sign up to day. Hey, Julie, welcome back to the podcast. I think this is like your third visit to help you well, yes, thank you for sharing your platform with me again. Speaker 2 (05:11): I appreciate it. Of course. And, and this month, the month of March, we're talking all about running, running injuries, running rehab, and I know something that you're passionate about is caring for the postpartum woman that returned to running after giving birth. And, and we'll also talk a little bit about running while pregnant. Right. So I think that there are, there's a lot to cover. And so we are just going to, we're going to zoom right through this unintended since we're on zoom. But let's start first with running while pregnant. I feel like there's a lot of myths around running while pregnant. I don't know that it's understood very well by many people, including clinicians as well as the pregnant women. So I'm just going to kind of throw it over to you and let you just kind of talk about the, the running pregnant woman. Speaker 3 (06:14): Yeah. You know, and I think I think that regarding running and pregnancy, I mean, that's our focus, but really exercise and pregnancy. We still have, we are limited in our understanding of all things. Related to that I think we are started, we have information about things like cardiovascular response or, you know, some of those pieces of the puzzle. But in terms of the musculoskeletal, the neuromuscular, the response of the female host inter like how is that impacting the mom's body systems. Right. and I think that where we are struggling to have a lot of research there in part, because it's hard to find women that are willing to be participate in research. And then there's also a lot of, I, you know, we have to be protective of them. We have to protect them. And so, so it's this, you know, we want to honor that stage of life, but we also need to research it. Speaker 3 (07:13): So so I think we are struggling to, to understand all that, but we're starting to get more and more attention on it, which is awesome. As far as pregnant runners go there's only a few studies that I'm aware of that actually look at the pregnant runner and and of those one is a case study and one is on five women. So we have very limited understanding of what exactly goes on, but there were some themes. So I'll just share some themes. One is that in, in both the studies, they were, they were followed, the women were followed throughout the pregnancy changes were seen in all of the women on how they continue to run through the pregnancy meaning. And particularly the one with the five women, they all did something different, which is the variability is what we're seeing now. Speaker 3 (08:07): Everybody's bodies individually adapted differently. But the through line for them was there was a loss of pelvic and trunk rotation. So when we think about that pregnant runner, this is the way I've started describing it. The belly covers a ton of joints. Like it goes from the thorax to the pelvis. It it's basically, it takes all of these reciprocating joints and it turns it into a unit joint. Like it's one big joint, it blocks motion. So it reduces pelvic and trunk rotation. And so it limits, and then it forces them to rotate elsewhere. All of these are adaptions to help them continue to move through space appropriate for pregnancy and running. But when they go into the postpartum, they carry it with them. And that was what happened in both of these studies. They found that at six months for the woman who was the case study, and then at six weeks postpartum for the women, the five women in the other study, they held onto these, these some of these variables into the postpartum period and where that's significant is that women are given that okay by their doctor at six to eight weeks. Speaker 3 (09:19): This just like, you can just start doing your thing again. But their understanding is I got to just lose weight and get a flat belly. What our understanding needs to be is we need to understand what's changed for them. Biomechanically neuromuscularly emotionally, you know, fatigue, stress, like all of we have to understand all of those pieces and help them restore their interrelationships. Neuromuscularly biomechanically to be more like their baseline in order to prepare them for return to run. Like it's not just, okay, let's get him stronger. It's how do we help them restore that efficiency in their patterns that they lost, but no one realizes they lost it. So six years later, they show up to an orthopedic office and they have some of these running injuries, but how much of it is related to the compensations that they carried into their postpartum. So that's sort of a, an entry point into our conversation. Speaker 2 (10:17): Yeah. And that's, that is so interesting. And it makes sense that they would carry that over because our brain has is plastic and it's going to adapt. And our our sense of where we are appropriate susceptive sense is going to adapt to that. And it just doesn't end because the baby's not inside you anymore. Speaker 3 (10:40): Correct. And you're pulling it off, like in your mind, like you're still pulling off running, like you're actually running. So it, the understanding of what has changed is not understood globally. And I think like, I mean this, the running study related to the five runners that I mentioned, and that was from 2019. So this is, you know, relatively hot off the presses in terms of clinical understanding. So our job clinically is to help restore reciprocation that's really, and we understand the reciprocation is so important for all sorts of pieces of the puzzle for running. And one of those things is actually reducing ground reaction forces, getting our center of mass over that lead leg. Reciprocation is a huge piece of that. And so understanding just that, if that is all you walk away with today, understanding that you're a female that has a postpartum is postpartum, meaning they have a pregnancy in their history when you're working with them related to it, running injury. Speaker 3 (11:39): If it has a ground reaction force components like a knee or anything, you should be looking North of the border, not just foot strength, not just cadence, not like you have to look North and understand, are they actually reciprocating? Where's that reciprocation coming from? Because when you have a unit joint of the lumbar spine in the lower, the only thing that's left is like TL junction and above. So that's where they're reciprocating is way up high at the chest. And if you watch Fumo runner, that's what they're doing. They're punching the sky, it's all up, up, up, up chest high. And it's, that's the pattern that they partially developed during the pregnancy to continue running and pregnancy. There's nothing wrong with that. It co it's an appropriate compensation, but it does. If you don't restore actual reciprocation between the trunk and the pelvis, that's what you're looking for. And if the woman is in gripping her abs, cause she wants to get flat abs again, that's a UDA joint, it's a uniform engagement of the abdomen is what most women hang on to, or try to do while they're running. And that continues to keep their reciprocation high. So it's like understand what's going on North of the border for these women, versus just looking at things like landing mechanics, landing mechanics are affected by what's happening North so Speaker 2 (12:59): Well that's so, yeah, that is so interesting. And now I'm going to be, you know, in central park watching all these women to see, okay, are they just running with their, from like the thoracolumbar junction up? And then just having legs move like a cartoon character or are they actually getting excursion and rotation through the trunk? Speaker 3 (13:19): Amen. Yeah. And then we're getting into summer, right? I mean, I'm here in California, so we're gonna be able to see people's abdomens. And the thing that I, my cue for my clinician friends is what's going on with the navel. Like if their navel is staying straight, dead, straight, the whole time they're holding their abdomen. So stiffly through their run, that they aren't reciprocated. Like they can't be like, that's an indication that's a quick and dirty clinical sign that you can see that that means the reciprocation is likely coming up higher. And then it'll sort of clue you in and you'll see it. And they're, they're the ones punching high in the sky. They've got ribs flared up, like it's sort of, and that's a lot of our female runners. And it's a lot of our women that have never had children because they're holding their abdomens. Speaker 3 (14:03): Cause that's what they think they're supposed to do. And we also have studies that have shown us that stiff abdomen when they had men jump off a height actually increase their ground reaction forces. So it makes sense it's part and parcel, right? Like, you know, we just got to sort of brought in and I think that's my hope when I talk about stuff like this with my ortho and sports medicine, friends and colleagues because that's really, I'm a sports medicine, PT, I'm not a traditional pelvic health PT, but is to broaden our lens and add these ideas into our differential diagnosis. Like we need to start thinking about how these things are affecting. Some of the things we look for in sports medicine. Like we understand to look at how ground reaction forces what's happening, but we don't often this into our thought process. Like how, why is that a typical running pattern for women? It's not just because we have brought her hips and Q angles and, you know, blah, blah, blah, look North, look North with me. There's more going on for these women. And and we have some strategy pieces that we could add into our thought process to help them Speaker 2 (15:13): Yeah, amazing coming in hot, right out of the gate pair with a great tip for everyone. So thank you for that. And one one question that I want to ask, just so the listeners really understand when you talk about postpartum women, can you define what that means? Speaker 3 (15:32): I'll give you my definition. Sure. It doesn't necessarily mean that it is the definition. But I consider anyone who's ever had a baby. And, and here's what I'll say about that. I think technically it's the first year that might be kind of more of a technical thought process. And that's mainly because I started learning this backwards when my, on my patients who were 35 and 45 and 55 and 65. And they still look like me. This is million years ago. Now when I was at postpartum early postpartum, like the way that I was using my body and it was creating issues for me, they were using their bodies that same way. And they were like, well, they had grandchildren at that point. And so once we start understanding, yes, it's a normal process that women go through, but our job is to understand what they went through and help them find their way back to efficiency and effective use of their structure and their systems and their like I D I was Chris. I love that Chris Johnson talked about their ecosystems, like, you know, like looking at all of those pieces for them and understanding our job is to help them get back to their baseline, their individual baseline. Cause my torso is this, like this with this link legs. Some people have long legs short, let you know, like to understand that. So my, one of my big pushes I hope to achieve at some point is to get baselines, like, let's start getting baselines. I was women. Yeah, go. Speaker 2 (17:09): I was just gonna ask that you, you beat me to the punch. I was just going to say, so if someone is coming to me as a woman who is a runner and she had a child would say a year ago or two years ago, even how do I know what her baseline is? Speaker 3 (17:27): Correct? Well, what I do is I have them try to bring me film from prior to the injury. So these are for women that haven't had babies or like what they look like running prior to having a baby. And again, so many women have said to me, well, I leaked even before I had a baby when I ran. So then you might find stuff in their running form that might help explain that like Mabel's that go straight ahead? You know, things like that. But it does give us sort of an understanding of, is the running form that we're seeing right now, is that speaking to why they're having the injury, the, whatever it is, or is this the running form they've always had and they used to run without any difficulty. Like, you know what I mean? Like, so for me, that's how I started to create their baseline. Speaker 3 (18:15): Even if I can't see what they look like. And a lot of women will, like, when we talk about diastasis, like, you know, something like along those lines, which I might have to define for the audience, but some women will send me pictures of them in a bikini from like their early twenties. They're like, Oh my gosh, you're right. I actually had a line down the middle, but I never gave it any thought because my belly was flat. But now that my belly is not flat, you know? So it's like, that's where we can start to kind of get some comparisons for baselines. But one of my goals is to reach into the medical community, meaning the obstetricians and the midwives and the nurse practitioners. If any of you are out there is to say, let's start creating baseline. You're the first contact for some women they'll come in for a prenatal visit or something like that. Like, let's get some baselines, encourage them to take video. How will they're lifting how they're running? You know, how are they doing these things that they want to get back to afterwards so that they have a library of their own baseline? Like let's understand what they look like beforehand so that we have a better idea of how to help them find their way back. Speaker 2 (19:18): Yeah. Yeah. Great answer. Thank you. And so we've talked a little bit about this return to run after pregnancy. And I know you said that is, that's what people want to know from you. How do I go back to running after I had a baby and you know, everybody wants a protocol. If you could do this, then do this and this then do this. Right? Right. So when someone says to you, when can I start running after I had a baby, what is your answer? Speaker 3 (19:50): My answer is, and everyone hates it. It depends, but I tell them what it depends on. And so, and that's what it does get a little tricky in a situation like this, because these are some of the variables that I want to know. So my, whenever I get a question like that, my favorite is when I get it from a practitioner, what should I tell my patient who wants to get back to running? And I'm like, okay, well, my, my response to you is I actually wrote a blog like this. Like, and I always get, Hey, quick question. And I'm like, it's not a quick question. It shouldn't be a quick question. You know, did they have a vaginal delivery? Was it traumatic? Did they have forceps? Did they have a Syrian? Was it, you know, did they have bed rest? Were they on bed rest? Speaker 3 (20:29): If you're on bed rest, no, you're not gonna start running right out of the gate. You're like, you know, like there's so many variables there was it a complicated pregnancy? Was there, you know, what's been happening to them during the recovery process, have they, you know, are they having postpartum depression? You know, what's the you know, what are all these variables that they're experiencing? Where are they having postpartum depression? Or are they depressed or having baby blues, partly because they've lost their exercise program. Like what, what are all of these variables that we're looking for and what was their athletic capacity before? What is it now? Or what are their goals? Cause I like to make goal specific recommendations. So those are some of like, those are just that's scratching the surface, but I don't want to make it sound like this is an inaccessible population to work with because you don't know what all those things are. Speaker 3 (21:19): But what I usually talk to my patients about is I understand their goals and then I break them down and we start preparing for them. So my program for you needs to prepare you for what you want to do. And I need to understand the demands that you're up against. If you want to run, I need to prepare you for impact. I need to prepare you for endurance. I need to prepare you for power and possibly change of direction, depending on what you want to do. Trail runs and jump over rocks and things like that. Like I need to prepare you for what it is you're going to be up against. And part of that preparation is looking at your form, giving you great form twos, helping you build in new form, creating an interval program, getting you impact ready. Like there's, it's not just, I need you to do some curls and tell me stuff and some cables, and now you can run. Speaker 3 (22:10): And I think that that's, but that's a typical postpartum recovery program, but it isn't a prep for return to run. I need to teach you to reciprocate. I need you to strengthen into those reciprocal movement patterns. I need you to do single leg work. I need you to do single leg loaded work. I need you to do single leg impact work. You know, I gotta get you practicing some of those pieces. Then I know you're prepared. And if you're leaking or having pain or having an I give you these things we're looking for while we're doing the prep work, we're just not quite ready. We need to modify those things. Keep giving you opportunities to build capacity and strategies for the kind of work you want to do. I'm going to build that back into your system so that you're ready. And if you're, again, if you're symptomatic during all the prep work, we're just not quite ready for the actual events, but let's figure out what still needs to be tweaked and what needs work. You know what I mean? And then like, let's start with elliptical, let's start with hiking. Let's start with things that don't have impact. If we're not, if we're having symptoms with impact, like sort of really parse, what's still creating the problems so that we can troubleshoot that. And then, and then get you back into interval prep, walk, run. You know what I mean? Like it's yeah. So it's yeah. So that's running, that's more running specific. Speaker 2 (23:27): Yeah. So if you're not, it's not like, okay, the doctor gave you the all clear at six to eight weeks depending. So I'm just going to give you a walk run program. And that's what you will do. There is a lot more building because like you said you to monitor, you want to give people their program, you want to monitor their, their reaction to it, their symptoms, and then make the necessary adaptations that you need to make and use your clinical judgment. Because we know that there's not a whole lot of research around even returned to run after pregnancy. There's not a lot of research to that, correct? Speaker 3 (24:05): Yeah. We're getting, we're starting, we'll give credit where you know, we're trying, but we, yeah, we have a lot of work to do. We need to figure out there's a lot. We need to understand just basics. But, but like some of the things that I, I I'm trying to create like little things, people can remember, like prepare, then participate, monitor, and modify. Like just keep get like put those pieces together for yourself. Cause some people don't have access. That's the other thing, like if anyone out there doesn't have access for whatever reason to the practitioner, like you are, you have a lot of power by knowing what to monitor for knowing it's not normal to have pelvic pressure or leaking or pain while you're running. It's not normal. Like we want you to feel good while you're running and you know, just cause you had a baby, does it mean that you should be in pain and leak for the rest of your life? Speaker 3 (25:01): Like that's an incorrect, like I think we did. We say we're going to bust myths. Like that's a myth D please don't buy into it. So yeah, and I think I lost your question in there somehow. Did I? No, no, no, no. Boston my own head. No, not at all, but it is. It's like these, like what else? You know, and then follow the other thing I try to tell people is follow your success. If it seems to be that you're having more symptoms on the flats, but you're okay if you are going uphill, which is not unusual because it sort of helps you have a better running form automatically. Then let's walk the flats, run up the Hill. You don't like listen to what's happening, but learn how to interpret it. I think that's what I'm hoping clinicians can be, is really great interpreters of what's happening with the patient standing in front of them so that they can they can be better guides. Speaker 3 (25:54): I mean, that's really ultimately what we're doing. We're guiding people through their process because everyone's process is going to be a little bit different. It should be. And I would love for, I would w I went a hundred percent with lots of over the protocol, charge everybody 10 books now, but it doesn't exist because everyone is different everyone's path through pregnancy is different. That one study we have was so fascinating. All those women did something different to get through the pregnancy running. So, so we, we were just learning, right. We're learning about, about everybody's path through, through all this stuff. So how can we guide them? And I think monitoring modifying, progressing not gradually in a scared way, but in a smart way, like, Oh, we tried that. That was too far. All right. So backing off a little bit. Let's try this. Let's modify, modify, keep adapting. So I don't know. Now I'm going down a whole nother rabbit. Speaker 2 (26:48): No, no, no, that's it. This is all, this is all amazing. And I, and I really think the listeners will, we'll definitely come away with, you know, the, the monitor and make it adaptations and watch and listen. And also, like you said you sort of referenced Chris Johnson, sort of talking about the whole ecosystem. So again, I think it's important to when you are sitting down with this patient for the first time, you know, you have all these questions, but then your other questions are, well, how old, how old is your child? Do you have more than one? What are your responsibilities at home? Do you have a nanny? Are you a single mom? Are you working? What are your time constraints? Like, because all of that feeds into what kind of program you can give this person, because they may say, Hey, listen, I have 10 minutes a day to do some exercises. And, and what happens a lot is people think I only have 10 minutes a day. It's never going to work. Right. So how do you get around those with your clients? Speaker 3 (27:51): I usually use their exercise program is their fitness program, whatever it is, like rather than ask them to stop. I, and so, I mean, we're talking early postpartum versus someone who's maybe coming back two years later. Right? So you know, I try to integrate, my goals have always been, or my path has always been about building brain strategies, neuromuscular. So then I'm teaching them how to re-establish. Some of the, the, the, so let's talk early postpartum things get kind of funky in terms of how components of the central stability Central's control system operates. I'm working on helping them reconnect and implement it into their function. They have to take care of their kids. If you're lifting your kid, we're going to do it in a way that sort of pulls in the brain's going to use all these components to help them start, to learn, to be reintegrated into your movements, just movement going up the steps. Speaker 3 (28:50): Guess what steps is just like running. We're going to actually, if your goal is running, I'm going to make going up and down the steps with your laundry hamper or your baby as your prep for return to run. But we're going to do it super low impact. We're going to think it through. We're going to have to, like, we're going to rebuild that reciprocation through walking up and down the steps. We're going to, you know, match it to your function right now. But if you're two years out and you're, it's a different ball game, I'm going to use your running as your program. I'm going to adapt your running and keep you below your symptom threshold or make it look a whole heck of a lot like running so that you're motivated to do your, if your 10 minutes is spent running and that's your goal, you'll do it. Speaker 3 (29:32): Do you know what I mean? But if I say you got to lay down on the ground and do these rehab exercises that make no connection for you, you human, emotional, or your brain to your goal. You're not going to be motivated to do that. So I have always broken down their exercise programs, if they are CrossFitters or going to gym or whatever it is, show me three exercises that you like to do. Yoga, Pilates, whatever it is, what are three things let's implement these ideas and strategies under something that you enjoy, because I know you'll be compliant. And then they know you're listening. That therapeutic Alliance is there, like out of the gate, you want to help them get to their goals, Speaker 2 (30:11): Right? So it's, it's like, you can take things they're already doing and modify, adapt it, allow them, give them the tools they need to implement. What will help them in that exercise. And ultimately perhaps help them get back to their running or whatever it might be. Okay. Speaker 3 (30:31): Break it down, break it down and then build it back up. That's got it. That's a pretty straightforward way to do it with any athlete. It doesn't have to be running. But you got to know what they're up against. So I, if I am not familiar with something, I just say, show me, I don't know, show me what that is. And I don't know the words, I'm the first one to admit it, but I can't remember what that, can you just show me that and they'll sh and then you can break it down. Like, I think that's, to a lot of people's barriers to working with athletes is they don't feel comfortable with the sport. And then of course we have, you know, members of our community that say things like, well, do you lift, do you even run? I know. And it's like, like, it's really I don't, I don't surf and I will never, my first surfer when I moved to California, you know what I did, I looked at YouTube and I looked at, I watched, I watched videos. Speaker 3 (31:30): I looked, I tried to understand what are the physical demands of surfing, but that didn't mean I couldn't help him. You know what I mean? Like, don't get me started. So anyways, so I think that it intimidates because also like, that would mean that men couldn't work with female athletes too. Like, cause you don't have a vagina. Like that's, it's a, it's an illogical argument and it makes me mad. So anyway, surfing is I that's one of the examples that I use because I don't surf and I never will because I'm afraid of sharks. So we w w your job, our specialty physical therapist should be movement analysis. That to me is a pretty basic part of our definition. And I know that you can at least pick out efficiency. Do you know what I mean? Like, you can pick out efficiency and I use video, like crazy. Speaker 3 (32:19): Have them bring you videos of them. Weightlifting have them bring you videos of running, and then you can slow it down. Look at it, really carefully. Look at it at home before you stand in front of them, start to break it down, look online. What is a clean and jerk, and then ask them to send you a video of a clean and jerk compared them and start to pick out where it's different. There you go. You know what I mean? Like, I think that we create this barrier for clinicians to be able to participate in this kind of care if we make it unattainable because they don't actually participate in it anyway. Yeah. Speaker 2 (32:56): Listen, I could not agree more. I think that's the dumbest dumbest argument against a qualified physical therapist, seeing the person in front of them, because what if you're the only physical therapist for 50 mile radius? What are you supposed to like, sorry, pal. I'm not an Olympic lifter can help you. Speaker 3 (33:17): Yeah, it's so stupid. It's so stupid. Well, and it's really the other thing too then is it's also important to sort of highlight and carefully and kindly and respectfully say that's also how pelvic health is understood by so many. Well, it's not, that's not my department, but it's physically inside the woman standing in front of you. It's part of her department. So like, you may be the only practitioner for miles and you are the only person that understands the human body, the way you do as a physical therapist. It behooves you to start understanding some of these processes. When we start to talk about our differential diagnoses for runners is to understand what is happening, what, how might this have affected what I'm seeing clinically? And then it's not, it's not pelvic health, like in this movie way, it's pelvic health as a, it's a, it's a friend to helping you understand what's going on with these patients. Speaker 3 (34:16): So, so again, like in the same way that, you know, folks get scooted away from participating with female athletes or athleticism, we don't want to scoot them away from pelvic health because it's scary or UV, or it's not their department. Like we need to open those doors broadly and say, let's, let's skill everybody up. Let's equip everybody, the pelvic health community to understand fitness better, and the fitness community to understand pelvic health better. Like let's everybody come to the middle and not create barriers inside the community to those things. Like, let's appreciate the perspective that we each bring so that we can optimize the care for our patients who don't have resources to go down, you know, and with telemedicine creates new opportunities until unless we can't do it nationally. Right. Can we have a talk about that? Speaker 2 (35:08): Yeah. I would love to have a talk about that. Like maybe every, every licensing board across the country, again, it's so stupid because we take a national exam, but we're only licensed in anyway. Yeah. We could have, we could have a round table on that one. But you know, what you said is really important about so for the physical therapist or even other health professionals listening pelvic health, it does not mean that you have to be clinically prepared to do internal work, right? No, not necessary. And it just means that you're treating the musculoskeletal health of someone who happens to have a pelvis, which last I checked is everyone. And so, and so you should, you should be able to do that. You may not ha you don't have to be certified as a women's health specialist, but you can take get information, read books, watch videos, take courses so that you are competent in, let's say for the sake of this month, I'm runners treating a woman postpartum that wants to get back to running. Speaker 3 (36:25): Right. And there, and that's, and I think that that's partially, I mean, to just be fair, I think we all learn pelvic health in a very isolated way in PT schools. You know what I mean? So I think that there's been a huge change in the conversation in the pelvic health community over the years. And it's just starting to get out there in, in other ways. So it also behooves those of us. And again, like I find myself always serve in the middle of these worlds. Those of us who communicate it in a way that's relevant to like, let's be communicating in a way that is enticing to learn more. Like, I want those to gain those skills and and understand it in a way that is relevant. And I, and so, yeah, so we have a lot of work to do to the physical therapy educational programming to start to build it into models a little bit differently, so that it's under some of the other side a little differently too. Right. So it's just, we're all we're evolving, but it is true that it has classically been defined that way. Right. Like, right. And so I think so anyway, yeah. So I, I agree with you, there's a lot we can do there. And it's also like, can you at least talk about like, and to have some ability to do that is important, you know, so, Speaker 2 (37:45): Yeah. And, and hopefully people like yourself and maybe podcasts like this and other podcasts that are out there will really help clinicians. And non-clinicians, you know, your, your, your gal that, that just had a baby. Who's like, I, I don't know what to do. How, what do I do? Yeah. You know, I just had someone contact me today who is eight months pregnant and she's starting to have a little low back pain. And she said, you know, should I just go to the doctor or should I just go to any PT or what should I do? And and I was like, Oh, I'm so happy that she's reaching out for a physical therapist, you know? But a lot of people just don't even know that that's an option. Right. So, Speaker 3 (38:32): Yeah. Cause the messages, while you're pregnant, low back pain, you're pregnant, you know? And, and so it's really, there's a lot of education that needs to happen, but I do think you know, so much of it is around I'm trying to think of a good way to say this, centering the woman as like that, those concerns just because they're common. I hate the common. Not more, it's not, I hate that. I get it, but it's also like, it just always has been, but that doesn't mean that's how it should be, or it has to be moving forward. Like I think we're starting to get more female researchers, myself trying to do that too, to help, you know, we're trying to have females asking questions for females and to the credit of this one particular, he will never know. I should write him a note, but like I had a conversation once with a running researcher. Speaker 3 (39:28): And I was like, did you think about the fact that that lady was probably in continent? Like he had just done something at CSM and he goes, that would never have crossed my mind. And I, and he wasn't like a poopoo that couldn't possibly be a variable. He was like, it looks like you need to start doing some research. And it was, it was literally like the last nail in the coffin of me, like meeting that, like I knew I wanted to go that direction, but it was one of those, you know, those really landmarking conversations that just sort of are like, w wait, wait, wait, wait, wait, I'm point. Knowing what I'm doing, like cooking you in the right direction. Yeah. It's to say, you know, this is you, you understand it. And I think that's, you know, again, you know, we talked a little bit about clinical utility and research, like trying to ask the questions that women need to ask, you know, so we need for your eight month pregnant lady, we got to get better information to her and to people that can care for her in her local community. Speaker 2 (40:25): Yeah. And, and again, you know, we talked a little bit about this before we went on, but, you know, asking the right questions, asking questions, asking simple questions. Because as, as we've spoken about the research for even simple, for simple questions is not there. So before we went on, Julie was saying, you know, we don't know what the pelvic does when we go to sit to stand, what is it doing when we're walking? We don't, we don't know what's happening in the pelvis and the pelvic floor and, and, and articulations above and below. So how are we supposed to know with certainty what's happened when you're running or when you have impact or jumping? So I think these, like you said, these smaller questions need to be looked at and researched, and then hopefully that body of work can build up to something much more clinically. Speaker 3 (41:15): Yeah. We need to sort of, we need to build in the basics and, and, and, and we're working like there are teams working on that, like we have, and we're using computer modeling as a way that this is starting to get there because we can't the issue. And also, I really want to make something super clear before we get moving. This direction is one of the things that I'm trying to be really careful about is not just talking about the pelvic floor, but to talk about pelvic health, because the pelvic floor is not the only gatekeeper that creates pelvic health. And it is a component of multiple body systems. And we need to understand that those systems affect the way the pelvic floor acts and behaves and the pelvic floor itself, you know, needs to be, have attention directed at it. But B because when we talk about just pelvic floor, I think it isolated away from relevance to other areas of care. Speaker 3 (42:05): So I just want to be clear on that. So but we don't know what its behavior is. Cause we can't see it. We can't put a, you know, it's just, we are, but we're starting to get new ways to be able to understand it better through a technology advances. So we're getting there, right? Like, so that's been a barrier to understand this better in in the dynamic, in dynamic activity. And we are seeing computer modeling as an option to help us start to understand this a little bit better, but that modeling is usually done on like an N of one. One of my favorite studies is a computer modeling study, but it's with something, I can't remember the title now off the top of my head, but it was something like, you know computer modeling of pelvic, the pelvic floor during an impact activity and an athletic female or something like that, or for female athletes. Speaker 3 (42:52): But then it literally says in the methods section that the woman they chose wasn't athletic and I'm like, well, crap. Okay. But I mean, it gives us, it gives us new insight. We'll take it. But I would really like to see it on someone who is an athlete, because, you know, we want to understand all of those variables anyways. So, you know, we're just trying to get there, but we haven't always, we can't visualize the pelvic floor in when we're watching a runner, but we can watch it's relationships. We know it's related to the glutes. We know it's related to the pelvis and the low back and the abdomen and diaphragm, we can watch all those other relationships. And we're really good at that in ortho, in sports medicine. So there's all of these interrelationships that we can watch and understand that a little bit better and differently, but you know, there's elements of what's going on there today. I am grateful to our pelvic health community for their capacity to treat directly. Speaker 2 (43:49): Yeah, yeah, absolutely. And now, before we start to wrap things up what I'd like to ask you is for, let's say the clinicians that are listening to us right now what, what is your best advice to those clinicians who are working with, let's say female runners who are postpartum at any point postpartum, whether it be six weeks, six months, six years, what have you, Speaker 3 (44:22): Oh let's see. That's kind of a loaded question, but I think it would be to learn to ask questions like that would be my best advice, like, and ask questions that make you a little uncomfortable. You will get more comfortable with it. And understand that what you're trying to do is open a door of communication. Like create a conversation around this with your athletes. Here's what we know, which is not much, but my understanding is after you've had a baby or two, it affects your running form and you can hang on to those changes six weeks, six months, six years, whatever, wherever they are, unless we actually look at them. So I'm wondering how that as part of your medical history is affecting what you're doing, but along with that often comes problems with how you're activating your abdomen. Or you might have a public health consideration like leaking when you're running or painful sex constipation. Speaker 3 (45:24): Like there's other problems that women have that are under the public health realm. You know, and so so I'm going to ask you, so have them in your intake form, have them, you know, are you comfortable having a conversation with me about that part of your life and your experience? Cause I'm wondering how it might be affecting what we're seeing here. We understand that there's an interrelationship with learning. The research is limited, but, and if you're not comfortable talking to me, understand that, you know, it is something that I think might be a variable. And so I'm going to actually at least try to incorporate your pelvic floor and your diaphragm and some of those interrelationships into our programming. But I also have someone down the street that you can talk to a few, be more comfortable. I just want to open that door, like open the door to a conversation. Speaker 3 (46:07): Like if that, if nothing else, if they aren't comfortable, you also should be skilling up to understand these components. How do you, what should, what do you see in a typical postpartum runner start looking for navels, start looking, going to central park, whatever it is, start to pay attention to these other variables and serve to give fit, give it new. Meaning like I, cause I read a lot of running research and athletics like sports medicine research and the meaning that it's attributed that is attributed to it is often based on what we've understood in men or like a strength based model. Like, well, they're just there post your chain. Isn't strong enough. Well, my question is why, why would every freaking females post your chain the off? Let's put that. Let's start thinking about that. That's the kind of questions I want to ask. Like the why we're seeing that as our common, it's not just structure, it can't just be structured because women aren't all structured the same P S all women do not run it into your tilt. Speaker 3 (47:08): Like they don't, what do you mean? Come on. Nobody does the same thing. All of us. Like it can't be. So it's like with what we've put this meaning on it and if you're postpartum or you're pregnant, you're you have an anterior tilt. Well, we have to have research has shown us. That's not true. So it's like, and then I don't know how you can overstride and inter tilt at the same time. Like, we need to really think about that because, but we've always, that's sort of the lens. And so everything gets filtered through it to the point that we exclude, like other, like, instead of thinking, Oh, well, this can't be the explanation. Let's ask other questions. It's this becomes the definition. Does that make, am I making sense? A hundred percent. Yeah. So it's like, how do we start say, okay, that's we didn't get to the bottom of it. Speaker 3 (47:57): What other questions can we be asking? And and, and to start to look at women, not just women, men too. So it's, it's like, how can we start to ask our questions a little bit differently? How can we start to and really it's to look for the, why's not, what is, why, why in the world are we finding this with all of our female athletes? Could it be the way that we've trained them to suck their stomachs in all the time, since they were 12 and 10, you know, like how could that possibly affect an entire generation of, of participants, right. Let's start looking at this, you know, so yeah. So I love her. Yeah. I mean, we brought up Eric Miura prior, so we'll throw him a little shout out here, but I wanna, I, I heard him speak at a conference. Speaker 3 (48:45): I don't even know time has no meaning now, but and one of the things he said was I, which I love was talking about with research. When you read the conclusion and research, is, is there any other explanation that could have come to that same conclusion based on what you're seeing in the light? And I thought that's so smart because sometimes I'm like, Oh, yay. My biases, my biases, whatever affirmed. And, but I, but so he was referring to that related to the research, but I think one of the things that I keep trying to think through for myself, and I think would be a really wise way for all of us as clinicians to think about it is what are other reasons why they responded to my treatment? What are other reasons that they could be experiencing this problem that has nothing to do with what I've always understood? Speaker 3 (49:28): You know what I mean? And I am sharing my bias. Like when I look at a female runner, I'm not like, Oh, that calf looks weak. I'm like, Oh, wow. Look at their central control system. Cause that's, you know, that's my lens. So I, you know, so I want to be open to understanding all of that other stuff, but I already, I already learned all that stuff. And this piece is something that isn't being considered by a lot of permissions. And so, yeah, so again, we need to start just broadening our lens and I think we're broadening it. I hope to look at females as not just little men and the problem we have wider pelvises, estrogen, and Q angles. Like there's other things happening for us that, that are not explained by those things. You know what I mean? Speaker 2 (50:13): Absolutely. Yeah. Thank you. This was awesome. Now, where can people find more information about you, more information about your, you have a running a female running course, where can, yes. Where can, where can we find all of that? Speaker 3 (50:32): I am at Julie PT and I have discovered that you can misspell my name and still find me. So it's J U L I E w I E B E P t.com. And I have, I do have an online course that was recorded from alive lives online opportunity. So it does have that flair that feel, but it also has the questions, which I love. And, but I also have lots of free resources in terms of blogs, videos. I do a lot of podcasts and have a newsletter to let you know about when opportunities are coming up. Like this one and what's coming up for us this next week to be a part of the round table. But but yeah, and I'm on all the socials Speaker 2 (51:19): You're everywhere. Thank you so much. You're all over the place in a good way. Not in a bad way, in a good way. So thanks so much before we sign off, I'll ask you the same question I ask everyone, and I probably asked you at twice or three times already, but we'll ask again, you can keep giving the same answer I want growing and learning. So that's true, but that's true. Yeah. So what advice would you give to your younger self? You know, what I'm going to share? Speaker 3 (51:49): It's funny. I was just thinking about this before we got on, but, and this is something that I've learned during the pandemic and and it's from Aaron Nyquist just, but he was referring to the spiritual, but I'm going to relate it to our walkthrough. Learning is instead of thinking of learning as this linear thing that I learned this, and now I know this, so that's stupid. I learned I'm making it on my hand. No one can see me. I forgot it was on a podcast, but instead of it being linear, which is so much of what ends up happening in our rural this dichotomy, Oh, well, biomechanics is stupid pain. Science is everything like, instead of it becoming linear in our thoughts is to think include and transcend. And instead of it being a linear line that it'd be concentric circles. And I was like, Oh my gosh, if I could be a learner like that, always if I had started my thought processes that way, like, wow, that would have been important for me as a person growing, but as a clinician growing to like that, instead of it becoming these battles that we get between these dichotomous, like VMO and like Karen, you remember BIMA, well, remember BMO, but instead of these like dichotomous thought processes, let's see, what can we continue to include? Speaker 3 (53:05): And then how do we transcend it doesn't mean that what we used to think was horrible and versus stupid. It's like, how do we keep building on that in concentric circles versus this linear thought process? So, yeah, so that was, that was just on my mind today. Speaker 2 (53:19): What wonderful advice it's like, it's like a reverse, it's like a reverse funnel. Yeah. Yeah. It just keeps getting brought. Our perspectives should broaden our questions should really never be answered. Like we should never get to the end of that. Do you know what I mean? And I just, I, anyway, it was a really just as so much has changed and, and it's been a really challenging year for all of us. I thought it was a, and we're headed back to a new transcendent, normal that I hope will bring a lot of changes for all of us. You know, I just, it was, I, I think it's a really important perspective as clinicians to, so I thank you so much for sharing that and thank you for spending the time today and tomorrow. I know, and tomorrow is our round table with you and Ellie and Chris and, and Tom. Speaker 2 (54:08): And I was saying like, gosh, to have the four of you on like one stage is like, Holy crap. I can't even believe it. So thank you for that. And so everyone you can find out how to join us all by going to podcast dot healthy, wealthy, smart.com. I mentioned it in the beginning, in the intro as well. So Julie, thank you so much. I appreciate you and appreciate your, your knowledge and your insight. Well, thanks so much for having me again, Karen. I appreciate it. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and stuff. Speaker 1 (54:38): Mark, 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.

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Chris Johnson to discuss empowering runners through rehab. He is a Seattle-based physical therapist, performance coach, speaker, and multiple-time Kona Qualifier.    In this episode, we discuss: Is resistance training needed for runners? Are training errors to blame for running injuries?  How can clinicians guide the decision-making process around pain and return to running? Chris's best advice to be a running injury expert.  How can the profession of Physical Therapy be thought of as your best friend in healthcare. The importance of being present and curious.     Resources: Chris's Instagram  Chris's Facebook Chris's Website How to Improve Profits AND Profit Margins in Your Practice Webinar from New Health Running Round Table Talk    More About Dr. Johnson:  Chris Johnson completed his undergraduate studies at the University of Delaware, where he earned a bachelor of science with distinction while completing a senior thesis in the physical therapy department under Dr. Lynn Snyder-Mackler. Chris was a member of the varsity men’s tennis team, scholar athlete, captain in 2000, and recipient of the Lee J Hyncik award for excellence in athletics and academics. He remained at the University of Delaware to earn a degree in physical therapy while completing an orthopedic/sports graduate fellowship under Dr. Michael J. Axe of First State Orthopedics. Following graduation, he relocated to New York City to work at the Nicholas Institute of Sports Medicine and Athletic Trauma of Lenox Hill Hospital as a physical therapist and researcher. He remained there for the ensuing eight years until 2010 when he opened his own physical therapy and performance facility, Chris Johnson PT, in the Flatiron District of Manhattan. In May 2013, Chris and his wife relocated from New York City to Seattle to pursue a more active, outdoor lifestyle. In addition to being a physical therapist, Chris is a certified triathlon coach (ITCA), three-time All American triathlete, two time Kona Qualifier, and is currently ranked 16th (AG) in the country for long course racing. Chris is also extensively published in the medical literature and has a monthly column on Ironman and an elaborate youtube channel.   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: Speaker 1 (00:00): Hey, Chris, welcome back to the podcast. I'm so happy to have you on in our month. All about running and running injury and running rehab. So thank you for carving out the time. Speaker 2 (00:11): It's fun to be back it's it's always a pleasure to connect with you. And it just snaps me back to New York city and I still don't know how we never crossed paths when when we were both there, but here we are, and I'm glad we connected and also happy women's history month. You're someone who's sort of spearheading a lot of great stuff in this space. And I think a lot of people, especially women look up to you and that you're a role model. So things that you've accomplished and continue to work on. Speaker 1 (00:47): That's very kind. Thank you. And now today we're going to do a basic Q and a with Chris Johnson. So Chris gets tons of flooded with questions and comments and things like that from emails to social media. And so I thought, well, let's see if we can make life a little bit easier, reach a wide audience and get some of these questions and concepts under control for you and out to the public. So let's start with a common question that you get is all is kind of around resistance, training and running. Do you need it? Do you not need it? I know that's a really broad question. So I'll throw it over to you around the the, the concept of resistance training and Speaker 2 (01:40): Yeah, and it's a, it's such a great question. I think that everyone's default answer is, you know, basically resistance training is a Holy grail for runners. And I do think it, it has its place, but I think that there are a lot of gaps in the research. And is it something that I prioritize myself as well as in working with the athletes I coach? Absolutely. But I think that anytime you're working with the runner, the primary goal is to get them into a rhythm with their training and to establish consistency of training. And then you can consider to start layering things in this is assuming someone's training and they're healthy. They have no remarkable past medical history. I, I think that, you know, the answer to that question differs especially if we start to get into master level runners who typically have a remarkable past medical history because most of these injuries and conditions go under rehab. Speaker 2 (02:41): You and I both know that as clinicians. So I think that a lot of the resistance training may just be cleaning up sloppy rehab that perhaps they didn't get around to addressing things at the tail end of the rehab. So there's a quote that I love, which is, you know, resistance training is really coordination, training under load. So, so yeah, I do think it has its place but it should be there to support our running, into build our capacity to run, but I've seen a lot of people get it wrong and they end up whether it's, if they're racing, they go into races where they're a little bit sluggish or they're carrying some residual fatigue. I've seen people get injured in the weight room if they're not perhaps if they're, you know, younger and more green. So yeah, I, I do think it has its place, but like everything you have to approach that, that runner athlete on an individualized basis and just understand where they're coming from. Speaker 1 (03:40): And in your experience, working with runners, what are the biggest barriers to resistance training for runners? Because not everyone has, you know, access to the same equipment and time and everything else. So what, what have you found to be the biggest barriers to resistance training? Speaker 2 (04:00): I think a lot of runners are intimidated by it unless they come from perhaps a multi-sport background where they've spent time in a weight room. I think right now with the pandemic, obviously resources and equipment or gyms are not as accessible or gyms opened in New York city right now are on a limited basis. Speaker 1 (04:22): They're open on a limited basis. I think you have to make an appointment a certain times and things like that. Speaker 2 (04:29): Yeah. And then I think that when people do get to the gym, they may not know what to do, and they may resort to something that they see on social media, some of the time, which might be fine. But I think that with running running has predictable performance demands. So it shouldn't be a mystery in terms of what we're trying to do. We're trying to challenge the calves, quads, lateral hip. And we're also we're not layering this in a ton. We're layering it in maybe twice a week on average. So but yeah, I think a lot of runners lack direction, and that's something that, you know, I try to put out a ton of content online. So people start to see how I'm approaching it. And I'm trying to essentially synthesize the literature and translate it to to just the everyday runner. Speaker 2 (05:18): And I think that there's also this element of rhythm and timing with running and that doesn't always get addressed through resistance training. I think perhaps a little bit more since some of Ebony Rio's research, but again, that's really in the rehab sector space talking about tendons, but I think that a lot of the TNT work or the tendon neuroplastic training work just has such salience to resistance training programs as well. So anytime, you know, people work with me, they're, they're going to get accustomed to using a metronome. It's just one more factor variable that I think that we can control for when we're prescribing. I Speaker 1 (05:58): Love the metronome. I love it. Love Speaker 2 (06:01): It easy. After a while though, I Speaker 1 (06:03): Give to everyone, even with my, even with my younger athletes, they get it, you know, and actually with those younger athletes, I'm talking teens, it's using the metronome, although they're like, Oh my God, I have to listen to this again. But it is actually good to give them a little bit of discipline around the, around the movement, around the exercise. But I love, I love the metronome. I have my patients like download the metronome, get used to it when you're exercising. I know it can be a little monotonous, but I think like you, like you said that with the research of Ebony Rio and others, I think it gives people, I don't know, like a, a little bit more discipline around their training. Speaker 2 (06:49): Yeah. I use it a lot when, if I'm giving someone calf raises something like a rear foot elevated split squat. If we're basically doing like a three zero three where it's like down on three seconds, up on three seconds without pausing yeah. It helps to maintain this rhythm. And a lot of the times I'll stop the exercise when they break that rhythm. Because it's telling me that, you know, maybe we're starting to reach the upper end of their abilities for that given exercise. Speaker 1 (07:18): Right. And we all know that three seconds to one person is very different to another. Speaker 2 (07:22): Yeah. Well, and this is what, you know, when Scott Morrison talks about anchoring and I just did that Instagram post on, you know, stop being awake or start to anchor. I'm starting to realize I'm becoming a dissenter. But you know, that's where the metronome comes in. And I've played with this so much. I mean, my, my neighbors probably think I'm crazy because I'm like out front with a metronome going, and I'm doing all these weird exercises. Well, weird to them. Speaker 1 (07:49): What sort of things do you implement to get over the barriers? Well, you just answered that. Anything else that you may implement to get over barriers to resistance training for runners? Like, like you said, in that runner who is very intimidated, maybe never used resistance training before. Speaker 2 (08:06): Yeah. I mean, I, a lot of the times when patients show up to my house, I mean, I'm working out of my garage. We have a space on our property, you know, when they arrive a lot of times I'm deliberately training. So they see what I'm doing and they see that this is a normal part of my routine. And then they get a lens into my racing background, yada yada. And so I want them to realize that this is something that is normal. And I think in a lot of running circles, and I think this is starting to change that it's not prioritized to the extent that it is. And maybe I'm just getting older because, you know, as a master athlete, it's amazing having dealt with some patellar tendon issues, like my body craves resistance training, where if I don't do it, I start to sort of get reminded. My knee feels so much better after I load it and load it relatively heavy. Now you have to be cognizant for reasons I mentioned before, in terms of like, you're not going to want to do a bunch of heavy squats. If you have a race coming up you can keep your body under load, but you need to be a little bit more calculated with your exercise selection as well as your dosage. Speaker 1 (09:12): Yeah. And, and that's where I think working with a coach or therapist or someone who understands understands one resistance training and two race training and how you can kind of blend those together is really important. And now sticking with training, let's talk about training errors. Can we just blame everything on training errors? Is that, is that an okay thing to do now? Or am I, is that not good? And I say, I say that with a wink for those people who are listening. Speaker 2 (09:40): Yeah. I mean, I think it's a convenient thing to do, but I think that I'm going to get myself in trouble here. I think it's a little bit lazy too. In, in, I think that having lived in New York city that you realize the life load factor, right. You know, there's different stressors in New York, between loud noises, you know, smelly things, you know, financial stressors in crowded spaces, you know, maybe your sleep has fallen by the wayside. So you may have a training program that's very sensible. And, and then all of a sudden you have something come up. I think to one of my, I'm an athlete who I'm working with right now, and this guy's just been just so tough and durable. And recently things have started to take a turn in a bad way. You know, he, he lost his mom. Speaker 2 (10:38): He's been having to contend with that. He's had some other job-related issues and and then he he's come down with the patellar tendinopathy and his training didn't change that much. And we actually dialed it back a little bit and it just shows it sometimes all of these other factors, you know, play such an important role in the overall being or totality of that athlete. So, you know, I, I, I think that we'd be much better off calling them ecosystem EHRs where perhaps there's a disconnect, but I think that we have to be careful, always blaming it on training. And I, I get the point, I think that, you know, from a, from a research standpoint, maybe the reviewers are requiring the authors to, to present it in that manner. But I just think there's a lot more moving parts. And I find myself having worked with a ton of athletes over the course of my career, being an athlete that you have to really be in touch with your ecosystem. Speaker 2 (11:39): And I don't know who first came up with that word. I know Greg uses it quite a bit, but I think it's something that, that is great to consider. And anytime I start working with an athlete, I have a conversation and it doesn't end during that initial consultation or phone call, but I'm saying, tell me about your life. What was it like growing up? You know, what, what was your relationship with food? You know, what kind of sports did you play? You know, were you in public school? Did you go to private school? What was college like if you went to college, you know, what's your current situation? Are you single? Are you married? Do you have kids? Are you a single parent? You know, I need to capture all this information and that's just scratching the tip of the iceberg in that conversation's never ending. So I feel like the more I know where people are in life, the easier it becomes to start putting down sensible workouts on paper and make sure when you put them down on paper, they go and pencil nodding. Speaker 1 (12:34): Yeah. I love that. Getting deeper into those questions and, you know, we had a conversation a couple of weeks ago with the surrounding a female athlete on clubhouse and Tracy Blake, who is just fabulous. I don't know if you're familiar with Tracy. She's a physical therapist in Canada. She's worked with a lot of professional athletes there, including their Olympic volleyball team. And she was talking about questions to ask. And I think oftentimes this is sort of floated over kind of skimmed over by a lot of PTs because we asked, tell me about, tell me what happened, what happened with your injury? Tell me what happened here, not the questions you just said. Tell me about your life. Are you married? Like Tracy said, you know, a question she always asks is, do you have children? Do you have pets? What, cause that gives you an idea. What are your responsibilities throughout the day? Yeah, Speaker 2 (13:29): I always say, you know, look, give me a lens into your situation and let the conversation unfold from there. And I think, you know, whether you're a physical therapist or coach, I think all physical therapists or coaches, whether they realize it or not, you know, you're, you're trying to basically capture that ecosystem. And to, to just have, you know, talk to people about, you know, I just have a candid chat with folks and from there, then we can start pulling levers. Speaker 1 (13:59): Right? Cause then you're getting a, really, a more holistic view of this person. And then you can say, okay, they have two small children they're working from home. Their kids are being at school, school, they're at home. They don't have the time to spend two hours a day between training and running and everything else. And how can you make things work for them? Is that about right? Yeah. Speaker 2 (14:25): And I think that any, any time a patient or athlete consults us, they're looking at us as an agent of change and the true agent of change is themselves. And it's trying to help them plot out their own course. And maybe you, you know, you're shining a light on the path here and there, or making sure that they don't step into a pothole along the way. But that's something that, you know, I find myself more and more. I have any expectations to, I don't do things to people. I sit there and troubleshoot with them. And, and I think that that's what we, as physical therapists are phenomenal with. And not only do we have the skillset, but a lot of times it most of us have positioned us to have the time to do that. And you can't rush that process. So but yeah, we're, we're not in a system that incentivizes that, you know, you don't get paid to talk to people, you get paid to do things to people. And that's the fundamental problem with, for the reimbursement structure, for people who are in network. I mean, you and I are a little bit spoiled in the sense that when we're providing care, it's just ourselves and the patient, but that's, I think that needs to be the standard or approximate the standard. Yeah. Speaker 1 (15:41): And isn't it like amazing when that aha moment comes as you're sort of talking through things like you said, troubleshooting, and the patient goes, Oh, wait a second. I can do blah, blah, blah, blah, blah. Or, Hey, maybe that I didn't even think about that. Maybe that is contributing to XYZ. Speaker 2 (15:57): Yeah. And I, that's a lot of motivational interviewing and sometimes, you know, I was talking with a couple of people yesterday. Sometimes people who've already arrived, you know, if we're, if we're discussing surgery, you know, I think our goal is to always try to help people avoid surgery, but sometimes people are just dead set and you say, look, you know, I get the sense that you've really just you've arrived at the fact that you're going to have this surgery. Am I correct in saying that, and you know, if that's what you've elected to move forward with, this is your decision. What questions do you have about the surgery? You know, and, and then you may start getting into a conversation and say, Hey, can I, can I share my experience? You know, this happened to me with my clavicle. I was in Hawaii, we'll be traveling to Argentina to speak. Speaker 2 (16:44): My wife was pregnant. We had a little one, I was going to have to do a lot of physical tasks. And I'm like, I just need the surgery. I didn't have it on my right shoulder when I, my clavicle fracture. And I was just dead set. I'm like, I'm in Hawaii, there's a competent doc. This is not a super involved procedure, like a soft tissue procedure of the shoulder hip. And I had this and I could have been kicked myself for doing it in hindsight, but no one would have talked me out of that at the time. So sometimes people have to learn through their mistakes and sometimes that can be a tough pill to swallow, but that, that patient ultimately controls that decision. So sort of bobbing and weaving, but, Speaker 1 (17:25): And, you know, you just led perfectly into the next topic I wanted to cover. And another question that you get asked often and that's, and that is surrounding pain and pain and decision-making, so we, you, I feel like you led perfectly right into that. So let's talk about how we as clinicians and practitioners, where our role is when it comes to pain and decision-making for that client or that athlete. Speaker 2 (17:53): Yeah. It's it's one of the first things, if not the first thing that I discussed with people I did a book chapter for this it's called clinical care of the runner. Dr. Harris. Who's a physician at university of Washington was the editor. And he asked if I would read a chapter on training principles. And I essentially said, the first thing that we needed to discuss is someone's relationship with pain and what their understanding of it is and how they approach decision-making in around pain. Because if you're running, you're going to be dealing with pain at some point, you know? And and I think people have an inaccurate understanding a lot of the times. So, and I think sometimes we, you know, I'll use an analogy that Mike Stewart or you used which I think is brilliant. You know, sometimes when we're out training and we're driving through a school zone, right? Speaker 2 (18:48): School's in session, the lights are blinking, slow down. All right. Sometimes you may be driving through that crosswalk. School's in session lights are blinking and you have a crossing guard. Who's standing in the middle of the stop sign. Maybe that's a case of someone's dealing with the bone stress injury. So you need to really hate that. Other times you may be driving through that school zone. It's a weekend, no blinking lights proceed as is usual. And I think that's a good way to think about training, but you know, you and I both know that if someone has a lower limb tendinopathy, you know, we want to monitor their pain and understand how it's responding as a function of a particular training session, whether that's a run, whether it's a plyometric training session or a heavy, slow resistance, but we don't want to shut that person down in it. Speaker 2 (19:37): As much as we in our profession may be, high-fiving each other thinking that we're doing a good job of this. Most of the people that consult me, even people perhaps worked with me in the past for short periods of time. They still, when they experience pain, they assume damage and inflammation. And what do they do? A lot of times they, they they'll resort to taking anti-inflammatories and here we go. I mean, this is a, this is where things go South. So I think it's just important to say, Hey, what sense do you make of this? You know, what do you, what are your reservations? Are you okay working through some pain? And I think from there then the stage is set to proceed. But with a lot of, I've worked with a lot of master athletes and they're, they've had a history of lower limb tendinopathy. Speaker 2 (20:23): I know that with my left knee, that, you know, I, I worked through almost a year of pain, but I never stopped training. And I was just sensible in how I was staggering, my workouts to afford appropriate recovery time. And and also just knowing how college and synthesis behaves. So yeah, I think that people have a, a skewed understanding and it's also something very personal, but yeah, if you're working with athletes, it's a critical conversation to have. And I do think that this is where I know Ellie was on talking about bone stress injuries, that if you are remotely concerned about a bone stress injury, and it involves a high risk site, like zero out of 10 pain is the goal. Most other instances, I'm a little bit more cavalier, but if I know, if I see some of the signs that I would associate with the bone stress injury, especially if we haven't had imaging, I'm going to be conservative as hell. Yeah. Speaker 1 (21:19): And I think it's important to, to note that understanding the runner and that's where understanding the ecosystem comes in and understanding, especially for bone stress injuries, where those high likelihood of those injuries occurring. So it also like you have to know your stuff as well is what I'm getting at when it comes to runners and, and having that conversation around pain can be uncomfortable for that runner or for that person. Cause you may have to dismantle a lot of long-held beliefs. So how do you go about that with your, your athletes? Speaker 2 (21:57): I just asked everyone who who connects with me. I say, can you give me w what, what's your understanding of your situation? You know, and I think runners, a lot of times may not come clean if they're dealing with pain, because if they go to see a healthcare professional, they're going to be concerned that they're going to get shut down work. Perhaps they interpret it as a sign of weakness. If they're out on a group run, they don't want, want to be the one complaining. So I just say, Hey, you know, what's your understanding of your situation? And no one's ever asked him that. And that's when the conversation unfolds. So, and I think the way people respond is going to be different pending the person, the situation. But I think it's remissive anyone who's working with a runner or an athlete if they don't ask that question. I feel like I started to answer your question, but I don't know if I do. Speaker 1 (22:48): No, you did. That's exactly what I wanted. That's exactly what I wanted to hear. Cause I want the listeners to get as much of this like great little tidbits of information from you as they can. And you know, all of the questions, the questions to ask the patient that you've given so far, I think are great jumping off points for any therapist, regardless of whether you're working for, with a runner or an athlete. But that question of give me the, let me know, what is your understanding of what's going on? And that opens up a whole lot of doors for you. And then, you know, as the therapist, you have to be well versed in the science behind pain and, and how to talk to people. And, and of course it's a whole other conversation, but you know, I think what you're highlighting here is that you can't wing it. Speaker 2 (23:36): No. And I think sometimes, you know, I had a question from a third year DPT student who watched a presentation. I gave at some and they're like, Hey, I feel like I'm starting to ask the right question, but then I don't know how to respond and follow up. And and I think that, you know, you can't rush this process if you're in, if you're a young clinician that you're going to get better at this through reps, through life experience and just through sort of being in the trenches with people. But you know, the other thing I tell folks is I say, look, you're a smart person, you know? And I, you know, when I first acknowledge the fact, I think it's good that you're being proactive and addressing the situation, but left to your own devices. What do you feel like you, you need to do to get on the other side of this and they start to formulate a plan and I do, I don't need to do anything. Speaker 2 (24:27): I just need to pose these questions and say like, I think that's pretty sensible, you know? Are you okay if we nudge a little bit and you start to basically prepare them for the fact that this plan has got to be progressive, if we're talking about getting them back to running, because they have to get back to a low-level plyometric activity. And I just love these conversations. And, you know, people ask me, they're like, where you learn motivational interviewing. And I'm like, I lived in New York city for decade. I'm like, I just talk to people and I have no agenda. I'm just curious, you know, it drives my wife crazy. Cause if we're ever out in public this happened yesterday. I went to, I had to get a new watch because my watch crapped out and this guy was checking out some watches and we just got to talk to me. And my wife was looking over at me, like, where are we go? Speaker 1 (25:12): Your wife is looking at her watch, like, come on, Chris, get it together Speaker 2 (25:18): And things off the shelves. Speaker 1 (25:21): But it's true. I think that, you know, asking good questions, motivational interviewing a lot. Yes. There's a lot of books. You can pick any book on motivational interviewing and read it and it will definitely give you some insight, but it's the more you do. It's the more people you talk to and not just your patients, anybody, the more you talk to anybody, it will help you be a better motivational interviewer. And the more that you listen and like really listen and start to formulate it's practice. I guess you start to formulate your follow-up questions in your head as you're listening. And again, it's just practice, practice, practice. Speaker 2 (25:57): Yeah. And it's, it's fine. I think that it takes on a slightly different flavor as a function of, you know, what generation the person's coming from too, you know? So but yeah, it's just fun to help troubleshoot with people and to really get them to trust in themselves. Because most of the, the folks that consult me, I mean, they're endurance athletes, namely runners and triathletes these days, and they're going to manage their situation conservatively. Sometimes I feel like they need to be talked off the ledge. If they're going to opt for a more invasive procedure, if that's not really appropriate or perhaps an injectable of some sort. So, but yeah, getting people to trust in their body and and not drag them in for therapy all the time, you know, and I, I have to prepare people for that to say, you know, how do you anticipate this is going to go? Speaker 2 (26:49): And they're like, well, maybe I'll see you two to three times a week for six to eight weeks. I'm like, who's footing that bill. No, no, one's good. Yeah. So I say, you know, but this, this requires a lot of work on us on the back end because when I write an email, I mean, email, I wrote to this person yesterday, it was basically like, you know, two pages and cause it, kids dealing with the bone stress injury, the parents don't really understand the implications of it. He's going to be running competitively in college. And, and I think that he was under the notion that he was going to be back to running in four weeks. And I'm like let's talk about more like four months. And I lay this out and I'm like, you know, I know this is probably a little bit, you know, overwhelming, or you weren't expecting to hear this. What are your thoughts on this? You know, to engage him, to just know where he is after I've presented this information and he got the memo. But that's, that's a tricky thing about bone stress injuries is people fall under the, you know, the idea that they're just gonna take a couple of weeks off and plugged back in. Speaker 1 (27:49): Yeah. Yeah. And again, that's where you, as a, as a therapist and a coach comes in and helps the decision-making you're ultimately, you're not that runner, you're not that athlete. So you're not the ultimate decision maker, but your job is to give as much information and, and your professional opinion as to their situation as you can. Speaker 2 (28:14): Yeah. And I, I think that it traces back to that question is like, what are your expectations or questions around this surgery? I mean, this is a very involved procedure. They're putting you under anesthesia and they're cutting your body open. Never we'll frame it like that, you know, when I'm working with people. But you know, I, I rehabbed all of these people after these very involved, soft tissue procedures of the shoulder when I was in New York, coming from Dr. Nicholas in his staff. And yeah, I'm like, this is going to be six months to a year before you feel like your, your shoulder is like firing on all cylinders. Speaker 1 (28:47): Yeah. Yeah. I had, I had a complex soft tissue shoulder repair and it was a year anyway, we can go on and on when it comes to a patient mindset, fear, trepidation, everything else. I think that's for another podcast. But I think you definitely got across the decision-making process on behalf of us as a therapist or coach and how we can influence that process for the patient. Speaker 2 (29:12): Yeah. And I think that if patients aren't on board, I mean, if they are around muddy water where there's a sinister situation and they start sort of dilly-dallying, I think that we need to really put our foot down his therapist too and say, look, you know, you've consulted me and here are my recommendations or here's my professional advice. And if you're not going to take it, let's just, let's just part here. And sometimes we don't need to do that a lot, but I think sometimes we drag our feet as clinicians and we need to, we need to put our foot down if we have to protect that person from themselves, because we can't get tangled up in that mess. I can't think of the last time that's happened, but it has happened over the course of my career. Speaker 1 (29:57): So those, I mean, those are sticky conversations to have, but for the safety, I mean, our job is to protect that, protect our, our athlete, our patients. So if that is our job, then you have to have those sticky conversations. Yeah. And that's it. All right. So I think that was thank you for that conversation on decision-making and hopefully it sparks plant some seeds in our listeners here. And now we'll go on to two more questions that you usually, that you get the easy ones. You will we'll breeze through these too. These are easy. How do you become a runner running injury expert To how many times do you get that question? How can I do what you do? Speaker 2 (30:41): Yeah, I it's, I, I love getting it it's flattering. You know, and, and it's something that it was sort of, I looked back and all, I, there, there were a couple of defining moments in my life. And one was when I was told that I'd never be able to run again. You will never run again. Right. I heard that a couple of times from very world-renowned orthopedists. And I think that's what ultimately put me on a trajectory to do this. And I never ran competitively when I was younger. I probably should have been channeled into a little bit more of a, a running program, but I was always playing sport, different sports, you know, from skateboarding to soccer, to tennis, to baseball, to basketball, to lacrosse, to, you know, rollerblading snowboard, like you name it. I played it. And except football, just because my high school didn't have a football team. Speaker 2 (31:39): So I always relied on running to help me in sport. But I feel very fortunate in hindsight that I never started really formal distance running until I moved to New York city around like maybe 24, 25. But I, I think that when I started getting into triathlon is when I started working with a lot more runners. And I think when I started distance running, that was around the same time and it's just a fun bunch to work with. And I think that initially I was overconfident and it got to be frustrating when I'm like, geez, this is a healthy person. Like I would send them out. I'm like, Hey, I think you're doing good. And they would come hobbling home. Or they would call him and be like, Oh, I blew up on that run. And I'm like, why are these people blowing up on these runs? Speaker 2 (32:25): Like I thought they were doing a good job. And then it just really forced me to stare at myself in the face and say like, what do I need to be doing to really help these people? And, you know, I started reading a lot of the research. I started spending time around runners. I started speaking a lot with this fellow Bruce Wilke, who was sort of like a savant with running who unfortunately has since passed. But I started to really get a handle on running and not only on running, but just the mindset of runners, how they approach training how they've sort of just been dismissed by the medical community. Because you're like, Oh, here's a runner here comes another crazy runner. And then you start to realize that runner, when someone tells you they're a runner, you don't have other athletes. Speaker 2 (33:09): When you meet someone, you know, you could meet someone, you could meet a world-class athlete and they may not come claim that the fact that they play a competitive sport professionally, or they play a professional sport until you talk to them, runners like I'm here, I'm a runner, you know? And so they really stuff, they go through an identity crisis. So you have to look at this from so many different lenses. You have to understand the performance demands of the sport. You have to understand, you know, just running communities. You need to understand that these people's identity revolves around their running. So they become fragile when they're not running. So I just loved the challenge of, you know, addressing all these different factors and and it helps that I, that I'm still training and racing competitively because I sort of go through, I think a lot of the same struggles and challenges that they face so I can speak to them. Speaker 2 (34:01): But I think that if people want to go, go in on running as a young clinician, coach running is having a moment go all in, right. We saw an uptick and running with the, you know, with the pandemic. And I think that if you're going to work with runners, you don't want to say like, Oh, I do general outpatient orthopedic, orthopedic rehab. It's like, no, my whole practice revolves around running. You know, people are like, they come to me because they know that, you know unfortunately I've had a pretty rich experience in terms of my, my didactic training. And, you know, when I was getting reps under my belt in New York city. So I feel like now I can look at things through a very global lens when a runner presents and we can troubleshoot most of the time, I'm seeing people for one, maybe two sessions. But I think that that running rehab is challenging in a lot of different ways, but if people have a, an interest go all in, Speaker 1 (35:02): I think that's great advice. And I also really liked that. You just mentioned, Hey, I'm not seeing runners three times a week for six to eight weeks. You know, I'm not, this is not how I'm, I'm, I'm building my practice. And I think that's important to let people know, because I think a lot of newer graduates or students might be thinking, Oh, this is going to be great. I'm going to be working with people several times a week for six weeks. And then they're all better. Not so much the case when it comes to running injuries. Speaker 2 (35:31): Yeah. And their runners just seem to perpetually get these niggles and aches and pains. But, you know, I, I, I think it's doing a disservice because if you bring someone in, if you say, Hey, look, I need to see a couple of times a week for the next six to eight weeks. You know, someone told me that I'm like, man, I must have something serious going on. So I just say, Hey, look I'm not concerned. Anything sinister is present. I want you to be sensible. You're around muddy water, but carry on. All right. In calling me if you need me. And I think that they're like, wow, I've had people reach out and are, you know, this person told me they were running five to six days a week and their quads were a little bit sore. I'm like, Oh, you're good, man. Speaker 2 (36:10): You don't need to see me. You know, I said, and I asked him some, some more involved questions, but I'm like, you don't need to see me. That's a really empowering message, you know, because the person's like, Hey, I'm here ready to pay you. And you're telling me that you don't want to see me. I, one of a guy who's become a good friend of mine. He was dealing with some hip pain. He was in a bicycle accident and he had some films in between x-rays MRR because of a woman who who's pulling out of a parking lot, had collide with him for whatever reason. And you know, and I got a lens, you know, I saw his power profile on his bike. I saw the lifts that he was doing because we were training at the same facility. And he's like, I, I need to come and see you for physical therapy. Speaker 2 (36:52): I'm like, no, you don't. I'm like, I'm watching you lift, man. You don't need to come and see for, you know, let's, let's just chat. If we cross paths here and he's become a very good friend, he, he always jokes. He's like, you're the only PT you've told me not to come and see you. He's like all these other people are like trying to get me in and get me on these programs and tell me, I need hip surgery and PRP and yada, yada. So, but you need to know that nothing sinister is going on the flip side of the coin. Speaker 1 (37:19): Right. And that's where experience comes in and confidence as a clinician comes in as well. And that takes time. So you're not going to be, so what I'm getting is if you want to be a running injury expert, go all in, read the research, do the things, take the classes and take time. It takes time and leave your ego at the door. Speaker 2 (37:39): Yeah. And I think the patterns will become, they'll become pretty straight away in terms of where runners are getting into trouble. You know, where are these injuries are manifesting? And, you know, I, I think that most of it is being disconnected or out of touch with your ecosystem and not laying down programs that sort of reflect your ecosystem and realize that target is always moving. Right? Speaker 1 (38:03): Yeah. Yeah. Excellent. Okay. Final question of our interview here. And again, it's, it's an easy one. So, so we talked about this ahead of time. This is an easy one. So, well, how do I even phrase this in looking at the profession of physical therapy, what can we do better to define what we do and kind of stake our claim on what we do as a profession? Speaker 2 (38:37): Yeah. I still am organizing my thoughts around this. I went into physical therapy because I thought it put me in the best possible position to help troubleshoot with people through a conservative approach. And I think that the challenge we have is physical therapy is a very tricky thing to define. And I think that where we're ultimately, and this is a quote from Jen Shelton, who was you know, in born to run, she was a young gifted ultra runner at the time. I don't know what she's up to these days, but she's she's a trip in all great ways, but she said physical therapists are your best friends in healthcare. And I think that we're well positioned to be the first line of defense because we're trained across such a broad through such a broad range. So, you know, you may see us working in cardiopulmonary capacity. Speaker 2 (39:40): You may see us working in wound care. You may see us working in a neurologic geriatric with geriatric population. You may see us basically with working with pro sports teams you know, pelvic floor. I mean, it's tricky when you have all these moving parts, but I, I don't think that we've defined who we are as a profession, to the extent that we need to. And and I think that's why a lot of other people end up defining us sometimes in good ways sometimes in bad ways. But I think that it's sort of like, you know, I'm in Seattle, I'm going to use a microbrew example. You know, you have run of the mill rehab. And I think some people lump physical therapy ended up, but physical therapy to me is sort of like a microbrew, right. We need to tell people what to think about it. Speaker 2 (40:34): We can't let them conjure up their own ideas. We need to really define who we are as a profession. And and I, I don't think we've done that yet. I think that we're, we're getting there, but I don't, I don't think we've done a really good job defining physical therapy. Cause if you ask people, you know, people are like, yeah, I've tried physical therapy and we know the same, the response, it's a heat ultrasound TheraBand. And it's always funny when people connect with me, they're like, this is so different from like what I expect to physical therapy to be. And I'm like, well, what did you expect it to be? And it was generally the response is what I just mentioned. And they're like, you just helped me troubleshoot and in sort of the seamless way. And, and that's what I think we do. Speaker 2 (41:21): We triage and troubleshoot. But we look at things through the people who I really respect in life. They're able to look at challenging situations through multiple lenses. And I think that that's how we're trained as physical therapists. And I think that that's why we're in such an incredible position to troubleshoot with people. So I don't know why you've got my gears grinding even more. And I, I, I think about this morning, noon and night is, you know, how do we better define our profession? So we don't let people conjure up their own ideas of what it is, because I think a lot of times if they've had a bad experience, that it becomes very skewed in physical just saying physical therapy doesn't capture it. Speaker 1 (42:09): Yeah. I agree with that. And so what can we do as a profession to change that? I agree it needs to be changed. And I agree we need to be the ones out in front talking about what we do and how we do it and why we do it. So when, when you think about that, what sort of ways can we be out in front and take control of the narrative? Speaker 2 (42:33): I mean, I think it needs to be orchestrated. And I think that that's, that's a major challenge right now. Because I think that is a profession we're a little bit more fragmented than, than one might think. So I think that we have to have a lot of people come together from different sectors of the field and have have a long, hard staring in the mirror and talk with each other to try and arrive in a definition for what we do. And I think it's a really challenging thing, but I think it's something that is very important, but I think also individuals like yourself where you start to represent the profession. You know, I try to do the same thing. I think that holds a lot of weight too. So I, I think it, you sort of have to take a multi-pronged approach. Speaker 1 (43:23): Yeah, yeah. So you have to take that 30,000 foot approach by having a lot of people from different areas come together and give that wide umbrella. But then from a micro position, individuals can also be out there and trying to, to change, to make a change. Speaker 2 (43:40): Yeah. And and I, I'm confident that we're going to do that. I don't know. I feel like I'm in my early forties now and I'm starting to become more reflective in life. Right. And and really think about, you know, a lot of things, one of which is a profession and, you know, I just feel like a pig in poop having landed in this profession because I'm such a diehard PT, but I also, like, I feel like the perception of physical therapy needs to change too. Speaker 1 (44:09): And, you know, I will say that I do see it changing slowly. I mean, this is a big ship to turn and I'm talking from a societal standpoint. And I say that because I see more and more in mainstream media, whether it be on television, print, blogs, podcasts, et cetera, that journalists are now reaching out to physical therapists. Whereas they would have reached out to a trainer, a chiropractor, a yoga instructor, or something like that when it comes to their articles on everything from training to, I just did an interview yesterday about pillows, you know? So it seems like, well, what, why would they reach out to a PT about pillows? You know, but it's nice that they are reaching out to PTs about things like that. And things about training and things about COVID rehab and, and long haul COVID patients, you know, physical therapists are now being part of that conversation. I'm seeing that more and more from main street, main stream journalists. So I feel like that's a good sign. Speaker 2 (45:12): Yeah, for sure. Speaker 1 (45:14): A good sign, for sure. And, and also showing that journalists are open to hearing from different groups. So I always say to physical therapists like contact your local newspaper, if you live. And, you know, I'm from a small town in Pennsylvania contact that local newspaper asked to write an article, ask to, you know, be a contributor, get onto your local news stations find, cause that's, that's the way the general public finds out, you know, on social media, there are some people like yourself and others that have great social media followings and are putting out great content designed for the consumer. But a lot of physical therapists on social media, probably myself included do social media posts for other therapists. So it's a little different, right. Speaker 2 (46:01): Yeah. And I think that's okay. And I think it's Speaker 1 (46:03): Okay. Yeah. But I think we, it could be broader. Speaker 2 (46:07): Yeah. I just, I think that when I work with folks and I, I'm not alone here, but when people start getting a lens into my thoughts on a particular situation, if they're like, Hey, I have some calf pain, they call me on the phone. They're like, they may be an athlete. And they're like, Hey, I have some calf pain, but a great example. This guy reached out to me the other day. And he was dealing with what he was told was an Achilles tendinopathy. And he was under the care of a physician and other rehab professional outside of the profession and I'll leave it at that. And when he came to see me, his primary complaint was he was starting to lose coordination in his left, lower extremity on the run. And he started to feel more disjointed on the bike. This isn't an Achilles tendinopathy. Speaker 2 (46:54): He may have symptoms that, you know, that are consistent, but that's not what's driving. So, you know, you start to think of, okay, well what could this be? You know, is there something going on maybe like from a differential diagnosis, you're starting to run through like, Hey, is he's telling you this, like okay, is this unilateral? Is that bilateral? You know, is there any loss of sensation, strength, power you know, is this, like if we just start asking a different set of questions, you know, could this be a runner's dystonia? Could it be something like multiple sclerosis, it could be ALS. So you have to, when someone says, Hey, I have this complaint, we're asking in terms of what's running through our mind and the questions we ask, they're very different. So I'm going to start challenging him from different coordination tasks. Speaker 2 (47:44): I'm going to take them through lower quarter screen. I'm going to get a lens into his running. You know, I'm going to understand how an Achilles tendinopathy would present if he's not having issues doing calf raises. And he's able to sit there and jump in place. I'm like, you're killing is, is pretty, pretty good, man. You know? So for whatever reason, there's this timing issue in his Achilles is probably seeing a different or an unaccustomed rate of loading that, that he's not withstanding from a timing perspective. So, you know, he's someone that probably ultimately needs to consult a neurologist, right? So why is no one told him that for a year? And they're telling him that he needs to do a more aggressive form of scraping and he's a candidate for a PRP, excuse my language, but that. Right. So this is where our role is just so critical because we sit, we spend an hour with people or at least, you know, a lot, and we, we can sit there and troubleshoot with people and really get them into the right hand. Why is no one ever he's like your assessment makes so much sense to me. And so many examples. Yeah, Speaker 1 (48:51): Many, many examples. Well, Chris, this was great. What a good conversation. I think there's a little bit of got a little bit of everything in here, and hopefully we answered a lot of w V a lot of the questions that you get on, on a daily, weekly, monthly basis. So thank you so much now, where can people find you? Speaker 2 (49:11): I can't tell you no, Speaker 1 (49:13): I'm going off social media now. Speaker 2 (49:17): Instagram is good. I'm just at Chris Johnson, the PT, and I'm in the process of revamping my website and that should hopefully be done at some point in the next couple of weeks. And and that's gonna really just, I think, make it easy to understand what some of my offerings are and how to sync up with me. And yeah, for folks, if, if you want to sign up for a crazy newsletter please join my newsletter. It's a little bit of reverence. So I'm preparing it now in, in good ways. So, Speaker 1 (49:49): And how can they sign up for your newsletter? That'll be on the website and Chris Johnson, pt.com or Zara and PT. Speaker 2 (49:56): Chris Johnson, pc.com. Yeah. Going back to my roots, Speaker 1 (50:01): Go keeping it simple. Right? Well, this was wonderful. Last question, knowing where you are now in your life and career, what advice would you give to your younger self now that you're, you're pondering, you're pondering life in your early forties. Speaker 2 (50:18): Oh, stop taking yourself so seriously be present with people, equally people, power, power, your phone off, and and be present with people. And for folks who are who are coming to see you understand that a lot of what brings about changes in what helps people are these non-specific effects, you know, during a clinical interactions. So don't feel like you need to have this gnarly didactic knowledge. That's going to come in time by continuing to read the research, spending time around other mentors or clinicians. You respect taking courses from them. But if you can just be present and engage with someone, take a genuine curiosity in their situation, that's going to do wonders and and yeah, take the pressure off yourself. Speaker 1 (51:07): Excellent advice. Excellent. And I thank you so much again, Chris, for taking the time out. And we will see you in a couple of days next in a week or so for a round table discussion, which I also think will be phenomenal. So thank you so much. Speaker 2 (51:22): Yeah. Thanks again for having me on Karen and keep up the great work. It's fun to, to just sort of follow your, your journey and calling me if I can do anything to support you. Speaker 1 (51:31): Thank you so much. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and smart.