Healthy Wealthy & Smart

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Drs. Julie Sias and Jenna Kantor to the show for our annual end of the year review. I also wanted to welcome Dr. Alexis Lancaster in spirit. All three of these incredible women are the team that makes this podcast happen every week and I am eternally grateful for all of their hard work, support and love throughout the year.  In this episode, we discuss: The ups and downs of 2020 for each of us How to deal with fraudulent Google reviews  Being a brand new mom and a private practice PT owner  What we are hoping for in 2021 And so much more!  Resources:  Jenna Kantor Physical Therapy  Newport Coast Physical Therapy Renegade Movement and Performance  Karen Litzy Physical Therapy A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.  More about Julie, Jenna and Lex I received my Doctor of Physical Therapy and Bachelor of Science in Biology degrees from Chapman University. I became a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association to better serve my wellness clients. I am also a member of the American Physical Therapy Association and Private Practice Section. In addition to working with my physical therapy and wellness clients, I provide consultation services for children and adults with neurological conditions. In my free time, I produce the podcast Healthy, Wealthy and Smart which features leaders in physical therapy, wellness and entrepreneurship. Fun Fact: I love the sun! I am thankful there are 277 days of sunshine a year in Newport Beach! From hiking Crystal Cove, sailing in the ocean, scuba diving the seas and kayaking through the back bay — there is so much to take advantage of! As your Doctor of Physical Therapy, my goal is to help you maintain your active lifestyle because working with you inspires me daily to get out of my comfort zone and try new things here in Newport Beach. Jenna Kantor, PT, DPT, is a bubbly and energetic woman who was born and raised in Petaluma, California. She trained intensively at Petaluma City Ballet, Houston Ballet, BalletMet, Central Pennsylvania Youth Ballet, Regional Dance America Choreography Conference, and Regional Dance America. Over time, the injuries added up and she knew she would not have a lasting career in ballet. This lead her to the University of California, Irvine, where she discovered a passion for musical theatre.  Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia. During her education, she co-founded Fairytale Physical Therapy which brings musical theatre shows to children in hospitals, started a podcast titled Physiotherapy Performance Perspectives, was the NYPTA SSIG Advocacy Chair, was part of the NYC Conclave 2017 committee, and co-founded the NYPTA SSIG. In 2017, Jenna was the NYPTA Public Policy Student Liaison, a candidate for the APTASA Communications Chair, won the APTA PPS Business Concept Contest, and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media. Lex is originally from the Finger Lakes Region of New York. She graduated from Utica College with her Bachelor’s in Biology and her Doctorate in Physical Therapy. She also earned a graduate certificate in Healthcare Advocacy and Navigation. She is very passionate about empowering the people she works with and is driven by their success. Lex has worked with people of all ages and her passion lies within the treatment of performance athletes and pregnant and postpartum women. For Lex, the most important part of physical therapy care is ensuring that every person who sees her is given one-on-one attention, a personalized treatment program, and a plethora of resources to ensure ongoing results. Outside of Renegade Movement and Performance, Lex practices in pediatrics, owns and operates her website design company, and is an Adjunct Professor at Utica College. She enjoys hiking and dogs of all kinds. Read the Full Transcript below: Speaker 1 (00:01): Hello, welcome back to the podcast, everyone today, we're having an end of the year wrap up. We've done this every year, almost every year since the start of the podcast. And I'm joined by Dr. Jenna Kanter, Dr. Julie CEUs, and perhaps Dr. Lex Lancaster. She is currently driving through parts unknown in Vermont, so she can hop in. She can, if not, maybe we'll get her in at at at another time. But I just want to highlight the people who make this podcast happen because it is certainly not my, myself and myself alone. It's just impossible. So Jenna has been doing interviews for a couple of years now, and Julie has kind of been on board since the beginning almost I would say close to the beginning. Right. Speaker 2 (00:54): I think it's been five years. Yeah, Speaker 1 (00:56): Yeah, yeah. So she's been a part of the podcast behind the scenes doing the show notes beautifully. And then Lex Lancaster has been on board for the past year doing, helping with graphics. So I just it's for me, this is a big thank you to, to you ladies for being so wonderful and generous with your time and your gifts. So thank you so much. And let's start. So what I wanted to kind of start with is kind of talking about our highs and lows of 2020. So if you're listening, I mean, we, we all know that 2020 has been an exceptionally difficult year for almost everyone started out okay. For most people and then really started to go downhill pretty quick. So let's talk about, and then hot, like even through this, I think it's also important to note that good things have happened as well. So Jenna, why don't we start with you? Why don't you let the listeners know kind of, what's been your high and what's kind of been your low of 2020. Speaker 2 (02:08): Hi mom. I just want to first give a shout out to my mom, like I'm on a TV show. So I just want to say hi mom, I love you so much. Thank you for giving birth to me that one beautiful morning or afternoon. I'm not sure. Ooh, 20, 20, well, the low, I would say where, Oh, I want to talk about this because I know there are other practice owners who have dealt with it and I was a I was bullied and harassed online. And and, and this was for a group in which I do musical theater readings. It's a great group. I it's, that I've run into where I get a lot of patients, but the majority of people I know on there, I just know through musical theater and just performing, doing readings. And there were people who did not like how I ran the group. Speaker 2 (02:59): It's just like any place. There are people who don't like what you do. So they go off and do their own thing. And I eventually made a decision to block them out of my life because I didn't want this small section of people to still be present and judging me. I mean, I don't know about you. I like to feel the love in the room, not the hate. So I did that as a gift for myself finally, which did was very good. I was dealing with a lot of anxiety, just even knowing that they were around. Unfortunately, I wasn't strong enough to just handle it. I wish I could say it was, but I was like, Nope, I'm really unhappy right now what their presence. And they decided to go after my business and write false Google reviews. I was fine with the public social media posts on Facebook and everything. Speaker 2 (03:42): You know, didn't saying mine, you know, denouncing me. I was fine with that. I knew they were going to do that. That's why I kept them in my life for so long because I was so fearful of the public humiliation they would be aiming for. But then I was very okay with it. By the time I did it, you know, you come to that piece. But to me, the lowest part was having instilled, dealing with it, dealing with these false Google reviews where they've never been paid patients ever, ever. So I think that was, was a big, low yeah. And, and knowing that we're all going through it. And it's a hard year for so many of us. I felt like I had less people I could talk to about it because everyone's dealing with so much crap right now. So I would say that was like a very, very low point for me. And I know people have had so much worse. So I do want to acknowledge that this is so minuscule. I'm lucky my family is healthy. My, my friends have been healthy during this very, very lucky, but that was my own little piece of hew, toothpicks as positives go. Speaker 1 (04:54): I'm trying not to swear. I'm doing a good job Speaker 2 (04:59): This America way to network as, and do positive right back to back. Speaker 1 (05:04): Yeah, sure. Go ahead. Oh, right. Yeah. Speaker 2 (05:07): Cause it is I would say is, I'm not going to talk. I'm going to focus on business since I was already talking about business. So I'll keep it on that. Was the different branch. My practice took every business in physical therapy has been dealt with some sort of crap if they haven't, I'm so happy for you. But a lot of us have really dealt with some sort of big shift and, and stress and strain and sleepless nights, especially at the beginning of this and some States it's pretty new. It's new for the practices. For me during the shift, I was focusing on expanding more in-person and then of course I started doing more tele-health and now I'm a hundred percent tele-health yes. I refer out if they're not appropriate for tele-health yes. I'm a hundred percent. I don't see myself going because one, I love it. Speaker 2 (06:00): And that's the first thing to the performers I work with. Most of them can't afford that in person. Most of them can't, most of them don't have health insurance. And then the last thing with my practice I've developed these wellness programs. Yes. They're injury prevention, but honestly, no performers are Googling injury prevention. They're like my ankle hurts. I can't do boots. What's up. So, but with these wellness programs, it's not physical therapy. It's the many humans out there in the singing, acting, dancing world where they get the help they need from a PT. And then they're discharged when they're, you know, quote healthy, but their body's still not functioning to where they ultimately want it to be. That's where I'm coming in. And it's great. It's this, these group programs it's really supportive. I definitely have my own jokes in there. I'm a hundred percent myself. Speaker 2 (06:55): If anybody knows me, you're like, got it. And it's, and it's just a joy. The bonding, the, the growth everyone gets physically to get to where they are is just, it's, it's been the such a rewarding discovery and, and a lot of work to make it happen, but well worth it because just I'm happy, man. Like when you really get to do what you really want to do without even knowing that's what you really wanted to do all along until you actually get to do it. That's what I'm living right now. So yeah, I'm pretty happy about that. So that's my positive and I'll take it to the bank. Speaker 1 (07:31): Great. Now let's, let's take a step back to not to harp on the negative, but because I think this might help other people listening. What did you do when you were like, Oh my gosh, I'm getting these Google reviews for my business. I've never seen them. What did you do to mitigate that situation or if it's even possible Speaker 2 (07:55): Crying and vomiting? Let's see. What was the next? So I, I vomit when I get really stressed out. That's a new discovery in 2020. I don't recommend it. It doesn't make you slimmer just saying. So I do not promote that. Okay. [inaudible] so I already have a lawyer, but I even, I contacted Erin Jackson who is a great human my lawyer Stephanie wrote in, but I just, you know, who do I contact first? Because I knew this was now in some sort of it's the physical therapy where we have HIPAA. We have so many things legally we need to be careful about. And as much as I say, swear words, and I joke like there's liability for these things. Like, but this was just how do I handle this? Because Google reviews specifically, which I was fearful, I pre reported these people before it happened, because there was no way to block them on Google. Speaker 2 (08:52): Not because they were going to, I was going a little bit in the Cuckoo's nest. Like, how do I keep preventing? Cause they're doing all this stuff fine on social media, but just in case let's pre protect, there was no way to, well, getting Google reviews is difficult. So here's some things that you can do by hand that are suggested they, you can have friends report it. And if you have friends report it, make sure you have a written out exactly where they need to click step by step, what they need to do. And, and boom bought a bang. Another thing that I did is I contacted the patients. I felt comfortable contacting, cause that is a thing I'm saying, this is going on. I've never gotten a review from you. Would you please write a review so I can get some actual from actual patients on here. Speaker 2 (09:38): So I did outreach to those individuals as well. Which was great in that sense. I mean talk about like, you know, unexpected, positive. So that was good. Then with my lawyer, which we're still in the process of doing so a little bit slower in the holidays. It also, I'm just personally, not in any rush because I got so stressed out about it that just like, I'm okay, I've got, I've gotten zero patients from Google reviews, so it's not the end of the world. But she's writing out in legal jargon, what I'm going to be now sending to Google to ask it to be, and it's according to their policies, why these are inappropriate reviews. And so that is what our next step is. I have not met with anyone else yet, but because of enlight of how bored people are, are during the pandemic. Speaker 2 (10:29): And they're putting a lot more emphasis on these negative things, no matter how small or how big they I am in the process of being connected with the lawyer, through my lawyer to learn when I need to do a cease and desist. And when I, when I know it's actually necessary, I still am getting a little bit harassed by them, but I I'm. I'm okay. I'm good right now. But I do want to know, and that I look forward to learning, to be able to share with people like, Hey, here is when you hire the lawyer officially, because that is a good question. Lawyers should get paid for what they're doing, but it's just knowing when you bring that in, which is a very big deal that I think should just be common knowledge. And then where we were able to get one review, Oh, there's also a thing after you submit in there's you can write a post about it on Twitter and you tag people with Google. Speaker 2 (11:28): I forget who you tag. You guys will have to Google it. You'll have to Google the Google thing, but it you can do, I didn't get that far. I also was so hesitant to do that because then it would take it into the physical therapy world at large of, Oh, what's the going down with Jenna. I'm like, Oh my God, like it's literally children who are upset about musical theater. Readings has nothing to do. Like, no. Okay. And then my husband was helpful. He was able to get one of the reviews down by reporting the person's profile. Speaker 2 (12:04): And that was very good. So that was one there's still two that have written reviews. There are three with just one star reviews without writing anything. And none of them have been patients. And we believe that they created two false profiles to put in two of those one star reviews. Interesting. but at the end of the day, they're not in my Rolodex of patients, so they're not patients. So yeah, it's been a bit of a journey dealing with it, but that's a little bit of what I did. There's not one way to do it. There are suggestions on responding to the person where you can say, Hey, I'm so sorry to hear of this complaint. I don't have any records of you as a patient. Please feel free to email me at because there's no conversations that happen within the feed. It's like your reply and that's it. And people can look at it. That's Speaker 1 (13:02): Actually, that could be pretty helpful. Speaker 2 (13:05): My, my lawyer said right now, don't just because we, she was like, let's just, let's just, I'm fine with waiting right now. You know what? The level of stress gets so high, it got real bad for me to be throwing up from stress is a big thing. So the fact that I'm not throwing up, I'm doing well is good. So I'm okay with it being a slow occurrence because my body does start to shake going back into that world, which to me is also just another recognizer of why it's important to know when it's time to block certain people from your life. If they're making you shake and vomit, because you're stressing, like they're just not meant to be in your life. It's fun. It's that simple, you know? But yeah, no, it's, it's, it's it's a very humbling, very embarrassing situation to be dealing with. But I have learned that there are, there are definitely a lot more businesses right now dealing with that, unfortunately. Yeah. I wish people invested more time in the positive stuff to raise up to be the positive changes that we want rather than let's just tear people down because in that action, the wrong people are being torn down. Speaker 1 (14:20): Yeah. Well, thanks for sharing that. And also, thanks for sharing what you did to kind of help as best you can at the moment. Kind of rectify some of that because now if people are listening and they go through that as well, they'll have at least an idea of like, okay, well here's a place where I can start. So thank you for that. Speaker 2 (14:36): Yeah. If anybody ever wants to talk some crap about what you're dealing with, I'm here for you. Speaker 1 (14:41): Yeah. Great. All right, Julie, let's go to you to your, your, your ups and downs of, I have a feeling that your, your and low point might kind of be the same thing, but I don't, I don't know. So go ahead. I'll, I'll throw it over to you. Yeah, Speaker 3 (14:59): Yeah. So I actually remember when we did the show last year, I said that I wanted 20, 20 to be more of a focus on more of my personal life and focusing on family and things in that direction, because in the past it had been all about my business and everybody has had challenges in the physical therapy world with their business. And we have with Newport coast physical therapy, we've actually come out strong. And that isn't really what I wanted to focus on because it's supposed to be personal. So I guess for my lows. Hmm. So me and Wade we've been together for 11 years. We had our 11 year anniversary. And when we're thinking about starting a family and everything, we were like, okay, we have to kind of celebrate the last year that we're going to have together. Just me and you. So 2020 we had like, all these things planned for our relationship. Speaker 3 (16:03): We were going to go to Switzerland, literally the day of the lockdown, that was our flight to Switzerland. And we were like, Oh no. Okay. So we can't do that. And then we had planned some things in the States, like going to national parks and all of those ended up closing down. And then, and then I I'm pregnant. I was pregnant with twins throughout all of this. So then as you know, I get further along in my pregnancy, it's getting harder to do anything just because pregnancy can for wound baby, but with two babies, it was just like, ah, I could give birth at any day. So I don't really want to be too far away from the hospital and everything. So I would say that for the lows, me and Wade didn't really get to kind of celebrate our last year together just as us and which is fine. You know, we, we, we made it work and did some other things, but I think that we didn't get to kind of grieve that aspect of our relationship changing. So that was a little bit of a challenge, but the highs, obviously Speaker 1 (17:15): I had my twins August Speaker 3 (17:19): In Westin and they're three months old right now. They are actually let's see, they're one month adjusted. So they were born two months early and they spent about two months in the NICU. So that was a little bit of a challenge, but given all the COVID and everything going on, luckily there was plenty of resources for my babies and they had great medical care and are super healthy now. So yeah, my highest definitely having my two boys, they're adorable and they're definitely a lot of work, all consuming basically, but hopefully in the next year, I'll get a better swing of, you know, balancing family life and managing my business and everything. So that's kind of a bit of a summary of my 2020 Speaker 1 (18:11): Now let's, let's talk about quickly for, cause you know, a lot of people that listen to this podcast, they're physical therapists and might be entrepreneurs, women kind of around in, in your stage of life who are thinking about I'm going to have children and what's going to happen to my business. How am I going to do this? So do you have any advice and, and what have you done with your business as, and I mean, twins, I goodness, but we should say that Julie is also a twin, so it's not shocking that you had twins. Speaker 3 (18:41): I wasn't surprised when they see that as having twins, I was like, you know what? There was a chance that was going to happen. Yeah. But I would say that for anybody that's in kind of a similar life stage, I fortunately, since my business model is pretty flexible in the sense that I can pick and choose when I take on patients, I don't have much business overhead just because of the, the mobile concierge practice model. That it's good for being a mom because I can kind of pick and choose when I want to take on clients. I would say that if you're, you know, the breadwinner of the family, that's a really tough position to be in because it's, it is really hard to balance everything because I'm going to be able to, you know, pick and choose clients that I want to see when I want to see them. Speaker 3 (19:35): And not everybody has that flexibility. So if you do own your business, it is a good time that maybe you could take a step back and be more on the business management side of things, where you can do things from home, from your computer and then hire somebody to go out and actually do the service. And I actually have a therapist that is doing some client visits for me right now, which thankful it's my best friend. So she's really chill to work with. But that could be a strategy that some people take on is that they end up doing some of the business management side of things instead. Speaker 1 (20:15): Yeah. So you're still working in the business. You're just not out in the field, so to speak because I mean, when you have a new, a new a newborn, I can only imagine that it takes up a lot of your time. Speaker 3 (20:30): Yeah. Every two to three hours, which, you know, if you're, you've never been around kids, I was surprised they eat that frequently. I was like, Oh my goodness. Speaker 1 (20:43): And you've got two of them, two miles to feed. Oh, that's so funny. And what, I guess, what has been your biggest aside from, you know, not getting a lot of sleep from being a new mom, is there anything that surprised you aside from how much children eat? You're like, what the hell? Why did no one tell me this? Speaker 3 (21:08): I'm trying to think. I think that the reality of taking care of a baby, like, I guess I thought it would be not as much of my time, but maybe it's because I have twins. I don't know. I don't know. I don't know any about anything about this, but it literally is like a 24 seven type situation right now. And I can only imagine for people that are going back to work at this point, because technically I've been off work for three months and not a lot of women are able to do that. They have to go back to work. I could see how challenging that would be. Cause if my twins were still in the NICU, so say I took off that six weeks of maternity leave and then had to go back to work before they even came home. That would be so tough to juggle. So it is a lot of work. Like it's the hardest job, just, just the physical toll it takes to be up and take care of babies. It's it's tough. Speaker 1 (22:08): And have you had pelvic health physical therapy? Speaker 3 (22:11): So I actually, haven't gone to a pelvic health physical therapist, not because of anything against it. I just haven't noticed any symptoms. Okay. So I do actually have a couple friends that are specialists in pelvic floor PT that I could reach out to. Maybe they would be testing me for certain things and be like, we need physical therapy. So that could be something I do in the future, but it's yeah. I fortunately have had like a very good recovery and haven't had to deal with anything on the surface at least. Speaker 1 (22:47): Excellent. That's so nice. Well, I love hearing your, your ups and downs and, and we should also say, cause I don't know that Lex is going to be able to come on here. Maybe we can splice her in later, but she did get married. So I can assume that would be her high point. If it's not, then she's, she's going to have some answering to her new brand new husband. I would assume that's her high point. And she also started her own practice in New Hampshire, which I would assume could, would also be a high point for her as well. And then what do you see happening moving forward? What are you, what are you, what are your goals, your dreams, if you will, for 2021, Jenna, I'll throw it back to you. Speaker 2 (23:34): Goals and dreams. Well we are moving to Pittsburgh. It's taken almost a full year, so I'm looking forward to moving there with husband and I have a dream office room cause I'm an actor as well still, and it's going to be decorated Disney theme. So I'm really excited to decorate and make my imagination finally come through and have the walls of tangled with the lanterns, hanging from the ceiling and have all my different collectibles up on display and my lights and my cameras and everything up permanently. So I don't have to keep putting it down and putting it under the bed in a New York studio apartment. I, that will be like Speaker 1 (24:21): For me, cannot wait, cannot wait, Julie, how about you? I'm definitely going to be going to Switzerland. Does I rebooked these tickets like three times and I don't know it's going to happen in 2021. I'm not from eight or tots with me. Well, yeah, go ahead Karen. I was gonna say I, if, if all goes well with 2021, I'll be in Switzerland in November. So you could come to a course, write it off. Oh my goodness. That's a great idea. What is the course? The course is only one day and if it happens I will tell you about it. Cause I don't think it's been announced officially yet. But it's just a one day course. So you can go to Switzerland, just pop over to burn for one day and then you pop out. Oh my goodness. It's it's the the, I think it's like the Thursday or Friday before Thanksgiving. Speaker 1 (25:25): All right. That'll be good. Cause the twins will be over one years olds. Okay. Throwing it out there. You guys, I will be in Switzerland. It's going to happen. Awesome. Well, I have to say Switzerland is really, really beautiful, so I'm sure you will love it. Love it, love it. I don't know. Should I talk about my highs and lows, I guess highs and lows. So I guess my lows were I think when, when everything happened here in New York and Jenna can probably corroborate this, but it was an, it was a little scary, you know, because it was everything locked down, nip. It, it locked down so quickly, but and nobody really knew what was going on. And I think that was a big, low, and I think I had, again, the sleepless nights and the anxiety about, well, what's what, what will happen with my practice? Speaker 1 (26:29): W what am I going to do? I see people in their homes, like you couldn't go anywhere, couldn't do anything. And, and so I think that, that, that sort of stress around that was definitely a low point professionally and then personally, well, my boyfriend and I broke up, but that's probably for the best in the long run. And then my sister had some health trouble, so it was a big sort of just like everyone else. 2020 was like a big sorta show. But that being said, the not knowing what I was going to do for work and being stressed as a low point turned into, I would say a high point along with Jenna is I started integrating tele-health, which is something I will continue to do. So now I do probably see half the people in person and half people via telehealth. Speaker 1 (27:23): And I love it. I love doing it. I think it's it's working very well. And I was also able to launch a business program to help physical therapists with the business and the business side of things. And that's been really fulfilling and getting nice reviews from that from people who have taken the course. So that, which makes me very happy because my whole anxiety was wrapped around. That was like, what do people take it? And they hate it and they think it's stupid and they don't want to do it. What am I going to do? And, and so, you know, you have all these doubts about like self doubts about what you do as a person and what you do as a therapist professionally. So I think those were, it was sort of a mixed bag of highs and lows. Speaker 1 (28:08): And I guess what I'm looking forward to, I too, am looking forward to going to Switzerland. And and just being able to travel and see people, like, I would really love to see my parents who I haven't seen in almost a year. And so that would be lovely because we did not, I did not see family for Thanksgiving or Christmas and probably won't until we all are vaccinated. Just to give everyone a little sense of that, like we're doing the right thing. So I think that's my, the biggest things I'm looking forward to is seeing my family, being able to see friends in person and colleagues in person, because, you know, we miss seeing all of you guys too, you know, so I think that's the things that I'm most looking forward to for 2021 is, and I don't, I don't think that things will go back to the way they were quote unquote, but I think that they'll be an improvement on where we are now. I don't know. What do you guys think? Speaker 4 (29:18): Yeah. I think having our support systems slowly return is going to be really, really fulfilling to just for humans. Like we love human contact and our relationships having all those kinds of slowly come back together is going to be amazing. Yeah. Speaker 1 (29:35): Yeah. I love the way you put that. Having our support systems back is huge. Yeah. Hugging. Yeah. I miss hugs. I know, I know one of my friends hugged me like a friend that lives here in New York. She hugged me and I was like, you know what to do? I froze up. I was like, Oh my God, what is she doing? Hugging is so good. Speaker 2 (29:57): Why my husband gives me time limits for my hugs. Cause I'll keep hugging. I love hugs and I miss hugs. I even miss the Wilson's a musical theater specific thing, but go into a musical theater audition and all the annoying screens of people reuniting with someone they only saw just a week ago, you know, cause we won't want to feel cool, but the people will see and know, but then we do it too. When we run into the people we haven't seen. Who's guilty of it. But yeah, hugging, hugging is just beautiful. Speaker 1 (30:32): Yeah. Human contact. Speaker 4 (30:36): What if on my flight to Switzerland, I have a layover in New York and then I can see you. Speaker 1 (30:45): Yeah. What is that quick? Have a quick one day layover and then Optus. Switzerland. Oh, I know. I forget. You're in California, such a long flight. Speaker 2 (30:54): You need to get pizza. You would need to get Levine's cookies. Oh yeah. And what else, what else would the food wise I'm thinking? I was thinking, Speaker 1 (31:06): Yeah, I just had, I just had a Levine cookie a couple of weeks ago. I eating live only a couple blocks. So the vain bakery was, it got really, really popular because of Oprah. It was like one of Oprah's favorite things like maybe a decade ago. Yeah. That's why they're so popular. But the cookies are like scones, like they're thick and gigantic. Like I got a cookie, it took me like three days to eat it. Speaker 2 (31:31): Yeah, no they're thick. It's, Speaker 1 (31:33): It's a lot, it's a lot of cookie dough there. But they are, they are pretty delicious. Now. You'd swear. We were sponsored by Levine. Speaking of sponsors, I have to say thank you to our sponsor net health. Speaker 4 (31:47): Great segue right there. Speaker 1 (31:50): Just getting it to me. So net health has been sponsoring the podcast for a couple of years and I'm really, really grateful and thankful to them and their support, their continued support. And net health has grown by leaps and bounds since they first started sponsoring the podcast. And so I'm really happy to see their growth, their Pittsburgh company, by the way, Jenna. Oh yeah. Pennsylvania company. And and so I'm really, it's really been exciting for me to see their growth and their movement upward and the fact that they are doing their best to help healthcare providers, which I think is awesome. And they also have, and not that they're telling me to say this, but they really do have some really good webinars. So they're usually free. So if you want like good webinars, business-wise they really have some good stuff, especially if cash based or non cash based. So I would definitely check out their webinars because they're all pretty good and usually free. I like free. Yeah. And everybody loves free. Okay. So I guess I'll ask you guys one last question, knowing where you are now in your life and in your career, what advice would you give to your younger self? Speaker 4 (33:05): Okay. I should be prepared for this because you know, this happens every single episode and did not think this question was coming at me. Okay. So the first thing that comes to mind, and I think it's important is that you should always maintain a sense of curiosity about everything going on in your life professionally, personally, I think that if you're open-minded and you can kind of think on things a little bit differently, just because you're not closed off, you might be able to see solutions in ways that you didn't think of before. So that is very theoretical, but I just think that that kind of vibe, if you maintain that sense of curiosity about everything, it can kind of lead you in new directions. What do you think? I think that's great advice. Speaker 2 (34:00): Oh my God. I'd love that. I, I I feel like I should have gone first because it naturally segues to what you just said. Oh let's Speaker 4 (34:10): Oh no, Speaker 2 (34:11): No, no, no. I think it's perfect. I loved it. I was like, Oh, you know, like for me, I get my best ideas on the toilet, but I still, I thought that was amazing. I was thinking the first thing that popped into my head was don't waste your time on the, focus on where, what your vision is for your life and put all your energy into that as it, and this is why it's like, why it's so good to yours. And now like the candles, I was like, Oh my God, this is perfect. It's so great for us. Speaker 1 (34:42): Perfect. I think that's both great advice. And, and I know I asked this question every time and how I would answer it, knowing where I am now in my life and in my career. I think that what I would tell myself, even like fresh out of, out of college is when it kind of goes along with maybe what a combination of what you guys both said. But what I would tell myself is to don't limit myself by what I see other people doing. Because sometimes like when I first graduated, I knew PTs worked in a hospital, they worked in a clinic and that was kind of it, you know? And so I didn't never saw that sort of broader vision. And so I think I would tell myself to look to people outside of the profession to help you your state in your own profession and seek out those people that have, that genuinely have an interest in you as a person and, and want to be a part of your life and a part of your success. Because I think I've fallen victim to people who I thought had my best interests at heart, and I'm a trusting person. And as it turns out they didn't. So I think really, I think as you get older, you sort of, you maybe, maybe I just have a better sense of who I am and what I want. And so I'm no longer kind of easily swayed and convinced by people who in the end don't really have my best interest at heart, Speaker 4 (36:28): But that's one of the qualities I love about you though. Karen is how trusting you are. I think that does serve you too in your life. So I think that don't ever lose that. That is something that it's, it's a gift and not everybody can be vulnerable. And I think that you wear that really well. Speaker 1 (36:46): Oh, well, that's nice. Yeah. I don't think I would, I'm not going to become that cynical of a new Yorker, but I'm going to, Jenna knows what I'm talking about. But I think that I'm just going to just be a little bit more discerning on the people that I choose to kind of surround myself with. And I think that I've been doing that more recently over the last couple of years, and I think that it has served me well, but that's what I would tell my younger self out of college anyway. Yeah. All right. So any last bits, any last, anything Speaker 4 (37:23): We're all gonna make it we're all gonna survive hopefully. Yeah. Speaker 1 (37:27): Yes. Rules. Yes. Jenna will be going to Florida next year because she missed it for CSM. I know, I know no CSM in Florida this year, but we did videotape our performance, little plug, Jen and I to have a thing at CSM on February 11th at 7:00 PM. Join us for our prerecorded topics on social media, social media. Yeah. Basically. How do you social media, mainstream media to improve your presence as physical therapist and then I think, but I'm not sure we might have a live Q and a afterwards at 8:00 PM. We're so clear. Speaker 1 (38:10): So we'll find out. So anyway thank you so much, Julie and Jenna and Lex for all of your hard work and all of your commitment and I love you all, all three of you. I was going to say, I love you both. And then a Lex, and I'm just getting, I love all three of you. And I really, from the bottom of my heart. Thank you so much. Thank you as well. All right, everyone. Thank you so much for listening. I wish you all the very best and, and fingers crossed for a better 20, 21 and stay healthy, wealthy and smart.

In this episode, John Honerkamp talks about all things running. John Honerkamp, affectionately known as Coach John, has coached runners of all ages and abilities for more than 20 years. A graduate of St. John’s, John was an eight-time All-Big East and six-time All-East (IC4A) athlete while running for the Red Storm. He earned 12 Big East All-Academic accolades and was the youngest semi-finalist in the 800-meters at the 1996 U.S. Olympic Trials. John is deeply involved in the New York City running community. He launched the Off the Hook Track Club, a local training group based in the Red Hook neighbourhood of Brooklyn and created The Run Collective — born out of a desire to unite the running community and connect, collaborate, and celebrate all efforts from various clubs, crews, and people in the city. Today, we hear some of the mental blocks and physical issues that John often sees with his students, and how he creates milestones to motivate himself to keep running. John tells us about choosing the right shoe, when to replace them, and he gives some advice to new runners, all on today’s episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways “Everyone’s a runner. Some people just choose not to run.” “You can’t change overnight.” “It takes 3 or 4 weeks to find a rhythm, sometimes even longer. Just be patient, slow down, and make sure it’s fun.” “Taking care of yourself is really important. There are a lot of little things like massage, stretching, eating right, and all these things that are small things that add up to bigger gains.” Suggested Keywords Running, Coach, Exercise, Jogging, WaterPik, Massage, Wellness, Health, To learn more, follow John at: Website:          Run Kamp Facebook:       @johnhonerkamp Instagram:       @johnhonerkamp LinkedIn:         https://www.linkedin.com/in/johnhonerkamp Email:              john@runkamp.com WaterPik Power Pulse Showerhead WaterPik Water for Wellness Council 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, John, welcome to the podcast. I'm happy to have you on. Speaker 2 (00:05): Thanks for having me. Yes. Speaker 1 (00:06): A fellow new Yorker, just over the bridge in Brooklyn. Speaker 2 (00:10): That's right. I'm a couple blocks from prospect park. So I do a lot of my running and activities and in prospect park. So I feel fortunate to have access to that space. Speaker 1 (00:20): Perfect. Perfect. So now let's talk a little bit more about you before we go on. So people know you're a run, a running coach and you've been running for the good portion of your life, but can you kind of fill in some of the gaps and let the listeners know a little bit more about kind of what led you up to where you are today in the running world? Speaker 2 (00:40): Yeah. I was fortunate to have an uncle that lived next door to me, and he was trying to lose weight and training for the marathon. Either the New York or the long Island marathon or both, this is probably like 1982, 83. And to DeVos's neighbor, he would just bring me along to some of these 5k and 10 K races. And that was kind of like in the first kind of first a second running boom. And, you know, I do the kids fun run, which to be honest, not a lot of kids were doing, it was usually about a mile distance. And then it gradually, I would, you know, after a year or two, I would, you know, take a stab at the 5k, which was a pretty far distance for seven or eight year old. But I just got exposed to running at an early age and, but not really, I mean, competitive against myself, maybe the clock, but not super serious. Speaker 2 (01:24): I did other sports, but when I w when I got to high school, when I went out for the cross country and track team, and we had a pretty good high school in sports in general. And I kind of had a leg up as far as I've been running for races for a couple of years. And I kind of had, you know, a little bit more experienced than the average freshman, but I definitely was better at running than basketball, football, baseball. I was very good on defense and I realized that equates to like, not scoring a lot of baskets, but it really annoying the other competitors where I had a good engine. And so, you know, I ran very well in high school. I got recruited and I went random, got a full scholarship to St. John's in Queens and ran there for four years. Speaker 2 (02:10): And I was fortunate enough to get better each year. And I had a really good year, my junior year and 1996, I qualified for the Olympic trials and the 800 meters. And that was also the year that the Olympics were in the U S and Atlanta. So it was just actually that kind of a perfect year. It was 20 years old. I got, I just advanced really, really well. That's, that's that's spring season dropped about four seconds of my 800, which is a pretty good chunk of time for that distance. The next thing you know, I found myself at the NCAA at the Olympic trials competing in Europe as the 22 and as a 20 year old. So that was kind of the beginning of it. And then obviously I got into professional running post-collegiate Lee. I ran for a team Reebok team based out of Georgetown university, but the legendary coach, Frank Gagliano. Speaker 2 (02:51): And I did that for a couple of years training for the trials in 2000. And in 2001, I moved and I was living in DC for those three years. And then I moved back to New York and I was still competitive. I ran for the New York athletic club, but I had to gradually kind of turned from competitive runner to not necessarily weekend warrior. I was still running a fair amount and I'm still competing, but I was focused on other things and then got into coaching and initially at running camps over the summer as a college kid, and then I coached high school was my first gig when I was coaching. When I was running professionally, I coached high school down in Virginia and then got up here in New York. And next thing I know I was coaching. I worked for the New York Roadrunners for five plus years and handled all their training and education and launched virtual training platforms where I was coaching 5,000 runners for the New York city marathon. At one time, the life I was just emailing people all the time, but it really gave me a nice quick you know, again, it's just different. I mean, there's a lot of same principles and at whatever level you're at and running, but coaching the folks that maybe aren't elite or don't have two hours to take a nap every day and do all the recovery things that we'll probably talk Speaker 1 (03:55): About are most people. Speaker 2 (03:58): Absolutely. I got a really, you know, a crash course in coaching, like the everyday adult who has two jobs and has kids and running as again, as I can sneak it in on the weekends, trying to get in before your kids get up, I'm finding I do that myself now being a father too. Yeah, so I started early and I never got burned out from it. I always had great coaches that didn't run me into the ground. And there's plenty of stories out there where kids, whatever sport we're talking about, or even other disciplines like music or dance or art or whatever, if you do too much, and it's not fun anymore, and you start not liking it. And I was able to, even though I didn't enjoy it all the time for the most part, I really enjoyed running throughout my life and at different levels of competitiveness. Speaker 2 (04:40): And and I'm very proud that I, I do, I do call myself a I've run races and stuff, but I'm not offended anymore when people call me a jogger or they asked me how my jog was. I actually realized that I was doing a lot of jogging, even when I'm at the elite level, the recovery runs were very easy paced. So I'm quite proud to be a jogger. And but yeah, that's kinda like my quick and dirty version of how I got into running and the kind of trajectory that I've been on. And again, I've been running for about 35 years and probably kosher for close to 25 at various Speaker 1 (05:12): Amazing. So you've coached, we can easily say you've coached thousands of people. Speaker 2 (05:17): Absolutely. Yeah. The technology and the online platforms recently, it does make it easier, very scalable. And you can say, yeah, Speaker 1 (05:24): Yeah, amazing. And just so people know the way John and I met was through so people who who listened to this or see me on social media, you know, that I'm part of the water Waterpik water for wellness council as is John. So they've got two new Yorkers and we're both council members. And one of the things that we have been working with is a Waterpik power, pulse, therapeutic strength, massage, shower, head, try and say that 10 times fast. But we'll talk about kind of how, how John sort of incorporates that with his runners and any benefits that they're seeing from, from switching a shower head, which is pretty easy. But before we get into all of that, John, let's talk about some of the common complaints or common issues that you're seeing with your runners. And just so people know, we spoke a little bit before we went on the air here. And the one thing I really want to hone in on first before we get to the physical things that everybody thinks of that happens with runners, but there's the mental side of it too. And sometimes that could be the more important side. So talk to me about what kind of mental blocks you're seeing from your, your students. Speaker 2 (06:40): Yeah, I mean, mentally it's it's funny because people, when they find out that I've given coaching all these years and been running and maybe I was faster and fast and slow is a relative term, but you know, competed at the Olympic trials, they're always Oh, well, you wouldn't want to coach me because I'm not a real runner or, Oh, I don't run like you. And I'm like, how do you run? You put one foot in front of the other, you leave the ground and move forward. It's very simple. And so people often have a love, hate, or just hate relationship of running because either it was a punishment for other sports growing up, we had to do laps. Oftentimes it had to do with pre-season conditioning. And if you're coming off the summer and like, you like me in high school, the first couple of years, you didn't do your homework over the summer. So you show up and you're, you know, you're out of shape and you're doing laps and it's hot. I remember that in football practice as an eighth grader, just being like miserable and like running was, was, was terrible, Speaker 1 (07:30): Especially in the Northeast when you've got the heat and the humidity and everything else. Yeah. Speaker 2 (07:34): So or they, you know, it was a gym class and they had it, they know the presidential fitness test and they had to do a time tomorrow on a terrible thing. But like, I was actually good at that because I liked running ahead at like an early traction to running. And I was doing pretty well at it, but for the most people, it was not fun. And it was just an awful experience. So whether they come to they're new to running in their adult life, or they were even if they were faster and fitter and did other sports as a, as a youngster that maybe they took 10, 20 years off based on whatever. And now they're getting back to it. And they're really the mental block of, Oh, I'm not a runner and maybe I shouldn't do this. And you know, and that is really oftentimes getting people to accept that they, that they're falsely claiming that they're not a runner when they're really just, I always say, everyone's a runner. Speaker 2 (08:22): Some people just choose not to run or they don't know how to start. So I really enjoyed that process of getting people over that mental hump, if it exists of, Hey, you're a runner I want to find out where you're at, and then we're going to take you from there to where you want to go. And you need to know where you are before, you know, where you're going. And so it's really like, I think oftentimes changing their mindset and saying, it's okay to run 10 minute miles or 12 minute miles or seven minute miles. I don't care. I like numbers and data when I'm crunching numbers about your training and maybe how you paced properly or improperly. So I'll get geeky about that. But I don't really care. I, I coach someone who runs 15 minute miles the same as I would someone coaching seven minute miles. Speaker 2 (09:01): And so it's just the mental space that they're in of, Oh, I shouldn't be here. I don't belong. I'm not really doing it right. And oftentimes they'll say, Oh, I'm not running is not for me. I get this all the time. I can't run more than a block. And I'm always like, well, what block you running up? Is it uphill at altitude when you're carrying a backpack of weights? Because probably most people could run a block and they're just running too fast. And they think of running as being painful. So that has to hurt. But to be honest, most of my training, especially for like a marathon, for example, I have a lot of first-time marathoners and most of the running is actually easy. Pace. Marathon pace is actually quite easy. It's just hard to do for 26 miles. So the barrier of like not pacing yourself or not going out too fast for a couple of minutes where they have to stop, those are quick fixes in my opinion. And that's the mental side of things. And then there's a couple of common physical issues that come up, which I can talk about for sure as well. Speaker 1 (09:54): Yeah. I know. I love the, that sort of mental barriers, because I think if we're talking about new, new to new to running folks or folks who maybe took a year, five years, 10 years off, and they're coming back to it, like you start and you think to yourself, God, it's taking me 15 minutes to run a mile. I feel like such a loser, everyone else, like, cause you hear Oh, eight minute mile, seven minute miles. Like that's where you should quote unquote, should be. If you want to run a marathon, you don't want to be running for seven hours. This is, you know what I mean? And, and I think that that's, that can be really difficult for people and kind of turn them off before they even start. So what kind of techniques do you have for someone like that who's coming to you saying, I feel like such a loser. I can only run a 15 minute mile or 18 minute mile, whatever it is. Speaker 2 (10:48): Yeah. I think I also encourage people to have a running log or a diary, which is an extra step, but it also helps you get progress. It also helps you with injury prevention and to deal with injuries when you do have them, which I'm sure we'll get into, but I often buy I'll run by minutes. So it's like today you're doing 20 minute run versus a three mile run or a five miles. So they don't honestly know how many now, if they have a GPS watch and they're tracking things, they'll know after the fact that, Oh, that was the 13 minute mile or whatever, but I'll run by minutes. So you don't, you know, and then that, I think sometimes it's a different mindset or a way of tracking where it does free you up a little bit of not having to do the three miles in 30 minutes. Speaker 2 (11:23): That's easy math. That's only 10 minutes or whatever it is. You just run for 20 minutes or whatever it is, 30 minutes, 40 minutes. And even when you get in your longer runs for longer distances, you're, you're, you're increasing by five or 10 minutes, not a full mile. Sometimes I liked that worked and that's kind of how I'd run anyway. I'll just do a 30 minute shakeout run or something and I'm not right. Especially if it's not a workout, it's a workout quality day where I'm doing six times 800 or I'm doing something like that. It'll, it'll be more important to know the pace and effort, but most of the running, just getting out there and doing it. Yeah. Speaker 1 (11:55): So it's like, you, you can accomplish that 20 minutes. You get that win and you gradually build your confidence, right? Yeah. No, that makes perfect sense. I really liked that. And I also like keeping a running log or a running diary. It's the same thing. We tell people if they want to lose weight, one of the, almost every nutritionist or dietician will tell you to keep a food diary. I do that with patients with chronic pain, I'll have them keep a pain diary so that they can kind of keep track of maybe what they did and what their pain levels were and things like that. So it doesn't work for everyone, but I think it works. Speaker 2 (12:28): I have a quick story about that when I was just just first year as a professional runner, I had all these shin problems. I got down to DC and I felt like this kind of like loser, cause everyone was just professional runners. They're all qualifying for the Olympics and trying to qualify for the Olympics. And I had shin splints. So I was like running 20 minutes by myself and I couldn't work out. And I was seeing like a, you know, PT person and I was doing exercises and just seemed like I wasn't getting anywhere. It wasn't improving. And then the PT said, Hey, you should really just monitor your pain on a scale of one to 10. And obviously you have a left shin and a right shin and both were hurting me. So I thought that was really silly and kind of stupid as a, as a 22 year old. Speaker 2 (13:05): And but I started doing it cause I had nothing else. I wasn't running riding much of my youth log. Other than I ran 20 minutes. I didn't have to take me a long to write what I did cause it wasn't a lot. So I had stuff to write about and to be honest, you know, say I had a six out of 10 or seven out of 10 was the pain level. And then all of a sudden, as I was ranking it throughout the weeks I was doing these PT exercises and, you know, strength exercises. And I'm like, are these really working kind of going through the motions? But then I did realize like one week or so in the sixes were fives and the fives were four weeks. And so I w if I didn't have that to document, I wouldn't know, I wouldn't be able to see the trend of in the right direction. Speaker 2 (13:43): So then I got more excited and I was more diligent about the exercises and I did them correctly. It was more intention. And that was really helpful because I could see progress where if I didn't have that, I would just be like, Oh, my shins hurt and not, you know, see, you know, again from five to four and everyone has their own relative scale of that, but it's just for that each person. And so that, I always tell that story. It was, I thought it was really silly, did it anyway. And it really helped me kind of snap out of that mode where I was like, wow, that really I could see progress. And I wouldn't be able to do that without having the data or the, or the documentation that I have it writing it down. So I'm a big believer in that. And I really it's, it's fun to see that you're, you're doing that with your patients as well, because that's one way to, you know, this, you can't remember everything and it's, we're all busy. Speaker 2 (14:29): And so if you can write it down and go back to it, even if they don't see the trend that you look at their, their, their diary, they might not see. And they're not going to be able to remember all these things, but if you can like read through their notes, you oftentimes, the coach will we'll pick up stuff before the athlete. And that's just like being a detective. Oftentimes I'm a detective as a coach, try to piece together. And the more information we have as coaches or detective detectives, you can get the root of the problem quicker. So document everything, it's, it's kind of like old school, but I, I can't speak more highly about that because that's really a game changer for me as a young 22 year old, but even to my athletes today. Speaker 1 (15:09): Yeah. Awesome. And now you mentioned shin splints. So let's talk about it. One of the common complaints that you get from your runners are shin splints. So as a running coach, what do you do with that? Speaker 2 (15:21): Yeah, it's funny. I was thinking about this in prep for this. And I got the same similar injuries as an elite athlete, as I do now is like weekend warrior. You know, dad, Bob jogger you know, shin splints and, and that's, shit's meds are pretty common because someone who's new to the sport either they're doing nothing. And now all of a sudden they're running 10, 20 miles a week, or they're someone who maybe was jogging and then they're training for a marathon all of a sudden, and they're upping their volume. So it's usually just an overage, an overuse issue. It can lead to stress fractures and things, a little more serious, but for the most part, if you have a good pair of shoes, which is super important, you don't need a lot of equipment, although it is getting colder here in the Northeast, and you do need to layer up a little bit, but you really just need a good pair of shoes. Speaker 2 (16:04): So that's really important and making sure that you're not doing too much too soon, because if someone is not shepherded you know, they're worried about calling themselves a runner and they get excited. If for whatever reason they get into the New York city marathon through the lottery or something, it's very easy to get overexcited and do too much too soon. And then you're kind of sitting on the sidelines. So it's really just kind of, and then I think a lot of new runners or new athletes, it's tough for them to decipher between pain and injury or soreness being uncomfortable. It's a guy I got to run through it that could lead to like, well, actually that pain is telling you something to slow down or to back off. And sometimes it is kind of navigating through aches and pains that just come with doing something new and doing it more often. So that's something that's always tough to decipher first time through, like, if you've never had shin splints, you're like, what are they? Like? You can ignore them and they don't go away and they become bigger problems. So shin splints, plantar, fasciitis, Achilles issues muscle poles it band with junk currently dealing with now my knee. Those are just kind of the common things that any runner will get, whether you're a professional at being or someone just starting out. Speaker 1 (17:13): And what are your thoughts on cadence? So oftentimes we'll all read or I'll see that if sometimes if you up your cadence and shorten your stride length when you're running that it's beneficial for some of these injuries, what are your thoughts on that? Speaker 2 (17:32): Yeah, I think if there's a chronic issue that keeps reoccurring, I definitely will kind of look at that, but oftentimes, and actually this is a good kind of tip for someone who's new to running. They often want to me to see them run the first time and like fix their form. And if they're 45 years old, like I am, you've been running for 45 years a certain way, or maybe 44 years because you didn't run as a six month old. But and my son just took his first steps this week. So that's exciting, but it's, you know, you're gonna get you, I, if you gotta get chased by a dog, you're gonna run a certain way. And so you don't need to change something you've been doing drastically, unless it's a chronic issue. That's always happening. People often say there's a breathing. Speaker 2 (18:15): How do I breathe in through the nose, the mouth? I said, however, don't even think about it. It's when you have a side cramp, that's keeps reoccurring that I tell people to kind of pay attention to that. But for the most part, don't worry about your form. Don't worry, your breathing just kind of get out there. And if it's something where you want to pass the time and count your steps, or there's some GPS devices that help you count. I really just pay attention to that. If there's something that's reoccurring, because otherwise I feel like you've been doing something and creating all this muscle memory for all these years and to drastically change form. And I often I'll hear this a lot where, Oh, my doctor told me I should run on my toes. I'm a heel striker. Well, then I see people running on their tiptoes in the park. Speaker 2 (18:55): I'm like, what are you doing? I know you can't just go from that to that. Yeah. When you run faster, you're naturally up on your toes. There's obviously certain shoes will help facilitate that. But like this, a lot of fast runners that run up their heel strikers, you don't have to be a toe runner, but I, I hear that a lot where my doctor said, or my coach or someone said on my toes and I'm like, not like a ballerina. So those are things where I think if you hear someone say, do this or work on your form, I think there's things to work on, but it's it's not something we want to change overnight because that could lead to overcompensating. And just other issues that I think people may make you maybe worse off than you were with just kind of figuring out something else, but your current form. Speaker 2 (19:37): And you can always improve things with drills and stretching and flexibility, which obviously the the power pulse therapeutic strike massage is, has helped us do. And we do even in my mid forties where I'm spitting up and spending a couple minutes a day focusing on that. But you can't change things. Even if you're 25 years old, it's still a lot of muscle memory made it. So you can't change it overnight just to be patient with that. And don't worry about it until it's kind of a problem that you see a persist, you know? Totally. Speaker 1 (20:07): Yeah. And you mentioned shoe selection. So this is always a question that I get as a PT. I'm sure you get it all the time, multiple times a week or hundreds of times a season, what shoes should I get? What sneakers should I get? And everyone wants to know what brand, what this would that. So what is your response to, what shoe do I get? Do you get, do you have like some guidelines to follow or what do you tell your, your athletes and your runners? Speaker 2 (20:34): Yeah, that's, you're absolutely right. I get that a lot. And it's really, I always tell folks, there's like, you know, everyone knows they're running brands, you know, there's new balance, Nike, this Brooks, you know, they all Saccone Mizuno, Hoka is on. Elena is new on running as a new, at a new company out of Switzerland. All those shoes will have the gamut. They'll have super neutral shoes, neutral being like you don't, you have a high arch, you don't need a lot of support. They have kind of the middle of the road where you have some support, some cushion, then you have like, you know, the Brooks base, for example, it's called the Brooks beasts or the new balance nine nineties. They're, they're meant for heavy duty. You know, someone might have a flat foot. And so there's the whole gamut. So there's usually, there's a shoe that's in that line. Speaker 2 (21:24): That's going to work for you. And you might not know that. And I was people tell people to go to a running store if they can, because, and they get intimidated by the Wallace shoes and they go for the pretty ones, oftentimes, but every shoe brand will have the same kind of like kind of small, medium, large, or they'll have the categories of neutral cushion all the way to really support and really corrective shoes and some shoes that are going to fit certain feet better. You know, and I've done some brand work for my business where I'm affiliated with a certain brand and I have to wear those. I'm always hoping that I can wear those and they're going to keep me healthy. But even when I'm repping those brands, I'll say, I don't, you don't have to wear the shoe that I'm wearing, even though I'm getting paid by that company to do various things, the shoe companies should want you to be healthy because then you can run and do more and more. Speaker 2 (22:12): So you know what one or two shoes might brands might work better for your foot? And some shoes are just run bigger. Some run wider as far as the shoe brands, but if you'd like a certain brand, historically, that's what you will and others haven't. But try on a bunch, take notes, document how you feel in them, but that every, every shoe company will have something for you. It's just going into a shoe store or doing some research of asking questions. And I was people that always afraid to go into a running store. They're there for mainly for beginner runners, because once you're like me and you know what you like, you just, you can, you can either get it from the store or you order it online shoes. I it's, you know, and obviously if I work for the new brand, I need to kind of re if I have to familiarize myself with different options, but it's really, I can't tell you, I mean, I can look at your foot and kind of see, okay, you're have a wide foot, you have no arch. Speaker 2 (23:06): You probably need a supportive shoe, but that's not like a blanket thing. You know, you also look at the wear of people's shoes from previous shoes and you can see where they're wearing down and I'm a podiatrist. But again, back to being a detective, you can, if you can look at things and say, but even my neighbor, the other day was like, what shoes should I wear? I don't like these they're too squishy. I'm like, well, you probably need a little bit more support. They're probably not too soft for you. Sure enough. I gave him the middle of the road running and these are great. It's also probably, I don't know how old the ones he was wearing were. So that's another problem. You go to the running store, you try on something a, maybe you're wearing heels all day at work, and then you go and try this awesome shoe on it's fluffy, and it's great. Speaker 2 (23:45): Then you go home and run out on a couple of times. And it's like, ah, maybe this is rubbing me the wrong way. I'm getting a blister. And oftentimes there's also the sizing. If you're a size 10 dress shoe, you might be a 10 and a half running shoe. And I'm someone who actually is 10 and a half in dress shoe and running shoe. But some of my spikes and performance shoes like flats and more racing shoes made it might've been a 10 because you actually want them either. So those are some other things to kind of think about sizing. Speaker 1 (24:13): What is the, what is the running, the mileage that you put on your sneakers before it's recommended to change? Speaker 2 (24:21): Yeah. I think the industry says the two 50 to 500, which is a big range. So it also, it depends on how often you're running, what surfaces, if you're running on the treadmill every day, then obviously you're probably getting less wear and tear than if you're running on the trails, getting them all dirty and stuffing them up on rocks and stuff like that. So, I mean, I would say close to the, and sometimes people say, I'll just say you should get shoes depending how much you're running like two a year. If not more, if some people would wear the same shoes for three years, I'm like, you probably be, yeah. So you need to invest in that, put that on your, on your shopping lists for the holidays or whatever. But I mean, I'll, and I also do this where I don't wait for the one pair of shoes to kind of run out, especially if I, if I like a shoe and I'm especially to train for a marathon, I might be, I might have one pair of shoes for a couple of weeks. Speaker 2 (25:09): I'll get another pair of shoes and I'll start alternating them. Actually one gets cycled out because you kind of know, people often say, how do you know, well, your knees start hurting more. You shouldn't start hurting more and it's not an injury. It's just more of an achy soreness and that's usually stuff. And also I get much more motivated when I put new shoes on you kind of like, you're more anxious to get out there and you know, you do have to break them in sometimes depending on what type of shoe they are. And, you know, I would just jump in, in a marathon without breaking in those shoes. But I mean, I've heard, I would say two 50 or 300, I feel better about, but I've read and I've seen, you know, up to 400 to 500, which is a little higher than I liked, but depending on what type of running you are and how hard you are on the shoes and what surfaces you, you, you could last, but definitely I think, you know, more than one pair of shoes for sure for the year. Yeah. Speaker 1 (25:59): Great, great, excellent advice. And now before we start to kind of wrap things up, what I'd love to hear is maybe you have a new runner, right? Because the majority of people, like we said, let's be honest, are more recreation. Runners are not professional runners. They might be new to running, or they're running after a little bit of a break. So if you could give that runner who you've probably seen thousands of times what would your top three tips be for those new runners? Speaker 2 (26:34): I would say, give it have some patience. It's like, you know, again, even if your S your pace is too fast at first block and you're stopping, you know, I always said, like, it takes three or four weeks to kind of find a rhythm sometimes even longer. So just be patient slow down, make sure it's fun. Whether that's, you know, I love the running community here in New York. It's so vast. It's actually a card to keep track of all the things that are going on. And even if you're in a smaller city, it's usually like their local running store and there's, there's, you know, you go get a beer or coffee afterwards. It's a great community sport. Cause it's, there's a lot of, there's a lot less barriers involved in entering the sport and you can also be a Walker everyone's kind of invited to the party. Speaker 2 (27:13): So, so yeah, I would say, you know, give it time patients make it fun, make it community oriented. Although I do my best thinking and problem solving when I'm running by myself. So definitely, you know, you don't always have to make it about a group training, but that's something that I think it's a great way, appreciate and meet new people in a new city and then take care of yourself. I think don't ignore the things that bother you get good shoes. I mean, my number one, when people are injured, come to me, they often come to me almost too late where it's, so their pain is so bad and their Shannon or their knee, Speaker 1 (27:45): Then they're thinking I should get a coach. Like that's the impetus for them to get a coach. Speaker 2 (27:49): So you're like, you know, take care of yourself. And to be honest, this might be a good segue for what we're talking about, because my first line of defense is go see a massage therapist because massage throughout my running career is like, you know, you go to a doctor and they say, it hurts when I run, they're going to say, don't, don't run. It's like my mom said back in the day, mama hurts when I do this. Okay, don't do that. That's kind of, that's often, but some doctors will say like, Oh, that's bothering. You just don't do it. Well, we want to do it. We want to be active. We want to keep doing it. So taking care of yourself is really important. And there's a lot of little things like massage and stretching, eating, right. And all of these things that are small things that really add up to bigger gains. And it's, it's fun to, to improve at it. You know, I mean, I'm never going to run a PR again because I ran faster than my youth, but I have, I have to make up goals now, like fastest mile as a dad. You know, whatever. So if these are all things that I have to kind of reinvent to kind of give me the motivation to get out there, but the self hair, the self-care piece is super important and often neglected. Speaker 1 (28:52): Yeah. And that self care involves sleep, recovery, nutrition. I think the massage, and like I said earlier, we're both on the Waterpik water for wellness council. And one of the, a couple of things that they're, and again, power pulse, therapeutic strength, massage, shower, head a couple of things that they have actually been shown that clinically shown to provide, like to help soothe muscle tension, to increase flexibility and to improve restful sleep. So the way I look at it as a PT, and I'm sure you may say the same as a run coach. Like we like to keep the risk continuum a little bit more on the reward side and a little less on the risk. Right. So if you can recommend things for people that have less risk and more reward, great. And if you can recommend things to people that are economical. Great. And I think that that's where that the power pulse massage shower kind of comes in along with, like you said, seeing massage therapists one of the things that I'm so glad that you mentioned is about the community oriented part of running. Cause I think a lot of people think that if you're running, you're just running on your own. Speaker 2 (30:21): Right. And then that's been the biggest challenge for me. It's just my own running is I've actually, I've been running 60. I usually run five or six days a week and it's done a lot of mileage cause it's, you know, being a dad and, you know, jogging stroller and whatnot. But I was running the same amount of times per week, but I was running and say 30 miles a week. And then I was running like 20 and I'm like, how am I running less? You know, I have more time to one degree. And I wasn't like, I would actually often rely on, especially for longer runs is to go to prospect park, which is very well trafficked with runners. And I know a lot of runners, so I, I usually run into people. I know. And then we go, we can, we run a mile or two or add on, and I didn't have that because everyone was running alone or, and so I was like, Oh, I'm not getting that extra motivation or, Hey, Hey, Karen run into Karen and we do an extra three miles because we're talking way and catching up. Speaker 2 (31:07): And so that's something that the community piece to that my mileage is that definitely I mean, I since realized that and, and try to pay attention to doing a little bit more, but I'm like, how am I running last? I'm still running six days a week. And that was the number one thing that I was different was I didn't have the buddies and I was running by myself all the time and that you weren't casually running into people and adding on. So but yeah, I think, and everyone says, you can run with people. It's just doing it safely. Yeah. Certain protocols. So it's just, and some of that was new in the beginning. And so, but there's definitely been a second kind of volt. Second, third, fourth, depending on who you talked to like many running boom, because gyms were closed and other things, so you have less, you know, nature get outside, walk run. So I guess a lot of more questions from new runners, especially neighbors because they're out there running and they knew, Oh, this guy runs on the block all the time and he must know something and all the questions that we went over already getting those. So it's you know, as far as silver linings to some of this stuff, that's going on. Speaker 1 (32:08): And now before we finish, I have one last question for you. And it's when I ask all of my guests. So knowing where you are now in your life and in your career, what advice would you give to your younger self? So maybe that 20 year old at the Olympic trials in 1996, what advice would you give to that kid? Speaker 2 (32:30): Yeah, well, I mean, back then running, talk about love. Hey, like it was so nerve wracking once I got the certain levels. And even that I ran the 800 meters, which is arguably one of the toughest events in track and field, they say the 400 hurdles experts today, the 400 hurdles and the 800 meters are the toughest. I think the 10,000 meters on the track is twenty-five laps. That that's hard puzzle to me because the hard I can't do it to cath on and heptathlon is all these different things. I think those are harder, but as far as the body and the body makeup that that event is kind of in between speed and endurance. And so but it, it just was so nerve wracking at the, at, when I got to that age, in that level, that running was and if I was running well and healthy, the world is great, but there was times where running was not so fun and I was sick or I was injured. Speaker 2 (33:21): And so I guess I would probably say, you know, it's tough to say, don't take yourself too seriously because I was training for the Olympics and it's really scary, really focused. But and actually, I, I, once I stopped competing, I actually took on a couple of years off where I don't even know how much I was running maybe once a week. And I definitely got out of the Cape. And I think when I was like maybe mid to early thirties, I got reengaged that there was a local team that needed some people to run for. And I kind of said, all right, I'll help out. And then I was kind of needed again, it felt somewhat relevant, but then the community of that as well, the peer pressure in a positive way got me into the fold. And I actually got, was able to get pretty fit again in my mid thirties. Speaker 2 (33:58): But it was one of those things where I did it to be really good. And then once that was no longer the goal, it was like, why do it, and sort of, it's a little bit of a gap there that, you know, probably mentally and physically, it was good to have because, you know, I get healthy and kind of cleared my head a little bit, but I wish I didn't take that long of a gap because there was only one reason to do it was to get fast, to win races, to make limpic teams. And as we all know now, and I know now is there's many reasons to run released best, you know, be competitive with yourself, you know, have be part of a community. See nature. Even though I started one of these things recently where I took a bunch of runners to to Ireland and I called it a run location and we spent four days and you actually can explore a lot of people. Speaker 2 (34:40): I coach where they're training for the marathon, we'll say, Oh, I can't, I can't run these two weeks. I'm going to be on vacation. I'm like, well, tell me more about this vacation. And it turns out that, like I had someone run on a cruise ship once and they actually sent me their GP. I'm like, there's probably a track on the, on the cruise trip. It's probably not that exciting, but don't say you have to take two weeks off. I would kind of like a little tough love there. And someone, I think of some woman sent me, she was going across the Atlantic to like Norway and her GPS was over the water, three 30 pace per mile. And it said she ran like 50 miles would showing around like 10. Oh. Because she was more like, not trying to get out of running. She was just like, Oh, I have to, I'm on vacation. Speaker 2 (35:19): I can't run. And I was like, you can make it a part of your everyday, regardless of where you go and you often can see more on foot then. So it's one of these things that would just I don't know, you can make it part of your life or it's not such this arduous thing and horrible thing. It, most of the time it could be pretty pleasant and fun. And I mean, I don't, I don't knock myself too much for being so serious about it, but I wish I didn't. I let myself off the hook a little bit and when I was younger and enjoyed it more and didn't take it so seriously all the time, even though there's reasons for that. Speaker 1 (35:50): Yeah. Oh, I think that's great. I think that's great advice to your younger self and John, where can people find you? What's your website? Where are you on social media? How can they get in touch? If they have questions they want to work with you, they want to learn more about Speaker 2 (36:02): The programs you have. Yeah. My, of a website is run camp and that's R U N K a M P. And I'm spelling incorrectly because my last name is Hunter camp with a K. Yeah. So nice play on words. Yeah. So run camp, you know, and you know, it's all things running, whether a training for a race or just getting fit or travel in this case, once we can travel again. And then my Facebook and Instagram is just John Hunter camp. My name's spelled so you can find me that way. And then email me a john@runcamp.com. If you have any questions, you, you know, you want to get ahold of me for any reason, I'd be happy to chat and help you through your training journey as, as you see fit. And as, as, as you see necessary. Speaker 1 (36:41): Perfect. And of course we will have the links to everything at the podcast and the show notes for this episode at podcast at healthy, wealthy, smart.com. So, John, thanks so much for giving us a little bit of your time today. I really appreciate it. Speaker 2 (36:57): Thanks for having me. It's a pleasure to join. You're happy to do this again and stay in touch even though we're so close so far. Speaker 1 (37:03): I know, I know just over the Brooklyn bridge but thanks so much for coming on and everyone else. Thanks so much for tuning in, have a great couple of days and stay healthy, wealthy and smart.  

In this episode, Dr. Steffan Griffin talks about his research into ‘Rugby Union, and Health and Wellbeing.’ Dr. Steffan Griffin is a junior doctor based in London, pursuing a career in Sport and Exercise Medicine. He is a Sports Medicine Training Fellow at the Rugby Football Union, deputy editor at the BJSM, and a part-time Ph.D. student at the University of Edinburgh, where he is researching the topic of ‘rugby union, and health and wellbeing’. Steffan also works clinically with a range of elite sports teams including Chelsea Football Club, and London Irish Rugby Football Club. Today, we learn about the different forms of rugby, and Steffan elaborates on the findings of his research regarding the health and wellbeing benefits associated with playing rugby. What does the review mean to those who are interested in gaining the health benefits from rugby? How does this review affect policymakers? What does the review mean for researchers? Steffan tells us about the common misconceptions surrounding rugby, and how his research aims to change that, and he gives his younger self some advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways  “There are 10 million people playing the game rugby, and they don’t play this blind to the fact that there are risks associated with ” The different forms of rugby: Contact Rugby: It’s the “collision game” that you typically see when tuning in on a Saturday afternoon. Touch Rugby: It’s a glorified version of “tag” with a ball. Tag Rugby: Players wear a belt with Velcro strips, and a tackle is when players manage to grab one of those Velcro tags. Wheelchair Rugby: Nicknamed “Murderball”. “Our research found that all forms of rugby can provide health-enhancing moderate- to-vigorous intensity physical ” “Symptoms of common mental disorders were higher in professional players compared to general ” “People are well aware; rugby compared to other sports has a higher injury ”   “What the review isn’t doing is saying that everybody in the world should play rugby… It provides an objective piece of work that can help people make a decision based on evidence and not on emotion and ” “We need to try and move away from just looking at studies where all the participants are white middle class ” “One of the potential conclusions that a reader could get from this study is that non- contact rugby is the holy grail of rugby, but actually there aren’t any level 1 studies looking at the injury risk of ” More About Dr. Griffin: Dr Steffan Griffin is a junior doctor based in London, pursuing a career in Sport and Exercise Medicine. He is a Sports Medicine Training Fellow at the Rugby Football Union, deputy editor at the BJSM, and also a part-time PhD student at the University of Edinburgh, where he is researching the topic of ‘rugby union, and health and wellbeing’.  Steffan also works clinically with a range of elite sports teams including Chelsea Football Club, and London Irish Rugby Football Club.  Suggested Keywords  Rugby, Health, Wellbeing, Injury, Research, Review, Benefits, Risks, Sport, Policies, Union, Activity, To learn more, follow Dr. Griffin at:  Website:          Rugby, Health and Wellbeing Twitter:          @SteffanGriffin Review:           https://bjsm.bmj.com/content/early/2020/11/23/bjsports-2020-102085 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 here: Speaker 1 (00:00): Hey, Steffan, welcome to the podcast. I'm happy to have you on Speaker 2 (00:04): Thank you very much for the invitation, Karen. So it's a real privilege to have been asked to come on and to have a good chat with you. Speaker 1 (00:11): Yes. And for those of you who may think to yourself, God, this voice sounds familiar it's because Stephan is the host of many, many podcasts for BJSM. So if you have the chance definitely, and you haven't listened to BJSM podcast, definitely go over and listen to all of them because they're all really wonderful. So but this is your first time on the other side, which I find hard to believe Speaker 2 (00:36): It is. Yeah, absolutely. As you said, it's something I've been doing for a few years for the journal now and yeah, it's the, it's very strange to be on the other side of the podcast. So I'm a different set of nerves. I'm really looking forward to it. Speaker 1 (00:49): Great. Well, thank you so much. And today we're going to talk about a recent review that was published in the British journal of sports medicine, the relationship between rugby union and health and wellbeing, which was a scoping review with you and also our good friend Nim but amongst other wonderful authors, but let's start out with the basic why behind this review. Speaker 2 (01:19): Yeah, sure. And I think that the main, why about this is that it was just, it's just a completely unexplored area. So I'm sure that, you know, for people in America, maybe their perception of room B probably comes from our friends at absurd with Ross, where I think he comes out pretty battered and bruised. And actually that's actually not too dissimilar to a lot of the perceptions in the, in the kind of the health and the sports science, sports medicine research landscape. We know about rugby's relationships with injuries and concussions. They're highly publicized and probably rugby is a victim of its own success in that because it's leading on player welfare and it's, you know, really pushing the boundaries in terms of trying to make it as safe a game as possible. Everyone's very aware of of the injury injurious nature of forgetting. Speaker 2 (02:12): But what I think for me personally, I've, I'm, I'm Welsh by birth. So I brought up on rugby and, you know, there are 10 million people playing the game of rugby and they don't play this blind to the fact that there are risks associated with it. So we know people know there are benefits to it, but looking at the actual scientific literature, there's nothing really providing a big picture overview of some of that, the health and wellbeing benefits associated with the sport. And really as we know, to make an informed decision about anything in life, be that sport, be that buying a car, for instance, people need to know the, the data surrounding the risks and the benefits, and, you know, we had a lot of the former so what we, what this really has been as aimed to do is provide, you know, some, some evidence not just emotion around some of the benefits associated with the sport. So really is a piece that hopefully prides balance to that, to the wider picture now. Speaker 1 (03:17): And what did, what did the review find? So what were those benefits to health and wellbeing? Speaker 2 (03:23): Yeah, sure. And before we jumped on the call, we kind of discussed the different types of members. So I'll probably just spend a tiny bit of time just covering and providing a tiny bit of context. So what we wanted to do is rugby, as we've mentioned, the friends app. So there is the contact form of rugby union, which is, you know, this collision gamers, if you're tuning in on a Saturday afternoon, typically here, especially in well-established rugby countries like England, like New Zealand, and it is growing in the U S and over in Canada as well, you know, that's the contact forms of the game, and there are other forms of rugby. So there's, non-contact rugby such as touch rugby, which is basically a glorified version of, of the game tag with a ball involved. And there's also something called tag rugby, which generally people wear a belt with the Velcro strips and tackle is where you manage to grab one of those Velcro type tags off. Speaker 2 (04:17): The other form of rugby then that we looked at was wheelchair rugby, which is I think given the lovely nickname of Murderball. But actually we want to, so you may have some of the listeners may have heard admirable being referenced and there are some wonderful documentaries on Netflix, you know, that really provide a good insight into the game. So basically by breaking it down to the type of rugby, we then wanted to break it down further. So people who read the review could really look to see exactly where the benefits lay. So if we kind of look at it from and I'll split it into, into some themes that some listeners might be might be familiar with. So as we know a big, I mean the world health organization, physical activity guidelines came out yesterday. So if we look at physical activity, so we know this is a huge global health priority at the moment, and our research found that all forms of rugby be that contact be that non-contact and wheelchair rugby can provide health enhancing, moderate to vigorous intensity physical activity, which, which really wasn't well known before. Speaker 2 (05:27): And then now it puts, it allows people like governing bodies and policy makers to align the sport of rugby with some of those global health priorities. As, as we all know, as practitioners, as practitioners, that muscle strengthening balance coordination and huge parts of these physical activity guidelines. And although we didn't find any studies that really look, look at that, per se, we found that lots of national population surveys, which are really based on expert consensus, consider rugby and all sports such as rugby to provide some of these benefits as well. So again, that was a kind of a landmark finding of this study in terms of the, we then looked at different kinds of health benefits. So we, first of all, wanted to look at physical health and we stratified by that by different domains. So for instance, cardiovascular health, respiratory health, musculoskeletal health, probably the best way to summarize this is non-contact rugby and wheelchair rugby have very supportive research kind of around that, you know, that rugby can provide quite significant physical health benefits into the contact drug B, which is kind of the traditional form of the game. Speaker 2 (06:43): There's a real mix there, lots of mixed studies and also just a lot of conflicting findings as well. Although a lot of the studies that look at that, you know, look to control for things like age you know, some of the demographic variables did show some supportive data that is conflicted by some other studies. And you know, what we couldn't do as part of this scoping review was really delve into the pros and cons of each of those individual studies. So in terms of, in terms of contact rugby, slightly more mixed findings in terms of physical health mental health and kind of wellbeing. So psychosocial measures such as quality of life and things, again, non-contact rugby or wheelchair rugby, rugby can provide a real wide raft of of mental health and wellbeing benefits. And most of the research in the contact game was, was, was focused on professional athletes and that fans that have symptoms of common mental disorders were higher and in professional players compared to general population though that is, you know, similar actually to professional athletes in other sports, such as football and things. Speaker 2 (07:58): And then the last thing is, as we've discussed right at the very top was the injuries associated with the game because we were very aware of is that it wouldn't be all well and good. That's just providing the health benefits, but also, you know, we didn't, we, although we didn't have the capacity to look at every single injury study to do with rugby relate to all the systematic reviews and Metro analyses around this. And as people are very, Oh, well aware, rugby compared to other sports has the higher injury profile and especially around concussion and things. So, so yeah, so sorry, that answer probably a bit tiny bit longer, but just to kind of try and break it down a little bit you know, in terms of the different types of rugby and then the various kind of health domains. Speaker 1 (08:38): Yeah. No, that was great. So let's break it down even further now. So let's say I am a player, or I'm a parent of a child who we want them to have these benefits of physical activity. And if rugby is something that maybe we're looking at to accomplish that what does this review mean to that parent or to that player? Speaker 2 (09:08): Yeah, sure. So, I mean, six months ago, if you, I mean, if I was a, if I was a, if I was a parent, you know, I was thinking about, you know, do I want my kids to play rugby, then I probably would have done, you know, Google search health and wellbeing rugby. And the vast majority would have been around purely to do with, you know, concussion injuries and not letting my kids anywhere near this kind of sport. Although, you know, rugby unions and, and people know there are loads of testimonials. As I said, at the top of the podcast, there are 10 million people playing rugby. They ha there has to be a benefit. It's just probably the scientists a bit slow to catch up. People can, kids players can reach all their physical activity guidelines and tick that box by playing any form of rugby. Speaker 2 (09:51): And then it's about individual perception of risks and benefit as to what kinds of rugby they want to play. So for instance, you might have, I might have, I might have a child for me. I don't know that, you know, the research says that participants in contact rugby, they say they, they there's Reese qualitative research really supporting the fact that it could provide a lot of psychosocial benefits that instills lots of confidence in people that builds teamwork. And people will say that they feel stronger by doing it and that's across across women, across youth players, across adult players. But also at the same time, you know, I think what there isn't doing is saying that everybody in the world should play rugby. It's providing people with the, with kind of a, some objective data so that, you know, someone else might come along and say, okay, we want our kids to be getting know taking all the physical activity boxes. Speaker 2 (10:43): Cause we know that it reduces the incidence of diabetes, heart disease. We know it provides X amount of benefits, but for me, the injurious side of it means that I don't want my kids or I don't want to expose myself to that risk. So what I'm going to do is look for a non-contact form. And I'll, I'll try and get and get, you know, reap the benefits by, by going down that route. So yeah, we hope that it provides an objective piece of work that can just help people make a decision based on, on evidence and not just pure kind of emotion and headlines, Speaker 1 (11:19): How novel, especially in this day and age now let's go, let's move on to what does this mean for the researcher? Speaker 2 (11:29): Yeah, she also, I mean, we, we found offset strategy. We found six Oh six and a half thousand studies of which we included 200 studies. And, you know, as, as I can, as I kind of said, like having broken it down into different forms of rugby in different healthcare domains there are some huge research gaps. So for the research right there, you know, we've identified we've identified a lot of research gaps that really, you know, there are some real low hanging fruit there that could really help them inform, help inform decisions further and provide more evidence in these areas. So for instance, I think there's a real pressing need to, first of all, look at populations outside of just the white, 70 kg male playing player. So we know that I think women's rugby had a growth from 2018 to 19. Speaker 2 (12:24): Excuse me, if the, if the exact percentage is off, I think it was that 28% increase in participation and it's growing in, in areas such as Asia, especially. And, you know, we, we, we need to try and move away from just looking at looking at participants and looking at studies that look at the benefits or look at, you know, studies where all the participants are, as I said, kind of white middle-class males, that's one big thing. And looking then at, you know, we do need to do more research. We need to, we need to try and quantify how rugby integrates with the physical activity guidelines even further. We need to be looking at more you know, how rugby interacts with various health and wellbeing outcomes you know, across more diverse populations, as I said. But also then I think, you know, I think one of the potential conclusions that really could get from this study is that non-contact rugby is, you know, the Holy grail now with rugby, but actually no, there aren't any kind of level one studies looking at the injury risk of that. So, you know, there are a ton of research areas that we've identified that that are going to be really important moving forward to allow people to make fully informed decisions. Speaker 1 (13:39): Excellent. And then moving on, how does this review then affect policymakers? You touched on it a little bit earlier and also international federations. Speaker 2 (13:53): Yeah, sure. So again, I've been very fortunate to have to work NAFA 18 months with the rugby football union, which is the essential England's national governing body for rugby. And two of the medical services director and the head of medical research that Simon Kemp and Keith Stokes to, to they for part of the scientific committee of the, of the PhD and their co-authors of the study. So we what's been great at doing this research and doing this PhD is that we're trying to answer questions that we know are relevant to governing bodies and to policy makers. So for governing bodies, for instance, you know, we're now able to provide the English from BMC, the RFU the likes of world rugby. Who've been really receptive to this kind of research with again, objective health objective scientific data that allows them to align the game with some of the current global health priorities, you know, be that physical activity or be that, you know, that we know physical activity levels are down because of COVID and because of lockdowns and you're could the sports such as rugby, such as football, tennis play a role in actually getting, you know, increasing health globally and then says as a policy makers, again, it's it provides because, you know, we know that sports such as rope in your needs, look at football or soccer. Speaker 2 (15:12): Now, you know, there's such a huge debater on head injuries and things, and these are, there's a sense that sensationalized to a certain degree, but they're also brought up in pretty in high places, you know, and government level. And, you know, what I'm hoping that this kind of research does is it provides, you know, a big picture for them to see and to look at it and say, well, actually, you know, we can promote rugby before. You know, whether it be that to kids, we can, you know, we need to make sure that rugby is a it's the welcoming environment for all types of all types of people and, you know, across society, because we know that it could provide people with lots of benefits and yes, we know that it might be more injurious relative, but, you know, as long as we put pressure on rugby to keep on making it as safe as possible, and that's where it's great, you know, that we're dropping all these governing bodies have player welfare as they're kind of strap by the number one priority, but it just provides a, you know, a broad picture that people government bodies and policy makers, like you said, can start to actually, you know, start promote things and to provide you filter that down to individuals and groups. Speaker 1 (16:22): Yeah. I think that's wonderful. And I love the thing that I really liked about this review. And we sort of spoke about it before we went on the air is I love that you included wheelchair rugby. I did not know that was murder ball, but now that I, now I'm like, Oh, okay. Yes, I get that. But I thought that was really important to include that because there are a lot of people in, across all countries who are wheelchair bound or who maybe cannot participate fully in, you know non-contact or contact rugby. And to include this, I thought was, was really, really great. And it, even in the wheelchair, rugby still had all of these physical, it's still taking the physical activity boxes, right. And still increasing muscle mass and improving cardiovascular and mental health and that feeling of a team. And so I thought that was really great. And to me, the non-contact rugby seems like a much much more forgiving game for people who are like, I would never do rugby. Cause I would like literally be in, you know, laid out for days or something like that because it looks so intimidating. Speaker 2 (17:38): Yeah, absolutely. And actually that's a lot of what you just mentioned, actually, it's pretty much going to be our next steps in terms of what we, what we do, because what we don't want to do is we don't want to set up in awards in like a research ivory tower and say, this is our research now go forth and do what you want to there. We really now want to see how people perceive our research. And I think rugby and rugby also wants to know what, so there's no point us, one of the, you know, one of the main points of the resets being, you know, playing rugby, which is your contact, rugby is good for you. Therefore everybody should do it because we need, what isn't known at the moment is how different population groups might perceive those risks. So for instance, if, for instance, you know, if someone's never played the game before, you know, is the fact that there are only really contact versions of the game available locally, is that a huge barrier to them then getting involved? Speaker 2 (18:36): So, so I think, yeah, you've touched nicely upon, you know, some of the real practical key issues there. And that's really what we want to be going into next is kind of being able to now piece together and also pretty much providing a toolkit to not just participants, but to governing bodies that says, you know, if you want more people involved, this is what matters at the, at the coalface and this is what you need to be providing. So no, you're, yeah, you're completely right. Because, you know, look watching, you know, watching 20 stone, you know, 250 pound blokes run into each other on a Saturday sometimes quite hard to think, how am I going to get from the sofa to that? Yeah. Speaker 1 (19:13): You can't even, you can't even picture it. You can't even imagine. Imagine it because it looks so scary. You know, and even as let's say, as a woman, if I were interested in playing, I wouldn't even know where to start. Right. So this research eVic, and I'm sure there's places I'm in New York city, there's gotta be rugby clubs and things like that, but I wouldn't even know where to start. And so I feel like this might spark some curiosity among people to say, Hey, listen, I can't do the contact. I just can't do it nor do I want to do it, but Oh, I didn't even realize there was a non-contact option. Or if you're wheelchair bound, gosh, I didn't even realize that this is something that I can do so great parts of the research. Speaker 2 (19:59): Oh, thank you. Yeah. and yeah. And just to kinda touch on you at the wheelchair, every point. Yeah. We were, we wanted to make this as big picture, as inclusive as possible. And that was one of the real, almost surprising things that the, that the evidence of, you know, of benefits associated with wheelchair rugby were so significant and so wide ranging. It was yeah. A really pleasant surprise. And the population group that isn't as well studied, you know, as we know. Speaker 1 (20:25): Excellent. All right. So before we start to wrap things up here, what do you want the listeners to take away from this discussion and also from this, from this research article, from this broad scoping research? Speaker 2 (20:38): Yeah, sure. I mean, I think some of it is, is probably a bit broad in that, you know, trying to, you know, we, so, so for when, so for instance, in my role with in revenue, we're looking at how to reduce concussion. We're looking at exactly, you know, nailing down what the incidence is kind of across various playing groups. You know, and that is the kind of thing that generates headlines in terms of you know, cause it, well, it's actually, as soon as something's published, it's now concussion rates up down the same for X consecutive year. That it's, it's, it's a, it's a common thing. Whereas hopefully what this does, it just provides the people. If people are aware that this now exists and there's this research going on, that they can touch base with either the paper with the website kind of with with any of our kinds of sites, social media platforms as well. Speaker 2 (21:32): I can just see what that, you know, if I do know someone, if I know a parent's a play, who's looking into it, this is actually, you know, this is where I'd go to make to be able to make a fully informed decision. So yeah, we're not, you know, the, the point of the research wasn't to show that rugby, you know, is this all singing, all dancing, wonderful sport you know, we're, it's always sunshine and rainbows just by the fact that for some people, it, it really is. But you know, it's just, it's just something that can provide, you know, as you, as you said, what sometimes feels like a bit of a novelty at the moment, just an objective overview, so people can make fully informed decisions. Speaker 1 (22:11): Excellent. And before we end, I'm going to ask you the question I ask everyone, sorry, I didn't bring this up to you earlier, but surprise now. So knowing where you are now in your life and in your career, what advice would you give to your younger self? Speaker 2 (22:27): I think just, just keep going, just keep doing what you're doing head down and hopefully everything so far, it all ends up working out. Yeah, just work hard and keep going. Speaker 1 (22:40): Excellent. Excellent advice. And now where can people find you social media websites, et cetera? Speaker 2 (22:49): Yeah, sure. So I'm probably I'm most active, especially from a kind of a professional research point of view on Twitter. So is that Stefan Griffin with Welsh spelling? So it's too, otherwise I'm not would kill me. Yeah. And then there's a website www.rugby, health and wellbeing dot com and, and yeah, and, and as, as you, as you've mentioned at the start, we publish the scope review and the question was sports medicine. So it's very easy to find to find the scrap from view on there as well. So, yeah. And if anyone has any questions and you, you know, once access to the PDF or anything, so unfortunately it is behind a paywall, then I'm obviously more than happy to provide all of that. Speaker 1 (23:30): Awesome. And we will have all of this information at podcast dot healthy, wealthy, smart.com under the show notes. Thank you so much stuff for coming on. This was great. Lovely to catch up, lovely to see you and congratulations on a great article. Speaker 2 (23:45): Thank you very much, Karen. It's lovely to know to chat to you and that's here. Everything's going well. Speaker 1 (23:49): And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, Founder of Working Simply, Inc., Carson Tate, talks about making any job your dream job. Carson has a BA in Psychology from Washington and Lee University. She also holds a Master’s in Organization Development and received her Coaching Certificate at the McColl School of Business at Queens University. She has 15 years of experience working with organizations across the globe, helping them each to improve employee engagement, productivity, and efficacy. Carson is the best-selling author of “Own it. Love it. Make it Work”, a sought after public speaker, as well as a staunch advocate for fair and flexible workplace practices. Her Productivity Style Assessment featured in the 2017 Guide to Being More Productive by Harvard Business Review. Today, we learn about the 5 areas that we need to explore in order to make our current job the best job, and Carson gives us 3 ways to identify our strengths. She tells us about her Abilities Opportunity Map, and provides the tools to avoid the “inevitable burnout”. Carson gives us the template we need to say “no”, we hear about the 15-Minute List and the importance of “protecting your 90”, and she gives some advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways  “Any job can be your dream job because you define the dream.” You’re in a job – how do you make it the best job? Carson has identified 5 areas that we need to explore: Recognition and reward, Strengths, Relationships, Recognition and Reward – What kind of recognition and reward do you need? “I’m talking about praise and acknowledgement.” We’re all human beings, and we really need to be seen for our work. Strengths – What are those things that you do almost at near perfection? “You can’t not do them. Even on your day off you might try to do them… The reason they’re so important is because this is what you bring to the relationship with your employer.” Relationships – Having real, authentic relationships at work is essential, not only for performance, but to be happy, fulfilled, and engaged. Development – This is about owning your own professional development. Meaning, Purpose, and Joy – Meaning is not defined by what happens to you; it’s your interpretation of the events in your life. “Every job has significance. Every job is meaningful. It’s up to you to figure out what that meaning is.” There are 3 ways to find and identify our strengths: Reflection, Performance Reviews, and Highlighting Successful Tasks.   “The relationship with your employer is a relationship, and any relationship is based on social exchange theory – both parties bring to the relationship and both parties receive. In a relationship that’s healthy, both parties work towards mutually-beneficial goals.” “When we are working from our strengths, the work is easier, there’s less effort but greater impact, more joy, and more flow.” “Even at the end of the darkest week, you can pull back and find a source of hope for the meaning.” “Every time you say no to something, you’re saying yes to something else.” “Clarity creates opportunity. Doing the work to identify what your dream job looks like opens up infinite possibilities for you in your current job and in future jobs.” “In play, that’s where you’re going to find those brilliant insights and connections, and the juice to not be burnt out. The one reason we get burnt out is we don’t play; we just work all the time.”    More about Carson  Carson Tate believes that work can be the full expression of who we are – the vehicle that takes us to a place where we reach the full potential of our greatness. As a visionary in the field of personal productivity and organizational excellence, Carson uses practical advice and empathetic training to guide and support her clients, helping them shine more brightly than they ever imagined possible.  A best-selling author, teacher and coach, for 15 years Carson has worked with organizations of all sizes around the world to help them improve the engagement of their employees, the productivity of their workforces, and the efficacy of their leadership. It is her mission to change how and why we work so that we can each make a greater impact on our own lives, on our communities, and on the world at large.  Central to Carson’s vision is her belief that when we do work that matters to us, it leads to greater success and wealth. It becomes the foundation of a harmonious life where we have the time, space, mental clarity, physical well being, and emotional energy to take care of ourselves and others.  Carson Tate is also the founder of Working Simply, Inc. where she equips organizations with tools, strategies, information and insights that inspire employees and leaders to use their gifts and talents to build their legacies.  Carson’s signature courses include: Mobilize Your Inbox: How email can work for you. Work Well With Others: Find joy in teamwork.  Work Smarter, Not Harder: Get up close & personal with work. The WORKshop: How To Work Simply and Live Fully. Carson Tate Masterclass: Own it. Love it. Make it Work.  A prolific public speaker, Carson teaches audiences how to identify what success looks like from a personal and professional vantage point; how to move beyond the way we’re working today, into a new world of productivity and accomplishment; and how to “own it, love it, make it work” by breathing life and inspiration into work.  Carson is a staunch advocate and champion for fair and flexible workplace practices that create healthy, nurturing environments for workers everywhere. Her goal is to shift the focus from output to impact – our value as workers is meant to be measured by our contribution.   There’s nothing Carson loves more than connecting with people. In her uplifting and empowering courses, one-on-one coaching, speeches and workshops, Carson shares surprising ideas and insights that clients and audiences can immediately apply to create fulfilling lives that align with their values and priorities. She inspires people to craft a future for themselves in which their work plays a joyful role. Above all, Carson believes that work is where your mission meets your spirit.   Book Mention Own It. Love It. Make It Work: How to Make Any Job Your Dream Job, by Carson Tate Suggested Keywords  Productivity, Job, Work, Career, Burnout, Strengths, Relationships, Meaning, Opportunity, Possibility, Play, Recognition, Reward, Purpose, Reflection, To learn more, follow Carson at:  Website: https://carsontate.com https://www.workingsimply.com Facebook: @thecarsontate Instagram:  @thecarsontate Twitter:   @thecarsontate LinkedIn:  https://www.linkedin.com/in/carsontate YouTube:  https://www.youtube.com/c/CarsonTate   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 Here: Speaker 1 (00:00): Hi, Carson, welcome to the podcast. I am happy to have you on Karen. Speaker 2 (00:04): I'm so glad to be with you. Thanks for the invitation. Speaker 1 (00:06): Absolutely. And now, today, what I really love to talk about is how to make any job, your dream job. So this is the title of your, well, the subtitle I should say of your book own it, love it, make it work, how to make any job, your dream job. So let's talk about how to do that because there are a lot of people now working in areas or positions or working in ways that maybe they didn't think they would ever be working because of the COVID pandemic. Right. So let's talk about making your job, your dream job. So how do we go about doing that? It's just an easy question. Speaker 2 (00:47): Easy question. I love the easy questions upfront, right? Yeah. Great. Well, first of all, let's go ahead and make sure folks aren't going to give me the eye roll forever. So here's, here's the qualifying statement. So any job can be your dream job because you define the dream. So to create your dream job means that you're going to identify what that is for you and not believe there's a one size fits all or a must or should, but it's what do you need to be engaged and fulfilled in your current job? Because the other reality for most of us is that we can't just quit and go be a lavender farmer. And the South of France that sounds blissful or entrepreneurship might not be the right option for all of us. So we're in a job and I don't want you to stay in suffer. Speaker 2 (01:46): So how do we make it the best job? So there are five areas that I found in my research and work with clients that we need to explore for ourselves. The first is recognition and reward. So what type of recognition and rewards do you need? So I'm talking about praise and acknowledgement because we're all human beings and we really need to be seen for our work. But Karen, you might be the kind of person that just wants the email, great job, Karen, that goes out to the whole team and you're like, Oh God, I feel good. I might be the person that wants yeah. The boss to stand up in front of the whole group, have me there and this great grand presentation of my excellence, but we're all different. And so it's knowing what I need is the first step. So admitting that you have recognition needs and knowing what those are. Speaker 2 (02:38): And then the second one is strengths. And so you're in health care and a bit, a lot of your listeners are as well, physical therapists. So you went into your profession because you had an interest in probably an aptitude in science and working with people. The second step is to really identify and own your strengths. What are those things that you do almost at near perfection? You were really good at you. Can't not do them. So even on your day off, you might try to do them. And as something you want to develop and grow, so you might read about it. You might take courses. You're the one that has the magazine that you want to look at. Those are your strengths. And the reason they're so important is because this is what you bring to the relationship with your employer. Your strengths are what enables your employer to serve their patients, their customers, and earn revenue. Speaker 2 (03:37): And so knowing what the strengths are, a column, your relationship currency with your employer, they're the gold. And when you work from your strengths, your performance goes up, you're more in the flow and you're just generally more happy and fulfilled. So we want to spend more time working from your strengths. But the only way to do that with our employer is to demonstrate how they benefit your employer. So you have to know what they are, and then you okay to help you achieve your goal company. When I do more of this type work, we generate more revenue. We have more customers you're satisfied. So Speaker 1 (04:13): When we're talking about identifying your strengths, you don't only want to just identify them for yourself. You want to share them with your friends Speaker 2 (04:22): Employer. Yes, exactly. And in not sharing with your employer, Karen, it's being very direct and intentional with your employer around how those strengths support the company's goals. So when I do this work, we are faster. We are better with clients. We earn more money because what you want, the goal here is to do more of them. You want to be able to make an ask, Hey manager, I have a couple of tasks that we really are not driving revenue. And aren't really serving the company that I can see when to let go of those and do more of this. Speaker 1 (05:02): Yeah. That makes sense. And if you're working from your strengths, you would probably enjoy it a little bit more, cause you'll see more success. Speaker 2 (05:09): Absolutely. And I am, I come from the school of positive psychology. So I take a strengths-based approach, which means we're going to work on your strengths because I can get a 10 X lift, 10 X, times performance out of a strengths-based approach versus working on your blind spots or your, your growth areas. It doesn't mean we ignore them, but I'm not going to spend a lot of time and energy on those because the return on that time investment for the output and the impact isn't as great. Got it. Speaker 1 (05:41): How can, how do we go? How do you recommend people go about finding their strengths? Speaker 2 (05:46): Yes. So there are three ways you can do a reflection, big fan as a coach of journaling and reflection. So you reflect, what was your best day at work? What do your friends, your colleagues, praise you or acknowledge in your work day? Where do people ask you for help or advice or support? Great place to start. Then if you have any type of performance reviews or three 60 reviews, always a great place to go, to start to mind for those core strength themes. But my all-time favorite way to do it is to look at your task list in your calendar list and go through with a marker and highlight those tasks, those meetings, those calls, the podcast where you were on fire. I loved it. It was really good, strong outcome. And then you start to identify some of your core strengths that way. Speaker 1 (06:42): Let's say you are not an employee, but you're an entrepreneur. So do you give yourself performance reviews? Speaker 2 (06:54): Really? I've never been asked that question. I would say your performance reviews come from your clients. It would be, you know, that email that you get, or maybe you do a survey with your clients. You ask your clients for feedback. That would be your performance review. Got it, got it. And if you're an entrepreneur, that's where the calendar and task list analysis is super helpful for them. Because if you're not working in that formal structure of the yearly performance review, and as an entrepreneur, initially you have to do it all. And ultimately if I'm coaching you, I want you really working from your strengths and we want to start to figure out how do we automate or outsource those other items. Speaker 1 (07:39): Okay. All right. That makes sense. All right. So we've got recognition and reward, which I love and, you know, quick story on that, a friend of mine works for a publisher and she said so do you know what happened the other day? She said, I got this package in the mail and it was from the company. And it was just like some gourmet teas and a mug. And it, and it was a card that says, you know, so-and-so, you're just doing a great job and we appreciate all the work. And she was like, you know, some people need big bonuses. Some people she's like, this is what I needed. So she sort of recognized like my reward is, is just someone identifying, I'm doing a good job and writing a nice note and you know, she doesn't need like the grand fanfare. So I think it's really interesting when you said that it came to my mind and it got me thinking, what do I really like as, as reward and recognition? And I have to say, I sort of like the, just a nice email letter. Like I don't need to be on stage. I don't need it to be in front of a lot of people. And that is what really makes me feel good. Yes. Speaker 2 (08:49): Yeah. And how empowering, just to name and claim that, and then what you're going to want to do if you work for a manager is let them know how meaningful it is. And so for you, as you're as an entrepreneur and business owner, how do we create more opportunities for you Karen, to get those affirmations from me who I'm like, Oh my gosh, you know, I had this terrible injury and now I'm running again. And I just finished my first 5k. I mean, that's what we want in your inbox. Exactly. Speaker 1 (09:24): Yeah, exactly. Okay. So we've got recognition and reward. Strengths is number two, what's number three. Speaker 2 (09:30): This is all about relationships because none of us work in a silo. We all work on teams. And what's interesting is that social pain. So conflict feeling excluded from the group is processed in our brains the same way as physical pain, which is, was show interesting to me in my research. So having really authentic real relationships at work is essential. Not only for performance, but we're talking about being happy, fulfilled, and engaged. And if you don't feel like you've got a best friend or that you can talk to someone or work through conflict, which is part of business, that's a problem. So in this chapter, what we do in the book is we explore your work style, which is how you think and process information, because this is how you're going to work with other people and then identify their work style and learn to communicate with each other in a way that you aren't triggering each other and making each other one of, yeah, I'm not going to work with you and ultimately recognizing where you might be unconsciously undermining that relationship by treating everybody the same way. Speaker 1 (10:43): Yeah. That's so important. Yeah. I'm a huge fan of relationships. And I mean, I have stayed in jobs longer than I probably should have because I love the relationships. I was like, I don't want to leave. I love it here. Speaker 2 (10:57): Yes. And that that's exactly it, the people are important, right. And those relationships that is so important and we've got to do the work right. And that's why that this whole pillar is around cultivate, which requires some self-reflection, but really intentional, thoughtful work to build these relationships that bring us joy and really stretch us and help us grow. That's the fourth one is the development and it's the develop. We call it the five pillars or the five essentials. And the fourth one is to develop new skills. And this is about owning your own professional development, not waiting for your manager, not waiting for your team member to say, Hey, Karen, I think you might like this course. Or have you thought about this position? No, this is about what do I want, how do I want to grow? What's my next step. And being really about putting your own development plan together and then asking your manager to support you. So they might have an internal training program you can join, or maybe they would pay for the conference for you to continue to Uplevel your skills. Speaker 1 (12:06): Yeah. And you know, I think, again, that probably takes a little bit of identifying where, what gaps you might need to fill. So can you sort of, when you went and looked at your strengths and maybe you did find some weaknesses, is this where you would want to start developing those? Or would you take your strengths and continue to strengthen them? I guess, as an individual, you know, Speaker 2 (12:33): So I'm going to suggest that, and this is just my training and background. Let's further refund strengths because I know that the outcome of that is greater. And we also talk about a tool that I created. I call it an abilities opportunity map, where you start to look at the leadership competencies in your organization, certifications did you not get a position? The best person in your field does this? And we don't do it from a place of comparison or judgment. It's just an awareness. Ah, okay, this person has this skill set or this certification I don't just looking. And then once you build this abilities opportunity map, then you go and say, what do I really want to focus on? And how am I going to develop it? Speaker 1 (13:26): Yeah. That makes sense. And kind of looking at your organization and maybe looking at the organization and saying like, I could take, let's say from a physical therapy standpoint it's this great clinic, but while no one's doing pelvic health in this clinic. So perhaps I can develop my pelvic health skills to plug this hole, because like you said, we want to bring more to our employer so that they see us as, you know, boy, this person is a real asset to our company and then you're doing what you love to do. And then they'll continue to promote that. So it sort of circles around, right? Speaker 2 (14:05): It does because the framework and the thesis that I'm operating off of is that the relationship with your employer is a relationship. And any relationship is based on social exchange theory, which is give and take both parties, bring to the relationship and both parties receive. And in a relationship that's healthy, both parties work towards mutually beneficial goals. So developing a pelvic health program is exciting for you. You're passionate about women. This is a way to really expand your skillset, huge win for you, huge win for your clinic. It might not be the only clinic in the city that does this. So this is a beneficial win, more of what you want revenue for your company, your company is distinguishing itself. So that's where it's the employee has an equal and powerful voice in this relationship, right? Speaker 1 (15:05): Yeah. Okay. Makes sense. What's number five. Speaker 2 (15:08): The last one is design your work for more meaning. So this is where we talk about meaning purpose, joy. Speaker 1 (15:19): Hm. Speaker 2 (15:20): Point our point here is that meaning is not defined by what happens to you. It's your interpretation of the events in your life. So we go back to where we started with my premise at any job can be your dream job because you just, you define that dream. And I believe every job has significance. Every job is meaningful. It's up to you to figure out what that meaning is for you, and then start to craft and shape your work for more meaning. So let's say for example, Karen, for you, one thing that brings meaning and purpose to you is helping women that have been struggling for years within contents, so that it's damaged their self-esteem. Maybe they're not going out in public as much. And this is really important that you help these women. It feels like a passion calls for you and meaning, okay. So by developing the skillset for the pelvic therapy, and then you bring it to your company, we're creating meaning you're doing more of what you love and we're generating revenue for your company. The meaning is in the service to these women and how you were an agent of change in their life, Speaker 1 (16:40): Right? So the meaning goes beyond can go beyond just you and just your clinic or just your office or your job, but it can go into sort of the world as a whole, as a whole, which I think is what a lot of people hope that their job can do. Speaker 2 (17:00): Absolutely. And I would suggest every job does that. If you will just step back and look at it. So if we go back to I'm a runner and I'm always injured. And so physical therapists, you are my heroes because you need to doing what I love. And so just a big shout out because you keep me up, right? Cause I'm invariably always doing something and not stretching. So, but if you keep me running and I'm staying engaged and I'm healthy and I'm able to care for and keep up with my kids, like we're now talking about a ripple effect of positivity that you can draw meaning from, but you just gotta reframe because what happens, I'm guilty of this. Karen is that we get really caught up in the transactions of our day at 14 patients to see, Oh my God, have you seen my inbox? The paperwork sucks. Yes. I'm not saying that's not hard, but if we can come back and look at our task as a collective whole, that's where we can draw the meaning from. Speaker 1 (18:08): Yeah. And I'm so happy that you brought up the emails and the paperwork and, you know, cause everybody, I don't care what line of work you're in. You can relate to the emails, the paperwork, the meeting after meeting, after meeting patient, after patient, after patient. Right? So this can often lead, I think, for a lot of people to state of burnout. Right? So how can we use these five tools to help us avoid that? That what some people think is an inevitable burnout? Speaker 2 (18:40): So I'm an, a challenge. Inevitable is I don't believe anything is inevitable. I here to put quotes, air quotes. No, I'm just gonna push back. Cause I think we're aligned on that. I think we better they're like no enough, you know? So two ways, one, we double down on strengths. So when we are working from our strengths, the work is feels easier. There's less effort, but greater impact, more joy, more flow. So the more we identify connect that to how it helps our employer and really intentionally push ourselves to keep doing more of that work can help tremendously the other, Oh, there's two more things. The other thing is back to this meaning that we'll want to pull on. So even at the end of the darkest week of, I am beyond exhausted been doing this, you know, my student loan debt does not seem to be going anywhere. Speaker 2 (19:40): I'm chipping away at it. Can you pull back and find a little source of hope from the meeting? And then the third piece is the productivity. So where are you getting really thoughtful about? Let's take your inbox. I believe your inbox can be the best personal assistant you've ever had. The technology is powerful. We just don't use it. So why are we not automating our email management? So you can write rules, you can automatically schedule and send emails. We can create whole systems that filter what comes in. We can create templates. There's so much that can be done with not a lot of effort that can save you hours. So I think sometimes in the burnout we're like, Oh, it's going to take me energy and time to spend 10 minutes in my inbox, setting up that rule and two templates and Speaker 1 (20:30): Yeah, exactly. I'm like, ah, one more thing. Speaker 2 (20:35): And you're not saying no way. You're probably having an expletive in there. And I'd say, if you do this set a timer, 10 minutes, I'm going to set up one rule and write one automatic template because people ask me this question all the time. I just want to be able to use it over and over again, and then I'm done. But those two actions could potentially save you hours. So it's 10 minutes on productivity tools, looking for automation saying no to meetings that you don't need to attend because they're going to print everything they talked about and posted on the bulletin board. Or you're not even sure why you're there and there's no agenda. And it's just going to people rambling. Don't go say no. Speaker 1 (21:23): Yeah. I think that's a huge thing for people. And I've just really come to get better at the saying no thing. Of like when it's not like, when, if it's something that's not working for me, like I have to get better at saying no, because then I over-schedule myself and then I'm all stressed out. Speaker 2 (21:44): Right. And it's a self perpetuating hamster wheel. Right. Just keep on it. And the no is freedom. So one way to look at it is every time you say no to something, you're saying yes to something else. Right. Speaker 1 (22:02): So how do you, what's a gracious way to say no, Speaker 2 (22:06): At this point, I'm not able to take on any more projects with the level of attention and detail that I like to bring to projects. So thank you so much for thinking of me. Well, that's good. I like that. Yeah. Thank you for inviting me to your meeting on Friday. I can't attend. If there's anything that you would like for me to think about or reflect on in advance, please let me know. And I'll send you an email. Speaker 1 (22:30): Oh, that's nice too. Oh, very good. Very good. Hopefully people are taking notes on those. Yeah. That's really good. That's a nice way to say no, versus just saying, Oh, I'm sorry. I don't have the time. Speaker 2 (22:44): Right. And the other piece of the, no, I learned this the hard way and I'm sure your listeners have tucked up, but I live in the South. And so Dan said, we've got a little polite niceness culture going on. And part of a, no is not inviting the second email or you not busy now, Karen, how about now to meet for coffee? So we want to know that has a firm boundary that isn't going to get the creeping back. Speaker 1 (23:14): Yes. Yes. And that's hard. So, cause I know sometimes I'll say, Oh, you know, I'm, I'm really busy for the next couple of months, but why don't you check back later? No, no. Should not be doing that. Speaker 2 (23:24): No, no, no. And there's also an, I think there's tremendous value of going back to my first example of you value and respect that person you value and respect to the board, the project, the ask enough to say you aren't going to get the best of me. I can't, I can't bring you what you deserve, what this organization deserves. Thank you for thinking of me. Speaker 1 (23:50): Yeah. Kind of putting, putting them before you. Yes Speaker 2 (23:53): It's because ultimately I, I do believe we want to do our best work and when we're stretched so thin, it's just not possible. And then we began disappointing ourselves and others and that's not a cycle we want to be on either. So the door firmly don't get the creepy crawlies coming back, asking how about now? It's two months later. Where are you? No, I'm still not available. Speaker 1 (24:17): Yeah. No, that's so good. That's so good. Have a firm close to that door. Gosh, that's great. Yeah. I love that. Now is there anything else that you kind of want to add on here? That maybe we didn't cover on, on allowing people to really love their work and love their job? Speaker 2 (24:39): Yes, but I have to share, I'm going to give you one more productivity hack. Can I do that? Speaker 1 (24:44): Oh my God. I didn't want to, you can give me 10 more. I didn't want to keep asking on what, what about this one? Do you have three more that I want to give you? I can't help myself Speaker 2 (24:57): Then listeners bear with me. If you don't like this, just speed up just fast forward. Okay. So the first one was stack. So stack saying no is hard. So what I coach my clients on is let's create a template and email to say, no, these are the no templates, no, to be on the board. No, to do this project. So you think about it. You write the know and when you get that ask click. Speaker 1 (25:25): And so when you have a template, so do you mean you sort of just keep it in like a word doc and then copy paste into your email. Speaker 2 (25:33): So depending on your email platform, so I'll start with outlook and outlook. The best way to do this is to create multiple signatures. So an outlet, people think about a signatures. Haven't, you know, Karen and your phone number. Well, you can create as many, many signatures as you want. So you go in and create a signature that is gracious. No to project ask you type it, you save it. Then when I send an email, Karen I've gotten great new task force really wants you to be on you. Hit reply, insert gracious, no project signature. And in 30 seconds we've saved time. And we haven't gone through the angst of how do I say no? How do I let them down? How do I close the door? No, we do the thinking on the front end. And we just use this over and over again. So we're stacking two habits here and leveraging technology. Speaker 1 (26:36): Nice. Yeah. That's great. Speaker 2 (26:39): In g-mail you can set up templates too, as that function the same way and absolutely care. Nothing wrong with the word doc I'm copy and paste key is we write it once and you use it over and over again. We don't do the rework time. Copy paste, drop and go. Yeah, that's fabulous. The second one that is one of my favorite ones for healthcare workers is so your day is scheduled for you patient, patient, patient. And so what happens during the day is a lot of things that you could potentially do, like little tiny task or maybe call. I don't want to get your hair cut or whatever doesn't happen. And so you have all this buildup of tasks that now you're trying to do on the margins of your day. So I tell my healthcare providers build something called a 15 minute list, and this is a list that lives with you. Speaker 2 (27:31): So put it in your lab jacket as a piece of paper, put it on your phone. I don't care Magnasco and how you get it around, but it needs to be with you. And these are tasks you can do in 15 minutes or less. So schedule your cats, that checkup prep for the one-on-one with your team member, call and cancel call all of the little itsy-bitsy things that don't take a lot of time. And then what you do is when you have that patient, that's 10 minutes late, you pull out your list and you go because I can get these things done and these micro segments of our day. So it's a really efficient way to stay on top of the nits and NATS that can add up and feel overwhelming. Great. And then the third one that works well and healthcare and for everyone, but a love it from a healthcare providers is something we call protect your 90. So this is 90 minutes a day on your strategic priorities. So it could be professional development. It could be, you might be doing some research, writing a paper, it could be catching up on your charts, whatever it is. But the way it works is it's 90 minutes a day. That's focused now it's not 90 continuous minutes. Speaker 3 (28:54): That's what I was just going to ask. Yeah, no, I made only unicorns have that and without I haven't met a unicorn. Speaker 2 (28:59): Yep. So this is the power of it. So it might be 20 minutes that you choose during lunch to do your focus. Then you have another little 10 minute window where you might do another little sprint focus, but the goal is 90 minutes a day because the power and five work days, that's seven and a half hours of focus time. That is a game changer. I have had physicians write really complex research papers using this strategy because we're just chunking just yeah. Intention, intentional chunks focused, and then we go back, but it's the consecutive effort over time that up. And it doesn't feel overwhelming. I mean that versus saying I need seven and a half hours of your time. Speaker 1 (29:47): Yeah, no, that's great. Very good. Very good. I love it. Okay. So I feel like we've gone over so much but I'm loving the productivity, hacks and tips, and also loving your sort of five step template or plan to kind of love your job again. So is there anything else about that? And like I said, productivity hacks, we can go for days. People can go to your website and find more. But anything anything else on people loving their job and loving what they do? What would you like people to really remember about the chat Speaker 2 (30:25): Clarity creates opportunity. So doing the work to identify what your dream job looks like, how you want to be acknowledged and rewarded what your strengths are, the relationships you want to develop, the skills you want to grow in the meaning you bring, it opens up infinite possibilities for you in your current job. And I would suggest in future jobs, that knowledge is power. Speaker 1 (30:55): Yeah, that's great. And before we sort of sign off and find out where everyone can get in touch with you, I have one more question that I ask everyone. And that's knowing where you are now in your life and in your career. What advice would you give to your younger self? Whether it be fresh at a college or what, you know, what advice would you give to yourself? Speaker 2 (31:16): Play more? I'm a type, a perfectionist recovering. Some days, some days I'm not recovering and I will get in that strive mode and I've done it since I was 18 years old and would go back and say, it's okay, play a little more. The work's going to be there. And what I've come to learn now is that in play, that's where you're going to find those brilliant insights and connections and the juice to not be burned out. So one reason we get burned out is because we don't play. We just work all the time. Speaker 1 (31:52): Yeah. That is great advice. And I have to say, I've heard that from a couple of people on this question is to just kind of like chill out a little bit more relaxed, a little more play a little bit more. So that is great advice. Now, Carson, where can people find you if they want more information about you and what you do and, and all of and yeah. Speaker 2 (32:11): And your book. Yeah. So the book own it, love it, make it work. All of your favorite retailers, Amazon is available online. And then my website, Carson, tate.com. Check out the blogs. If you want productivity hacks, they're there tips on loving your job. We've got assessments. All the goodies are on the website. Carson, tate.com. Awesome. Speaker 1 (32:32): And then for social media, Speaker 2 (32:35): Yes, LinkedIn, the Carson Tate. Awesome. Well, thank Speaker 1 (32:40): You Carson so much. This was great. I think you gave my listeners so much to work with, so I thank you so much. Speaker 2 (32:47): Thank you, Karen. I appreciate it. And thank you guys for all that you do for us. Speaker 1 (32:52): Thank you. Thank you. And everyone who's listening. Thanks so much. Have a great couple of days and stay healthy, wealthy and smart.  

Episode Summary Are you willing to experience anything? In this episode, the Founder and CEO of MEG Business Management, Brian Gallagher, talks about the power of the intrapreneur and entrepreneur in private practice. Brian graduated with a BSc in Physical Therapy from Daemen College in 1992. Soon after, he founded Gateway Health Services, which quickly became one of the largest staffing companies in Maryland. In 1999, he founded Cypress Creek Therapy, which was awarded the Anne Arundel County’s “Most Family Friendly Business” for several consecutive years, and in 2011, Advance Magazine awarded CCT as the “National Practice of the Year”. In 2006, Brian founded MEG Business Management and has grown to become among the top 10% of private practices across the US. Today, we learn about the difference between an intrapreneur and an entrepreneur, the four types of PT owners, and Brian gives practice owners some advice on the interview process. He tells us why he sold his practice with a contingency, and how the current environment is ideal for entrepreneurs. We get to hear about the 4 C’s, how we can become a successful Go-Getter Owner, and Brian gives his younger self some advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways   •       “Typically, an intrapreneur is a manager within a company who assumes no financial risk, but they’re willing to promote and execute on the development and implementation of innovative products or services.” “An entrepreneur is similar, but it’s one who will find the needs out there within the business community, and simply fill them by developing their own ideas into actualities, by assuming the full financial risk and development of that idea through a business model of their choice.” •       “Your practice is a reflection of you as an owner. Figure out which type of owner you are first.” •       “The secret to successful hiring so that you can be correct 85% of the time is that you have to get the entire team involved in the hiring process.” •       There are 4 types of PT owners: The Innocent Owner, The Caregiver Owner, The Know-It-All Owner, and The Go-Getter Owner. The innocent owner – the person that falls into ownership, and is managing based on census. They never really thought about being an owner; they just had an opportunity.   The caregiver owner – they assume the perspective of a clinician first and owner second. They tend to run their clinics like it’s a democracy. The know-it-all owner – through their life’s experiences, they’re not open to new ideas. The go-getter owner – they have an entrepreneurial spirit, they like to manage based on performance, and they’re in a continuous pursuit of knowledge. •       “This is an entrepreneur heaven right now.” •       “If we’re going to sit here and go through our profession, and continue to colour inside the lines and make our picture like everybody else’s, you’re only going to get that.” •       “When you ask what the common denominator is to all success, the highest thing would be confidence.” •       “Transparency breeds trust.” •       “The secret to success is giving.” “I hate a win-win relationship. A win-win relationship implies that I’m going to allow you to win as long as you help me win.” •       “Don’t react; respond.” Book Mention The Go-Giver, by Bob Burg and John David Mann Suggested Keywords Intrapreneur, Entrepreneur, Owner, Courage, Capability, Commitment, Confidence, Success, Listen, Introspection, To learn more, follow Brian at: Email: info@megbusiness.com Website Facebook Instagram                         Twitter     LinkedIn YouTube More about Brian:  In 1997, Brian founded what became one of Maryland’s largest therapy staffing companies, while at the same time launching a multi-site private practice that resulted in a sale in 2006. Brian re-acquired the practice in 2008, thus doubling it, before winning “Practice of the Year” in 2011. MEG Business Management began in 2006 as an educational coaching company training owners and their key employees on innovative practice management strategies. Today MEG has taken another major leap forward by developing a Virtual Training platform that practice owners can now have the tools and training resources to professionally enhance, track and manage employee performance, and hold in compliance with every employee in the company. This platform is available 24/7, 365 days per year. When Brian is not coaching, or working on the VT training platform, he can be found giving lectures at the APTA, PPS and CSM Annual Conferences, as well as APTA State Chapters and DPT Schools across the country. Brian believes strongly in giving back to the profession of physical therapy and does so by supporting the APTA through lecturing, writing articles, and performing webinars. 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 (00:01): Hey, Brian, welcome to the podcast. I'm happy to have you on, Speaker 2 (00:05): Oh, thank you so much, Karen. Thanks for taking the time and hooking up with me and doing the show. Speaker 1 (00:10): Yeah, well, I'm actually really looking forward to the topic today because it's something that I've spoken about a lot and that I have friends of mine who are business owners and, and love to empower their employees. So today we're talking about the power of the intrepreneur and the entrepreneur in private practice. So before we get into it, can you define the difference between those two terms? Speaker 2 (00:39): Yeah. And there's lots of definitions out there. I think if we Google it or YouTube, it you're all gonna, you know, find various forms of definitions for this. But for me, and I've always operated under this basic definition that typically an intrepreneur is a manager within the company who assumes no financial risk, but they're willing to promote and execute on the development and implementation of innovative products or services. In our case, it would be services and they do that via marketing branding, or other various forms of public relations, but they're innovating within somebody else's company. And that's my definition, that's my operating definition of an entrepreneur. Speaker 1 (01:19): And so when you're, when you're thinking about an injury, an intrepreneur and it can be a person who takes the initiative to maybe start a new program and within a physical therapy practice or right, something like that, Speaker 2 (01:41): Something like that, it could be as basic. And as simple as that, where they've taken an idea, they've worked it through to a concept and then they've developed that concept into an actuality. So that's what I really see with an entrepreneur. I have certain characteristics that we look for, and I think we'll talk about a little bit later that will really give you the identifying markers of an entrepreneur and what you should seek in an entrepreneur within your clinic, because an entrepreneur is similar, but it's one who will find the needs out there within the business community, whatever the market is that they're in and simply fill them by developing their own ideas into actualities by assuming the full financial risk and development of that idea through a business model of their choice, through the development of their business operations. So innovating within your own company is more of that, of an entrepreneur, assuming that financial risk. And that's really the defining factors between the entrepreneur and entrepreneur. Speaker 1 (02:37): And so what does, what does it take for one to stand out as an entrepreneur? So if I'm the entrepreneur, I own the business. What am I looking for for this? For a standout entrepreneur? Okay. Speaker 2 (02:52): All right. Well, I have a good story for that. And just to give you an example of a, of an entrepreneur, you know, it was several years ago. I, my clinics are in Maryland and I live in Florida and so I had six offices in Maryland and I was running them from Florida and I had a team that I had built. And so I had a chief operating officer working for me. Her name is Denise, she's now the CEO of Meg. And she runs our whole billing division. But at the time she was running the clinics and our largest clinic, it's a, you know, a 8,000 square foot office. And I got to talking to her on one Monday morning and I was asking her about, you know actually I didn't do my normal, that, that's how it actually came up. I was talking to her Monday morning, I got right into business, which is unusual for me. Speaker 2 (03:33): I'm usually like, how was your weekend? And how's the kids what's going on, you know, fill me in and all right, let's get start. But I was in a rush and I just got right into it. And she just started spouting off the things I wanted to know and just hitting it. And then I caught myself and I said, you know what, Denise, I'm so sorry. I apologize. I didn't even mean to ask you about your weekend. You know, how's your weekend go. And to my surprise, she says, well, you know, the air conditioning unit kind of backed up and it flooded the whole place I had to bring in a fan system. And my husband, I lifted the carpets and we dried them all out and got them down. We didn't miss a beat. We were ready Monday morning when the, when the patients got in here. Speaker 2 (04:05): So we're all, you know, find a good, I'm like, Oh my gosh, I had no idea. Like she never called me. She never made that problem. My problem. And I remember getting off the phone and saying to myself, what a level of responsibility, you know, what a level of responsibility. And that's one of the key factors that I look for in an entrepreneur. Now, in this case, I'm not giving you that shining, you know, example of somebody who started a women's health program or a pediatric program. I mean, she's obviously had done that through her time with me, but just this personality characteristic of I'm going to own the responsibility of this situation or this individual or this environmental breakdown, because it is my level of responsibility. And that's somebody who is thinking beyond themselves. And that always stuck with me that she just took that being this on, if you will, of an entrepreneur, when in fact this isn't even her clinic and that's really the sign of a true entrepreneur. Speaker 1 (05:00): Yeah. So someone who's really willing to take the initiative and to kind of really think of the, it sounds like someone who's really going to think of that clinic as, as their own, and really have a stake in it. You know, a true sort of emotional stake in the clinic and a sense of pride in, in where they work and what they're doing Speaker 2 (05:21): Exactly. And they typically come to the table, you know, if you're hiring well, and you're building that management team around you, you're looking for the foundation, right? I mean, every bridge is only as good as the foundation. And the foundation that I'm always looking for is does this individual have the personality, characteristics of confront, right? Are they willing to say what needs to be said to whomever? They need to say it to now, of course you communicate in manners. You never go out manners, but you can't shy away. And we live in a culture. Now we're in an environment where nobody really wants to offend anybody. Nobody literally wants to tell anybody anything they don't want to hear. But in fact, if you're raising children and many of your listeners probably have children, you can't raise your kids and say yes to everything for a month. Speaker 2 (06:02): Yes. Chocolate cake for dinner. Yes. You can go to bed when you want. Yes. You can have candy in the grocery store line, I'll visit your house a month later. It'll be chaos. It'll be a nightmare. Right? So when we run our clinic, we have to have that level of discipline. And that means you have to have that quality of confront. I need to be willing to confront my staff, say what needs to be said, always within good manners. And that's when it comes down to the, the, the equation of communication, you know, how can I communicate in a manner that I can bring about understanding, right? Because after understanding comes agreement, and we're always striving for agreement, but you know, that's the final as the final marker. And then the, the last two building blocks of foundation, I think that really make an intrepreneur entrepreneur is accountability and responsibility. Speaker 2 (06:43): And the difference between those two in my mind is accountability is one who's who owns the obligation and willingness to be accountable for their own actions. But responsibility is like the example I gave of Denise, where she took full responsibility for the whole wellbeing of the clinic and everybody inside it. So just to summarize, I'm always looking for who has a high level of confront who can communicate and bring about duplication and understanding and the art of their communication and who can be accountable to their own actions as well as responsible to that of others as well as situations. So I'm always looking for that and if I don't have them, how can I grow me? Speaker 1 (07:19): And, you know, I love the fact that you're always looking for that. So what advice do you have for a practice owner who is interviewing people, you know, to come and work in their clinic? Cause it's, I think it's hard, let's say in one or two interviews to kind of get those for confrontation communication, you'll get countability responsibility. So what advice do you have for business owners in those first couple of interviews to hire someone to kind of get this, this type of intrepreneur, if that's what you're looking for in your clinic. Speaker 2 (08:00): Yeah. And if you're looking to get distance from your practice, if you're looking to get freedom and flexibility, that's typically what we're trying to hire. Right. So that's a great question. You're asking a fantastic question. I think my answer is going to surprise you. I don't think it's going to be the path that you may be expecting. I think what my advice would be based on my experience now, I've been in and out of 400 offices. I've been in every state in the United States, helping practice owners throughout the whole United States, except for four States. And in doing that, I've come to the conclusion that it has to start with you. It really has to start with us looking at ourselves in the mirror and asking ourselves, what kind of owner are we right. I mean, to some extent you're, you're you're and I like to use family analogies a lot. Speaker 2 (08:38): I don't know, maybe because I had a pediatric clinic and adult clinic. And so I always saw the dynamics there, but I think your family you know, performance, your children are somewhat of a reflection of you as parents, right? I think your practice is a reflection of you as an owner. So I think you really need to look at yourself. So my first bit of advice is look at yourself and kind of know what your own strengths and weaknesses are. You know, there are four kinds of owners out there, and I think we'll talk about that. So figure out which type of owner you are first, second, when it comes to the interviewing, which is kind of what you were leading to. It's a, it's a five stage hiring process, and I've been, I've been pushing this and teaching on this for, well over a decade. Speaker 2 (09:17): Now it's a five phase hiring process and the secret to successful hiring so that you can be correct. 85% of the time with every single candidate you're trying to hire is that you have to get the entire team involved in the hiring process. Your entire team know selectively, right? There's some key individuals, some individuals where you're like, Nope, that's not going to be a fit, right? But for the most part, you need to include everyone in your clinic, in that process. And let me just quickly summarize. So first and foremost, it starts off with phase one, the ad for the ad, you know, you're advertising for somebody you're trying to recruit somebody. Let's say you're looking for a therapist. Let's just pick what everyone's thinking about. Well, here's, here's, here's a tip. Always open your ad with a question, always open your, a question. When you start the ad with a question, it prompts the person to think and reflect on themselves and raises their curiosity. Speaker 2 (10:06): You know, here's an example. Let's say you were to say, you know, are you GM's next? You know, senior financial analyst. And then before you even get the next sentence, the person who read that for sense of like, I don't know, maybe I am, maybe I am qualified. Are you the next senior manual therapist who can work in an autonomous work environment? The therapist's coming? I don't know. Maybe I am. So it gets their interest in. So the ad really has to stimulate their interest and then step two, they have to reach in for a phone call, phone screen. Now the phone screen, here's the, here's the death to any interview process. Don't talk about you. Don't talk about the clinic. Don't get into that. Don't sell your clinic. Don't sell yourself. Look, you have to, this is dating one Oh one. You have to be more interested than interesting. Speaker 2 (10:47): Now what happens here is once you're demonstrating your higher level of interest, their comfort level goes way up when their comfort level goes way up, their natural persona, their natural personality is going to be there. And that's what you're really striving for in the interview process. You know, phase three, they come into the clinic, they meet the front desk. They, they introduce themselves, give them the application, they fill it out, then let some other member of your team, give them a tour of the clinic. It shows that you're so confident in your staff. You're so confident what you built, that you can leave that potential applicant alone with another staff therapist who can just give up five minutes who are, and now that candidates going to ask, you know, the popular questions you know, how, how do you like the way they run the schedule here, right? Speaker 2 (11:28): That's always a difficult question in, in, in hiring or what do you think of the EMR system, right? Encourage that, encourage that outflow and encourage that dialogue with another individual. And then of course you bring them into the interview process. And then finally, you're going to wrap it up and potentially offer them a position, but you have to ask the questions that are getting them to reflect on themselves. And I'll, I'll end with this in the interview and this one of my favorite questions, you know tell me about a time when you last help someone. You know, it's really interesting when people go blank and they pause, you know, I don't want to hear about work. I want to hear about like, when you genuinely tried to help someone, it tells me a lot about the person and how they live their life, because I think striving to serve others and adding more value to other people around us is what's fulfilling. And so I'm really looking for that when I'm hiring. I know I can make somebody a better therapist. I can't always make them a better person. Speaker 1 (12:19): Very true. Very true. And thank you so much for outlining that interview process. And hopefully that gives a lot of the entrepreneurs listening, a better idea of maybe how they can do that on their own and kind of make it their own. Now, before we went into that, you said there are four types of PT owners. So let's go back to that. And I want you to let, let, let, let us know what are those four types of PT owners. Speaker 2 (12:43): Okay, good. Now this is just based on experience, you know, for the thousands of engagements I've had going all the way back to, you know, I started the business in 2006, but I've been a physical therapist since 92. And so what I see out there and what I've been able to categorize is four types of owners. The first one is the innocent owner. All right. And I think we've all met that person. This is the person who falls into ownership and, you know, they're, they're, they're managing based on census, right? They're like a poll taker, you know? But they're always open to help. They're always willing to get help. They're always willing to seek some advice and some help, but they're the type of person like, yeah, I was in this clinic and the owner just decided to retire and they didn't really want to move on with it. Speaker 2 (13:25): They didn't want to get out on the market. You know, they told me a hundred thousand, I could just buy it out. And so, you know, it's less than a Tesla. So I bought the clinic. Right. So, you know, that kind of owner who never really thought about being an owner or whatnot, but they just had an opportunity and they just jumped out and they did it. They didn't give it much thought and then they quickly find out, wow, there's a lot more to this than just treating patients and being great therapist. Right. similar to that owner, you, you run into the caregiver owner and I, I run into this a lot, especially out in the Pacific, on the, on the West coast. You know, Karen you're on the East coast, I'm on the East coast. The average collections per visit in the U S is like 83 to $85 a visit. Speaker 2 (13:58): But if you get up in that New Jersey, New York area, you know, it's not happened. And I have clients and stereotypes. Yeah, exactly. It's such a, Oh my gosh, $68 a visit $73 a visit. But if I'm over in Portland, Oregon, 125, $127 a visit. So you get some of these owners that are in these very high reimbursed environments predominantly. And they're what I call the caregiver owner right there, that caregiver. And they go into practice. And they're the one who assumes the perspective of a clinician first, an owner second. And they can be a bit of a martyr. Right. And they tend to run their clinics like, like a democracy, like it's a vote like everybody has equal say, right? And so these are the people that, that call me and, you know, come to find out, they're paying themselves, you know, 45, 55,000. And they've got, you know, therapists two, three years out of school making 85,000, you know? Speaker 2 (14:52): And so, but they're always, they're always justifying well, will we put our patients first? And it's all about the patients. And I'm like, so is that to assume that the other 30,000 private practices in the us are not doing that? I mean, really let's, let's just keep this in balance, right? So you really have to, you know, my success with them is I really have to coach them that the minute you open up your clinic, your senior responsibilities to your, your flock, you know, to all the people coming into your clinic, you own that responsibility. You have to be an owner first and clinician second. And then one of the most frustrating owners, number three is the, know it all owner, right? This is the owner has been around a while. They've had some wins, they've had some losses and through their life's experience, they're not really open to a lot of ideas. Speaker 2 (15:34): They're not really very open-minded. They got off fixed ideas. They're a little resistant to change. And here they are like, you know, reaching out to us, Hey, Brian, how do you do your social media marketing? Or how do you do your hiring process or what's your, you know pay for performance model and you start going into it and they start, boy, I know that, or I do that, or I don't do that. Or that, you know, this, this know it all kind of thing. Well, you're only going to be as good as you're willing to open up and willing to look at new thoughts and ideas. If you're not willing to look, you're not gonna learn anything. So that's a real shutdown right there. And that's really hard to, to get past that the suite owner, the one that I go for every day, I'm striving for. Speaker 2 (16:10): I love it's usually my startups that I've run into that are the go getter owners. These are the ones that, you know, they have an entrepreneurial spirit. They like to manage based on performance. And they're in a continuous pursuit of knowledge. You know, they're just continuing to pursue their knowledge. You know, I always tell people I'm 52. I want to be a better 53 year old. And I was a 52 year old. The only way I know how to do that is listen to podcasts like yours, read books, do audible. I mean, there are so many great people that are adding value to people's lives. You just have to go and get it. You have to take it in. So that go getter that go get her owner. That's the one, that's what we're trying to move everybody into that bucket. Speaker 1 (16:47): Okay. So how do we do that? So we're ending 2020. It's been a hell of a year. A lot of unpredictability moving into 2021. I think it's safe to say we're still there still a lot of predictability. So how do we, how do we become that go getter? How do we become successful as that go getter? Speaker 2 (17:11): All right. So I was listening to Gary V earlier today, I was watching one of his interviews and he was talking about this exact moment in time. And he said something that I just could not agree with. More, just could not be more in agreement. And I know it's probably going to shock everybody when I say it, but this is an entrepreneur heaven right now. This moment in time, this period in our life and our society in our profession is an entrepreneur. Have it? I mean, this is a 89 degree swimming pool. This is perfect time for you to jump in. And I see it in my business. I mean, we're having our record year. This is our most, most expansive year, yet on record going all the way back to 2006. And I think it's because if you really think about the true essence of an entrepreneur, an entrepreneur like you, Karen like myself, and so many others that we meet, I mean, look, you and I were talking earlier about your practice. Speaker 2 (18:06): You have a mobile PT practice. You're doing tele-health, you're willing to color outside the lines. You've always been willing to color outside the lines. If we're going to sit here and go through our profession and continue to call her inside the lines and make every picture like everybody, else's, you're only going to get that. That's all you have available to you, but if you're an entrepreneur and you're a willing to experience anything, and that you got to think about those words, I have to be willing to experience anything. When I sold my practice the first time. So my practice, the first time, two years later, it's tanked the people. I sold it to tanked it. They stopped making their note payment to me. I had a clause in my agreement that if you stop making the no payment, I come back and I buy the clinic back for a dollar. Speaker 2 (18:48): I bought the clinic back for a dollar. I bought this product for a dollar. Yup. I was 30 years old, two years later, they tanked it, bought the clinic back for a dollar. I got rid of all of the offices. I kept two. I lost half of the staff. And my wife says, you know what, honey, you can go up there and rescue that clinic. But I am not going to live here in this house in Florida with these two little girls all by myself. That is not what I bargained for. So you can go away for two weeks at a time, but you have to come home for at least three to four days. And then you can go back. And I said, I promise that's what I'll do. I ended up doing that back and forth, back and forth. I turned that clinic around two years after I took that back. Speaker 2 (19:24): It became practice of the year practice a year. Why? Because I was willing to experience anything. It had vendors that I owed $150,000 to, it had taxes that hadn't been paid for a year. It was in a middle of a Medicare audit where the patient was seen 141 times a Medicare patient, 141 times. And when Medicare audited them, they failed the audit a hundred percent. I'm like, you didn't even sign your name. Right? And so then I come in and I take it over. And I, I said, I sat on the phone for four hours to finally get to the person whose desk that was running. The Medicare audit, who advanced the R we are an advanced documentation, right? Who are notes were being mailed to mailed to this person in Alabama who was reviewing the notes. Right? And so we found who person was. Speaker 2 (20:18): And I said, I'm going to talk to you every single week. I'm getting off this ADR as quick as possible. She says to me, and this really funny Southern accent, and she's like, I've never seen anybody get off an ADR in six months or less. It's going to be at least that, you know, they only pay you one third of your Medicare dollars. I got off that advanced documentation review that Medicare I got off in three months, I was a hundred percent success in three months. And she, she caught us off, but that was me being willing to experience anything in pursuing the knowledge that leads to greater. And that's all that was Karen was, I didn't know anything about that. I didn't know how, what it took to get off an advanced documentation review. I didn't know how I was going to pay those vendors back or rebuild a whole operation with half the staff, but I did what needed to be done. Speaker 2 (21:00): And that is what I think really makes an effective leader. Who's really going to be that go getter owner. And the last two P the last three things about that is I'll say I was listening to a audible book by Dean Graziosi. You know, he was mentored by Tony Robbins and he talks about the four CS courage commitment capabilities that naturally grow confidence. I think every successful person who's in this space, who's, who's in this entrepreneurial space business space. When you ask, what is the, what is the one ingredient that is the common denominator to all success? I think they'll all say if you took a tally, the highest thing off the chart would be confidence. It takes confidence, but you're not going to competence. If you don't have courage, like I had to go back and rescue that clinic. If you're not going to be committed to it, like I was going to go the distance, no matter what, if you're not going to have the ability to go to podcasts, read books, go to courses, go to seminars, invest in yourself and get the capabilities to actually do it. I ended up you know, took that clinic back, made it practice the year, two years after I took it back, I took it back in 2009 and it was practiced a year in 2011. So I like to pull from those natural experience. I like to pull from those and share them with everybody. I mean, that's, that's wild. It was a rollercoaster. Speaker 1 (22:19): And now, so when you, I have to, I have so many questions. So now when you sold this practice, so you sold it with the contingencies. So you didn't just sell it and be like, okay, I'm selling this and I'm outta here. So why did you not do it that way? Because I think that's an interesting question to ask for people who may be, might be in similar situations. Speaker 2 (22:40): Absolutely. I do a lot of mergers and acquisitions and sales. I have three owners right now that I'm working with helping get them, getting them connected to selling their practice and connecting the right people. So at that time, I had spent $115,000 between three different consulting firms and training firms to really train up my management team, train up myself. And that's what I did. And so I invested that money 115,000 to hook a home equity line out of my house. Now you're going to find like, I'm not your typical speaker. You know, when I do my podcast and I'm on other people's podcasts, I believe this Karen, I, and I hope you don't mind. I believe a hundred percent of my DNA that transparency, breeds trust transplants. So I'm willing to just like wear it on my sleeve no matter where it goes. So what happened? Speaker 2 (23:26): I manned up this management team. I invested 115,000 into this group. I got back to 2005, 2006, I'm working 15 hours a week. I'm making like $45,000 a month. I'm a thousand miles away living in Florida. I'm living the dream. I'm living the dream. I'm like, okay, I'm going to devote the rest of my life to showing other pet owners how you could be a remote owner and make this happen. A year of that goes by. I get a phone call my management team, the leader up there says, Hey, we want to buy your practice. So I said, all right, let me talk to my wife, Lisa, and I'll get back to you. So I tell my wife, I was like, absolutely not. Why in the world, I am not, we we've worked our whole lives to get to this point. This is, I am not. I said, Lisa, let's think this through. If I call them back and say, we're not interested. What's their next action. Speaker 1 (24:15): Find someone else to buy it. They're going to leave. Oh, Speaker 2 (24:19): Because they're thinking, well, wait a minute, I'm running this, this $4 million operation, $6 million operation at, why would I stay here? If I don't get a piece that I'm, I'm going to go. So I literally flew up. I wrote on a napkin at dinner, I wrote $6 million. They said, we can buy that. We're going to give you a third up front and we're going to give you no payments on the rest. And I'm like, well, I love these guys. Right? I built them. I groomed them. I put them in a position. I want to see them win. Right. Done deal. Now the nice thing about doing it that way is I already have the skills and knowledge to know how to run the business. So what's my risk. My risk is exactly what happened. They tanked and they crashed it, but I have the skills and knowledge and ability to go back and rescue it. Speaker 2 (25:00): Right? So that was the, that was the risk that I had to be willing to accept. What's the upside. Well, two thirds and a note I'm making, you know, fi was a 6% interest on that money. So I'm getting well over my asking price over the course of the time that I'm making, making the payments. It also gives me this guaranteed income, which I made for the two years. And I could go do other things with it. Right. So it was a really good win-win, but the nightmare happened. They defaulted. I had to step in, I had to do. And that goes back to my, you know, my four CS courage commitment capabilities. I had the ability to, I knew myself well enough to go do that. So of course that's what ended up happening. But in 2017 I sold it all again. So it's kind of like in the big scheme of things, it really worked out. But in 2017 I won and done, you know, here's the keys. Thank you. Here's the check. I love it. One and done. So it was a different, it was a different, so I've, I've lived through both experiences. I've lived through both of those opportunities. And that's how it went. Speaker 1 (25:57): Yeah. Wow. So I think it's great for people to hear that there are different ways to even sell a practice and, and that it really behooves someone who is in that position to find someone, to help them guide, guide them through that. Speaker 2 (26:13): Right. Absolutely. You know, even tiger woods has a coach, right. And he's the best golfer at the time. You know, Tom Brady has a quarterback coach. I think every practice owner needs a coach when you're running the practice. And especially when it comes time to sell your practice. You know, I paid somebody $5,000 just to be a sounding board for me when I sold my practice. Like, because it's an emotional rollercoaster. I said, I don't really need you to do anything. I just need you to pick up the phone when I call, I just need to bounce ideas off of you. And just tell me I'm crazy or tell me I'm being too emotional or tell me. And I just needed somebody to consult with. You know, I just needed a little counselor to help keep me on track. And, and that, that was well worth the $5,000 for me to, to move it on through, you know, I kind of despise the idea of people brokering these deals and taking 6% of somebody's livelihood that they built their whole business for 15 years for like a four month transition. Speaker 2 (27:01): I like to just coach people through the sale. I like to help coach them through it, just pay for the time don't pay a percentage of business, but that's me, that's just my opinion on it. You know? I mean, how many of us have sold a house in real estate? And the realtor, you know, blows in and sells a house in 60 days, blows out and walks away with 50 grand. I'm like, I don't care how many website things you did. There's no way I can justify that 50,000, but that's the market. Right. That's how that industry works. Speaker 1 (27:24): Right, right. Wow. That's a great story. Thanks for sharing that. And now, before we start to wrap things up what would you like the listeners to take away from what we just spoke about? What are your key discussion points? Well, Speaker 2 (27:44): I'll start with what is one of my most favorite books, and if you're going to start there, I think you, if you, if you get this book and you'll listen to it on audible, or you read it, it's, it's the Go-Giver by Bob Burg and John David Mann, that book completely changed my life. And what I got from that book was I got this, that the secret to success is actually giving the secret to success is giving all successful. People will keep their focus on what they're giving and that's what actually gives them their success. You know, I grew up on welfare, you know, my mom raised three boys on her own, you know, government, cheese, bread, butter, food stamps, the whole nine yards, no car. And, you know, I was always of this mentality. Like once I get successful, I'm going to give back. Once I get all my, you know, shelter and security and this and that, I'm going to give back. Speaker 2 (28:37): And along this journey, I realized that was completely false. That was completely false, like right here on my computer. I'm talking to you right now on zoom. And I'll just rip off this post-it note and just put it right in front of your camera. I mean, that is what I look at every single day. And it says strive to serve, strive, to serve. And I realized the more I embrace that philosophy of it's about giving more in value than you ever expect in return. I hate a win-win relationship, a win-win relationship implies. I'm going to allow you to win as long as you help me win. I want to see you win in spite of whether I'm winning or not. And I think once I really grasp that, and for those of you with are listening, the more you can focus on surrounding yourself in improving the lives, both personally and professionally of the people you work with. I think that gift of giving is going to pay off tenfold to your community, to your patients, to your employees, to your family and to yourself. That's what I, that's my message on that. That, that's what I've learned. It's been a long haul. It's been a lot of ups and downs, but I'm, I'm convinced that that is what has led to my success and the success of so many other people I've worked with. I've been blessed to work with over my lifetime. Speaker 1 (29:49): That's awesome. And now I feel like I'm going to ask you the question I ask everyone, and, but maybe you just answered it. I don't know, but looking at where you are in your life and in your career, what advice would you give to your younger self? Let's say right out of, you know, right out of college. Speaker 2 (30:07): Oh my gosh. Right out of college. Well, I think the advice I would give my younger self is to be more introspective, you know, be, be a better listener, you know? Don't, don't be so full of your own fixed ideas, you know, be willing to be willing to step down off of that and, and embrace the ideas of others, no matter how foreign they may be to you. So I've looked at it like that. I think that's really changed my perspective over the, over this, especially this last decade, but I've learned to not think of my thoughts. First. I've learned to focus on what's being said to me first and literally take it in, duplicate it to its fullest. Meaning before I communicate back and I'll leave this one phrase and this rattles through my head all the time, whenever I'm in a situation, I'm always reminding myself, don't react, respond, don't react, respond. And so many wild things are happening in our society today. And I think a lot of people respond, respond, respond, and I tend to sit back and take it in a little bit more. And I like to give an approach. I mean, react, react, react. I like to give an appropriate response rather than just be so reactive. So I think that's really changed a lot about me. And that's, that's about all I can say about that. Speaker 1 (31:38): Yeah. That's great advice. I mean, great advice. I love the respond, not react and guilty, guilty here of, of reacting maybe too much when I need to just sit back and respond. So it's something I'm going to remember now, where can people find you? If they have questions they want to get in touch with you, they want to learn more about you, the business, all that stuff. Speaker 2 (32:00): Oh, great. Well, they can reach out to us. You know, we're on Facebook at Meg business management, you know, that's our handle there and you can follow us on Twitter at Meg business or Instagram at Meg business management as well. Our website is www.megbusiness.com. One of the things we really like to do is we like to, like I said, give and without, so we give free practice assessments. We give free practice stress tests. So if they want to reach in, you know, they can email us@infoatmegbusiness.com, for sure. And for your listeners, you know, special for your listeners for this year, you know, until we hit 20, 21, any service they want to do with us any training they want to do with us, they get a 10% discount. We'll just take 10% off anything they want to do. And that's just for your listeners. Karen, all they have to do is reach into us and say, they heard us on this podcast and my team will just go ahead and honor that anything we can do to add value, I'm happy to do it. Speaker 1 (32:51): Awesome. And just so everyone out there listening, of course, we will have all of the links to this one, click away at the podcast website at podcast at healthy, wealthy, smart.com. So if you didn't take everything down, don't worry about it. It's will all be in the resources section under this episode. So Brian, thank you so much for coming on. This was this was wonderful. A lot of great advice, especially as we're winding up the year and kind of moving into 2021. I think this is the perfect info for all of those physical therapy, business owners and entrepreneurs, and intrepreneurs out there. So thank you so much. You're welcome. Speaker 2 (33:30): You're welcome. You know, I think we should look into next year and everybody should have a handle on the bottom of their email. I know when my email signature goes out, it always says, expect to do well. And that's one of the things I like to get people just wake out of bed, wake up out of bed, start every day, expecting to do well. Speaker 1 (33:46): Awesome. I love it. I may, I may add that as a little sticky note on my refrigerator in the morning. I'll frame it. I love it. Thank you so much for coming on and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.    

On this episode of the Healthy, Wealthy & Smart Podcast, I welcome Dr. Theresa Marko, PT, DPT, OCS, to talk about advocacy efforts in physical therapy. DR. Marko is a Board-Certified Orthopaedic physical therapist & Certified Early Intervention Specialist with over 20 years of experience. She is the owner of Marko Physical Therapy, a private practice in New York City, specializing in orthopedics, adolescents, and pediatrics. In this episode, we discuss: -Her path to advocacy -Federal Bills that are important RIGHT NOW: 9% Cut, Telehealth permanence, Student loan Debt -State vs. Federal Advocacy  -Traditional Advocacy vs Armchair Advocacy -Key Contact: APTA & PPS -Social Media importance: AMPLIFY, Access, Recognizable, Find others Resources: Dr. Marko on Twitter Dr. Marko on Instagram Dr. Marko on Facebook Dr. Marko on LinkedIn Advocacy is not a Spectator Sport A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.  More about Dr. Theresa Marko:  Dr. Theresa Marko, PT, DPT, MS is a Board-Certified Orthopaedic physical therapist & Certified Early Intervention Specialist with over 20 years of experience. She is the owner of Marko Physical Therapy, a private practice in New York City, specializing in orthopedics, adolescents, and pediatrics. She has helped thousands of people to overcome injuries, optimize their movement, and return them to work and sports pain free and better than ever. When she is not caring for patients, Dr. Marko can be found in legislative offices in Washington, D.C. or Albany, New York. She is passionate about making a change in healthcare and has made advocacy a cornerstone of her practice. For over five years, and hundreds of hours, she has lobbied on behalf of her patients and her profession on topics such as repealing the Medicare cap, reducing student loan debt burden, and lowering copays. She forms public policy priorities as part of the American Physical Therapy Association’s Public Policy & Advocacy Committee, the advisory council for the board of directors of the association. In 2020, she was awarded the prestigious Doreen Frank Legislative Award, given to only one person a year, by the New York Physical Therapy Association for her outstanding advocacy work. Dr. Marko’s expertise is featured in The Wall Street Journal, PopSugar Fitness, Self, Cosmopolitan, Muscle and Fitness, Business Insider, LiveStrong, and Healthline. She has spoken at Columbia University, Duke University, & Touro College about patient and physical therapy advocacy. She was recently appointed to the editorial board of SpineUniverse as the first and only physical therapist on the board.  She lives in Brooklyn, NY, with her husband of 13 years and her French Bulldog, Rondo.   Read the Full Transcript below: 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 podcast. I'm your host today's episode Speaker 2 (00:40): Is brought to you by net health. So net health has created the reduct patient portal, which provides a secure line of communication between you and your patients. You can use it for video conferencing for tele-health for secure messaging, to respond to non urgent questions from patients. You can share documents and photos, and your patients have 24 seven secure on demand access to their therapy, health information without phone calls and voice messages. If you want to learn more about the Redarc patient portal, contact them at redox that's R E D O c@nethealth.com. Now on to today's episode, we're going to be talking all about advocacy for the profession of physical therapy. And I couldn't think of a better person to have as my guest to talk about advocacy. Then the 2020 Doreen Frank legislative award winner, which is given to only one person a year by the New York physical therapy association for outstanding work in advocacy, dr. Speaker 2 (01:44): Theresa Marco, she's a board certified orthopedic physical therapist and certified early intervention specialist with over 20 years of experience. She's the owner of Marco physical therapy, a private practice in New York city, specializing in orthopedics, adolescents, and pediatrics. She has helped thousands of people to overcome injuries, optimize their movement and return them to work in sport pain-free and better than ever when she's not caring for patients. Dr. Marco can be found in the legislative offices in Washington, DC or Albany for over five years and hundreds of hours. She has lobbied on behalf of her patients and the profession on topics such as repealing the Medicare cap, reducing student loan, debt burden, and lowering copays. She forms public policy priorities as part of the AP TA's public policy and advocacy committee. The advisory council for the board of directors, her expertise has been featured in the wall street journal, PopSugar fitness, self Cosmo, muscle, and fitness business, insider live strong and health line. Speaker 2 (02:45): She has spoken at Columbia university, Duke university and Touro college, and she was recently appointed to the editorial board of spine universe as the first and only physical therapist on the board. So what are we talk about? So today we're talking about her path to advocacy and how you can get involved and why advocacy is so important. The federal bills that are important right now, which includes a 9% cut to Medicare, very important, call your legislator, tell them not to do that. The difference between state and federal advocacy, how to find your legislators and find out what Theresa calls, armchair advocacy, what key contacts are, social media around advocacy. And so, so much more. So this is a great episode. If you are at all, considering getting involved in advocacy efforts, then you're going to want to listen to this whole thing. Theresa gives a lot of really easy ways to get involved. So thanks to Theresa and everyone enjoy, Speaker 3 (03:49): Hey, Theresa, welcome to the podcast. I'm happy to have you on. Thanks for having me, Karen. Yeah, absolutely. And today we're going to be talking all about advocacy. This is one of your specialties. So you've been involved in advocacy around the American physical therapy association for the profession of physical therapy. For many years, you're a mentor to many up sort of younger physical therapists and physical therapists. Who've been around for a while, but are just new to advocacy. So why don't you give the listeners a little bit more about why this is one of your passions? Sure. So I didn't start out on this path and this is not something that I thought I would be involved in. There's two main events that kind of propelled me towards this. And, you know, the first is I've been a physical therapist now for about 20 years. Speaker 3 (04:43): So I'm older than I look. And what happened was I started to get some hip and back pain that was pretty substantial, you know, MRIs. They wanted me to get an injection. We were talking about surgery and unfortunately the things that I had done to try to rehab myself, didn't get me that much better, but I found dry needling. And I found a physical therapist who became an acupuncturist. Bianca bell, Deni leveraged a death, and she's a master at dry needling. And I loved what she did. And basically, you know, I had a severe spasm in my opterator internist that was killing me and my hip flexor and they were fighting. So I loved the needles. They made such an impact in my life. I can now walk around and not feel that pain in my hip and going down my leg every day. Speaker 3 (05:28): And I wanted to use the needles because I loved them so much, but we can't use them in New York. Why? Because it's the law. So that made me upset and I wanted to change the law. And I was really interested in that and why dry needling was such a, you know, variation from state to state, but it's a state law. So that was something I found out then kind of soon after that, or during that time, I also decided to go back and get my transitional DPT. And I took a professional development course. They talked a lot about advocacy and it just dawned on me. And I had an aha moment that basically all the things that I didn't like, the Medicare plan of care, the authorization, the way that you get like six visits than four visits than three visits, you get kicked off with some insurances. Speaker 3 (06:14): These things that I had been practicing inside the system for so long that I found so frustrating and so annoying, I realized where because of the law and that they could be changed. And I just decided that one day after taking that class, that it was going to be my mission to try to change these laws, to make the profession better for me, for those generations coming after me for our patients and basically for everyone. And it also dawned on me that legislators in general really don't know what we do. And if no one tells them, they won't know, and they won't make the laws in our favor that will help us our profession and our patients. So, you know, whether anyone likes it or not, we all have to operate in quote unquote, the system. And, you know, that's the government, the democracy, the bureaucracy, the politics. And in order to change that you have to be involved in advocacy. So that's, that's my why. And the other thing that I'd like to add is, you know, what's the alternative to not say anything, to stand by yourself, to get swallowed up by another profession that has a bigger association and a bigger lobby who would be our voice. So if not you then who I love, Speaker 4 (07:28): I love it. And I think that's a great reason to become an advocate for the profession. And so often, even when I ask people, why did you get into physical therapy? It's always, you know, you have these aha moments. You have these times in your life where you're like, well, this isn't right. And, and as you dig deeper, you think, Oh, there's actually something I can do about it. I can use my voice. I can speak to my local legislators. I can speak to my, my national or federal legislators. And so let's talk about that. So you've got each state has a state government, and then we obviously have our federal government. So how, as a, as a physical therapist, like, what's the difference? How do we, how do we advocate to each of these groups? Speaker 3 (08:21): So when I had to made that decision, that I wanted to become an involved in advocacy, it was tough to figure out at first. And that's one of my other passions is trying to help other people figure out the path because the path is not easy. And these things are very frustrating and confusing. So some things are, remember that. I get asked a lot of questions about art to remember that we have state government and we have federal government. And some of these laws are state laws. And some of these are federal laws. So when you look on the AP TA's website, under advocacy, apa.org, backslash advocacy, it'll show you the federal bills and the things that we're, you know, constantly fighting for now. And then if you go to your state chapter and they should have hopefully an advocacy page on there, on their website, it'll show you the state laws. So dry needling, as I mentioned before, is a state law. Whereas something like making tele-health permanent for the entire country, that's a federal law. So that's kind of, you know, you need to know the difference in like what you want to fight for. Do you want to fight at a federal level? Do you want to fight a state level or do you want to fight it? Both me personally, I think they're intertwined. So I go for both Speaker 4 (09:33): And there, but there are some laws that are very specific to the state, right? Speaker 3 (09:40): Yes. Like direct access. So that's another one, right? So direct access is super important in the state that you and I live in New York, we have a direct access that allows us 10 visits or 30 days, whichever comes first. So currently on the New York physical therapy associations agenda, we are trying to fight for unrestricted direct access. And that means you don't need a physician's prescription to go see a physical therapist. And again, when we talk about, you know, legislators don't know what we do, patients also don't know what we do. And I found that out and that's become another passion of mine is to get the word out and let society as a whole know what we do. And I repeat myself over and over. No, you don't need the prescription to go see a physical therapist, look up the direct access law in your state, all States now all 50, have some form of direct access. Some are a little bit better than others. But like, I think Texas, right now, you can only go see an evaluation and then you have to get a prescription, but that is a state law. And that does vary from state to state. Speaker 4 (10:40): Right? So if you are interested in advocacy, I think the bottom line between state and federal is know what your state is fighting for, and then know what, what the, what you're fighting for at the federal level, which brings me to my next question. And that is what are the federal bills that are important right now, as we speak today is Monday, November 2nd. What is important right now? And FYI, as we all know, tomorrow is tomorrow is election day. But that being said, what are the bills that the AP TA is fighting for right now on the federal level? Speaker 3 (11:23): So there are so many bills, but the two, you know, cream of the crop right now are going to be reversing the 9% cut that CMS centers for Medicare services has instilled upon the profession that will start January 1st, 2021. And the reason why this is so important. So this is federal okay. If CMS decides to cut Medicare recipients, 9%, that for some businesses is going to be, make or break, even with the pandemic loss revenue and everything, they might have to close their doors. They might have to stop taking Medicare patients. Medicare patients will have less access, there'll be less clinics. So that's, that's one aspect of it. But here comes the second aspect, you know, of the trickle down possibilities, whatever Medicare does is generally the precedent for what all the other insurances do as well. So the other insurance will probably start to follow suit and there you have cutting reimbursement to our profession. Speaker 3 (12:20): Again, more businesses closing all patients, having less places to go, less availability, less access through my years of advocacy, one of the phrases that I've come to realize is barriers to care, you know, access to care. There are all these stumbling blocks that make it hard for people to get the services that they need, you know, instead of seeing physical therapy, because it's difficult, you have to get a prescription or you don't only have, you know, six visits. It is easier to go see a physician and get an opioid prescription, things like that. So certain things drive it. So advocacy is intertwined with all these things. So that 9% cut is really important for that reason. And then the other hot button item right now is tele-health during the pandemic you know, here in New York city where I live, I shut down for a little while. Speaker 3 (13:10): I know a lot of people did. I didn't have tele-health set up with my practice at that time, but then I implemented it you know, in late March and many people across the country, physical therapy practices did have tele-health. We were not able to use it before for Medicare recipients, CMS applied a waiver, allowing us to use it. And it ends when they declared the pandemic over. So there we are going backwards again. So one of the things we're fighting for is to make tele-health permanent permanent again, access that people can get in the door and see their physical therapist. And I've used it. I had a patient who she fell down and she hurt her foot in the pool. And she said, Oh, someone at the you know, pool was a, I guess, a personal trainer, no disrespect to them, but they said, Oh, it's not broken. And I took one, look at it. I said, Oh no, your foot's broken. I could just tell. I was like, we need to get you in a boot. You need to go see, you know, get an x-ray. So, you know, tele-health is invaluable to people. They can get any immediately, the minute they hurt themselves. So making tele-health permanent is really important Speaker 4 (14:18): Because if we're supposed to be really taking care of the most vulnerable, especially during a COVID pandemic and the most vulnerable are over 65, it only makes sense to allow those people to have tele-health appointments. Speaker 3 (14:34): Yeah. I mean, also I used it with the patient the other day. She said that she wasn't feeling too well out of an abundance of caution. She was going to get a COVID test, but she opted for a tele-health session. So we switched from an in-person to a out just like that same time, same, same day. She was able to do that. She just didn't want to put me at risk. And I appreciated her watching out for my safety. So during these times we need that, you know, also people who live in areas where they have to travel far or snow treacherous conditions. Do we want people out in these conditions tele-health could be useful for that? I had a patient who I'm currently treating for her knee. She woke up the other day, her back was an agony. She said, Oh my goodness, my back's hurting. Speaker 3 (15:18): I don't know what to do. I said, let's get on a tele-health we did some gentle movements and some stretching. And she said, wow, by the end of it, my back feels much better. Thank you so much. I didn't know that a telehealth session could help that much. And all I did was show her some things to do to give her some advice. So telehealth is so useful in so many situations that I do hope that we can make it permanent. Yes. So do I? Okay. So now we know what federal bill bills are important. Your state bills, obviously you'd have to go on to the, your state PT association. And like you said, before we went on, hopefully there is an advocacy tab within your state physical therapy association website. And that's where you can find out what is on your state legislative docket right now. I mean, we're not going to go through every all 50 States. So for the people listening out there, that's where you would find it. Am I correct? Exactly. Yeah. Okay. All right. Now here's a question. How do we find who our state and federal legislators are? And on that, Speaker 2 (16:28): No, we're going to take a quick break to hear from our sponsor and be right back with Theresa's answers. This episode is brought to you by net health, helping you maintain strong relationships with your patients. The redox patient portal provides secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages, video conferencing for tele-health secure messaging, shared documents and photos and view health information, and appointments to learn more, contact them@redocatnethealth.com. Speaker 3 (17:16): So at a federal level a PTA makes it so easy for you. If you go to the APGA action app and that's downloadable in the I store and also Android. And I think you just type in APGA advocacy and the Apple pop-up. And if you're a member or non-member, you can use it. You just, I think if you're a non-member you just type in your address and it will, auto-populate all of your legislators. I actually think it does federal and at the state level too. So one way, but if you want to do it, you know, without that you could also, for federal, you could go to gov track.us, and that would look up your federal legislators, but then at a state level, your state Senator, and your state house or assembly person, you would have to just probably go to the, each one's website and look that up. Like in New York, we have a state assembly and state Senator website that you can search it for. So it's not that hard. Speaker 4 (18:13): Okay, awesome. Very easy. So people people understand how simple it is. Just one click or one downloaded app. So now let's talk about the act of advocacy, right? So we talked about why you wanted to be an advocate, how to find those legislators what bills are on the docket? How do we reach out to advocate? How do we do it? Speaker 3 (18:37): So the traditional way of advocacy is what we call lobbying. And that would be to go in person to have a meeting face to face with your legislator and ask them to do what's called co-sponsor the bill. That means like, say for the tele-health. If we have a bill number that has been introduced into the Senate or the house you would go, and you would ask them, would your member of Congress sign on to that bill? And then when you get enough co-sponsors you can get a vote. And that's how the bill can get passed into law. So that's traditional. And we can do that both at the federal and the state level. You could go to your state Capitol, like here in New York, it would be Albany. I could go there. So you can do advocacy, AKA lobbying to either one of those, but there's some stumbling blocks with that, that I found people. Speaker 3 (19:30): One are a little bit intimidated to do that, too. It can be far three. You have to take off time from work, usually because it's only during weekdays. You know, for me, I live in Brooklyn, Albany's a hike. So it takes a while. So there are some stumbling blocks with that, but that's their traditional way. It is a really fantastic experience. Anybody who wants to can come to Washington DC, the APGA does have a federal advocacy forum every year. It's generally in March this year, it will be in September because of the Centennial, but it's pretty exciting to walk the halls of Congress. And hopefully, you know, the country opened back up and we can have those face to face meetings this year. We did those kinds of meetings, virtual on zoom. It was okay, but I wouldn't say exactly quite the same energy. Speaker 3 (20:15): So that's the traditional way. But here comes my favorite part. I call it armchair advocacy. Literally things you can do while you are just sitting, you know, watching a movie, half watching. So there are things you can do where you can you know, go to the action app. You can fill out one of the templates there. The APGA has made for you where you can just send an email. You can go to your legislators own website and send them an email. There. There's always an email me button. You could just donate some money to PT pack to let other go do these things for you, let your money do the talking. But one of my favorite ways would be Twitter, right? So Twitter is free. Your legislator has an account. They're always there. You can follow them. You can like them. You can engage with their tweets. Speaker 3 (21:05): Just yesterday here in New York city, you know, speaking of legislators, I heard that mayor, bill de Blasio, he had to stand in line to go to early voting for three hours and he was complained. His back was her. And so I sent him a little tweet saying maybe he needs some physical therapy. So, you know, they're always on Twitter and you can send them a message anytime you want. You could also send them a message asking them to co-sponsor bills. I send out tweets to them doing that all the time. But one of the amazing things that I love about Twitter is you find like-minded individuals, you support them, you amplify their message. And, you know, you can kind of collaborate with people on advocacy there. Some other ways is that your member of Congress generally has virtual town halls these days, and they will post it on Twitter or Facebook usually only a day or two before. So you have to kind of watch out for that, but you can attend the virtual town hall and you can make comments and you can ask questions. I've been to several of my members of Congress town halls, and I asked them questions. I asked them about the 9% cut. That's something I will use support, you know, revoking this 9% cut. Those are the questions that I put in there. So, you know, lots of ways that you can do the armchair advocacy. Speaker 4 (22:19): And can you also talk a little bit about the key contact programs? So there's key contact programs. I know for APG as a whole, we're both part of the private practice section. They have key contacts. So what exactly is that and how can someone get involved if they're, if they want? Speaker 3 (22:39): Yeah, so AVTA has good point. APGA has key contacts and basically what a key contact is. It sounds a little bit more involved than it is. It just means that you are going to be that liaison to your member of Congress. That you're going to basically try to let them know what it is physical therapy does. And you're going to ask them to co-sponsor our bills. So the ask is, and you can be an apt, a key contact. And if you're a member of the practice, Speaker 4 (23:06): Have a Speaker 3 (23:06): Practice section, you could be a PPS key contact, and you can be a key contact for both APA and PPS. If you remember PPS. So what you would do is whenever there's a bill coming out, like say, there's going to be something coming out about the 9% cut. You would get an email from the key contact email list or from the PPS key contact email list. And it would just say, send this email and they generally give you a template. You could just copy and paste and you could send them the email on their website. You could send them a tweet. You could call the office. It's basically just asking your member of Congress to support our legislative agenda and our bills. And you would do that, you know, through those pushes. And then in August, we have August recess. When the members of Congress, your Senator and your house person comes home to the district to do district work. And generally we ask you to try to get a meeting with them, either on phone or zoom or in person, you know, before COVID to ask them to co-sponsor some of our bills then. So it's, you know, really a big push in August for those August recess meetings. But throughout the year, it's just a little pushes for the current bills that are going on. So it really doesn't take that much time. And how successful Speaker 4 (24:19): Are the, is the key contact program Speaker 3 (24:22): It's very successful because the whole point is good point. I forgot to mention this most members of Congress. If I called up your member of Congress, he is not going to be so interested in me because I'm not a constituent, that's the magic word. I don't vote for him. So yeah, he will care what I say, but his ears are not going to perk up as much as if you called because you are a constituent. So that's what key contacts are. They are a voting member in that person's district, AKA constituent. And so then the member of Congress cares more and they will listen more closely to that person. So you become that link, that voting constituent between the physical therapy profession and your member of Congress. And it's been very successful. We've had a lot of people sign on to bills, you know, currently with the 9% cut. I forget how many people signed on recently to a congressional letter, but it was the most that we've ever had. It was I think a couple hundred. And you know, hopefully that's something that we can get overturned and that's because the key contacts reached out to their member of Congress to ask them to sign on to this congressional letter. Speaker 4 (25:31): Yeah. So for me, what I'm getting out of this talk is that there's so much happening behind the scenes to advocate for our profession and advocate for our patients. But I think a lot of people don't realize, and if you want to make a change, then you have to let your voice be heard and advocating for the profession, whether you're a key contact or you're sending a template letter that you can easily get on the app is such a great way to get involved. And it doesn't take a lot of time. It doesn't take a lot of money and it's a way to help advocate for the profession and push us forward. So, you know, it sounds cliche, but like you, you want to be the, what is it? You want the change you want to be in the world or something like that, but be the change you want to see in the world. So if you're not in it, then, you know, Speaker 3 (26:25): Yes, absolutely. One thing I did want to mention is that APA has something called the advocacy network. If you just Google APJ advocacy network, it will take you to that link sign up for that newsletter, basically, that is part of the advocacy army. And you will get all of the news alerts of what's going on and they will send you, you know, literally a template that you could just fill out. We have this thing called voter voice, which it's just a automatic template. You input your name and address, and you can fill that out and you send a letter to your member of Congress. So sign up for the advocacy network. That way you'll always know what's going on. I am in a lot of Facebook groups and I see people upset and complaining. And I understand I used to feel the exact same way, but they are some uninformed and don't know what's going on. So join the network, know what's going on. You know, I always say one of my things is that I firmly believe the bigger voice, the bigger impact. If we can get a bigger collective voice, we already have a pretty big one, but let's make it louder. You know? And let's, let's make more of an impact and see real change because legislatively is the only real way to make the system different. Speaker 4 (27:39): Absolutely. And I was going to say what, you know, as we start to wrap things up, what do you want people? What's the message that you want to leave for the listeners, but I think you just said it, is there anything you want to add to that? Speaker 3 (27:53): Yeah. Join the advocacy network. And honestly, I would say, you know, don't be afraid of Twitter and come on Twitter because you can, we can build the army because when other, when you say something on Twitter and then you can amplify each other's message and then it kind of catches on and people, people, you know, get more informed and you can spread the message. So being able to amplify and spread the messages. Speaker 4 (28:15): Awesome. And now, before we leave, I'm going to ask you the same question I ask everyone. And that's knowing where you are now in your life and in your career. What advice would you give to yourself as a new grad, fresh out of physical therapy school? Speaker 3 (28:32): I would say get good at what you do, your skills of being a PT. That was really important to me at first, but don't forget the professional aspect of it. That was something that I was lacking. And I think that, you know, recently I was also featured in an article for APGA on burnout that just came out last week. And I think that that was one piece I was lacking and being involved professionally in advocacy and not just, you know, becoming a super PT and good at my hands. But having that professional aspect, I think also does help prevent burnout because you, you see that there's a bigger mission and you see that there's something beyond yourself and you're fighting for that bigger mission and you feel part of the community. And I think it's Speaker 4 (29:16): Awesome. Great advice now, where can people find you? Where, where are you on Twitter? You mentioned a couple of times and then give us all the info. Speaker 3 (29:24): So of course I'm on Twitter. It's Theresa T H E R E S a Marco, M a R K O P T. And then I'm also on Instagram, dr. Theresa Marco, and I have a Facebook page, Marco therapy Speaker 4 (29:42): And LinkedIn too. You can find me there. Teresa Barco. Perfect. Very easy, very easy, very easy. So listen, if anyone has any questions, they want clarification on advocacy, Theresa is your go-to person. So I encourage you to follow her on social media to reach out with any questions because she will get back to you. So, Teresa, thank you so much for coming on and giving us such a succinct and informative episode on advocacy. Thank you so much. Thanks for having me and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart. Speaker 2 (30:19): Thank you to Teresa. So hopefully now everyone has some good action items that they can add to their list, to become advocates for physical therapy. And of course, thank you to net health for sponsoring today's podcast. They have created the Redarc patient portal, which provides a secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages to learn more, contact them at redox that's R E D O C at net. Hell.Com. Speaker 1 (30:59): 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.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Gina Kim, PT, DPT to talk about making the move from a physical therapist assistant to a physical therapist. Dr. Gina Kim is the owner of Maitri Physiotherapy, LLC in Central Ohio, the producer and host of The Medical Necessity Podcast, is certified in Integrative Dry Needling, is pursuing certification in MDT, and also uses her 10-year background in Tibetan Buddhism to educate her clients in mindfulness meditation. In this episode, we discuss: How to transition from a PTA to a PT What is a bridge program for PTAs The benefits of being a non-traditional physical therapy student The ups and downs of physical therapy school while juggling work and life commitments.  And much more!  Resources:  Maitri Physiotherapy, LLC Dr. Gina on LinkedIn Dr. Gina on Instagram Dr. Gina on Facebook A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.  More about Dr. Gina Kim: Dr. Gina originally wanted to play the trumpet when she grew up. Performance anxiety in high school changed her mind. But what was more worrying was the low back pain that began around that time. She endured that pain for years, but X-rays and muscle relaxers didn’t help. She was fortunate to work with a physical therapist.  Being free from back pain was so dramatic that she decided that’s what she wanted to do with her life: Help people change their lives by treating pain, especially back pain, without drugs or surgery. She stated at the bottom as a rehab aide. Next, she earned her license as a Physical Therapist Assistant and worked for years in settings ranging from outpatient orthopedics to acute care to home health. While working as a PTA, she completed her Doctorate through the University of Findlay Weekend College Bridge Program. Dr. Gina is certified in Integrative Dry Needling, is pursuing certification in MDT, and also uses her 10-year background in Tibetan Buddhism to educate her clients in mindfulness meditation. She is also the producer and host of The Medical Necessity Podcast. Read the Full Transcript below: Speaker 1 (00:01): Hello, Gina. And welcome to the podcast. I'm so happy to have you on, Speaker 2 (00:06): Well, I'm happy to be here, Karen. Speaker 1 (00:08): So you've got two podcast hosts here. So now you're on the other side of the mic. Speaker 2 (00:15): Oh goodness. It's great to be. Speaker 1 (00:20): So today we're going to talk about sort of your non-traditional route to becoming a physical therapist. So as, as a lot of people know, or maybe some listeners don't know the physical therapy profession, we're now a doctoring profession. So people are going to school for an undergraduate degree and then usually going right into physical therapy school as their graduate school of choice. But Gina made a definite detour from college through to where she is now as a physical therapist. So I will throw it over to you, Gina, and just kind of tell us your story, because I'm sure it will resonate with a lot of people. Speaker 2 (01:04): Oh my goodness. So my bachelor's is in computer science and I won't say how long ago, but let's say windows 95 was the hot new thing. Everybody was getting a computer science degree. I was even, I was even a company's webmaster for a time. So here's the thing, here's the thing. I have zero patience for technology longstanding low back issues. Okay. And especially sitting at a desk job, you know, we all, you know, PTs, you know, now I, now I know well when I was working one particular job, you know, and couldn't take the back pain anymore. And what do I do? I go to see my, go, to see my family doctor and it's x-rays and muscle relaxers, and guess what? Didn't help shocker shocker. And I can't tell you how many years passed between then. And finally, someone I remember I had hired a personal trainer who was himself, a physical therapist, and he said, Oh, you need to see someone who really specializes more in the low back, you know, cause so sky was kind of more on the equipment sales end of things. Speaker 2 (02:38): So I found I found my PT and he it's it's so trite, you know, saying he did his magic on me. It's like, I know what he did on me now. But I went from unable to touch my toes. You know, being in pain, you doing, doing that shuffle walk too. Hey, I don't hurt anymore. Yeah. And his reaction was right. And I'm like, wow. And I kind of went away and being kind of in the transitional phase that I was in with a kind of not loving, you know, computer, you know, computer science, you know, that kind of field and also being kind of a gym rat myself. So I was hanging, I was hanging out with with my PT and kind of, you know, kind of doing my own observation hours and doing my due diligence and asking about the education and everything. Speaker 2 (03:46): And he said, well, you know, because I was already I think at that point out of my twenties, right. He S he said, well, you should think about getting, becoming a PT assistant. So I looked into that, it's like, okay, I've got my bachelor's let me go to community college now, which, which involved you know, of course there was like a well years waiting period. And, you know, so I'm taking my anatomy and this, that, and the other completed that in 2013 and then worked as a PTA and all the time thinking, you know, I, I just want to go ahead and be able to practice on my own. So then that led to well basically looking at my, looking at my options for grad school and especially being someone by this time, let's see, what was I doing? Speaker 2 (04:57): I, I was, I w I'm trying to think about my day as a, as a like during my PT assistant time, I was going to school and then going to work as a rehab aid. And that at night I was going to skate with the Ohio roller girls. It's like, I don't know how I did it. So then I'm thinking if I go into a graduate program in, you know, physical therapy, I there's going to be this age difference at age and experience difference. And I remember I interviewed with one school and the she was, she was the admission secretary. And I won't say which school, but she said, you know, people are working later in life. Speaker 3 (05:55): Yeah. Yeah. Speaker 1 (05:58): So I, Speaker 2 (05:59): I had heard about the bridge program up at university of Findlay. We can college bridge program. So that required preparation, as far as retaking physics taking, you know, my chemistry series, you know, thank goodness I had already taken exercise fits, but doing, you know, doing the thing so I could apply. And then that I got in, and at the same time, I was still required to work as a PTA as we went up to Finley every other weekend. And when I say we, I say, I met with my cohort from who came in from all across the country. So I had a two hour drive. There were people flying in from Seattle. Speaker 1 (06:51): And where is, so is Findlay college in Ohio Speaker 2 (06:55): And like colleges in North West. Speaker 1 (06:59): Okay. And can you explain a little bit more about what a bridge program is, should that people kind of understand what that means from like a PTA to a PT? Speaker 2 (07:10): Sure. So it's a bridge in the sense of you're a PTA and you want to become a PT, here's the thing. You will need your bachelor's degree. Okay. So I had that check you know, plus prerequisites, you know, check. And then since part of the requirement for working was to help with assignments that we would have, you know, and we would be given so we could focus more on the evaluation part of because we were all over the treatment part, you know, and there were people in my class who were already directors of rehab. So I, I was in a very very well-experienced and pretty, pretty smart class. It was, it was pretty intimidating. But also you get that benefit from, you know, all this co-mingling. So then it's basically like any other DPT program. It was three years, you know, with clinicals at the end, and then you take your boards and your, then I became dr. Dr. Gina. Speaker 1 (08:38): Right. And so within that, those bridge programs, how many of those programs exist in the United States? Speaker 2 (08:46): My understanding is only two, this one and one in Texas whose name is escaping me. Right. But but yeah, and here's the thing too because I always always kind of had in the back of my mind, well, I can always apply to the bridge program. It was, it was kind of like in my, in my back pocket, right. University of Findlay is a private school. So you also have to keep in mind the two wishes that goes with it, right. Plus travel accommodations, and also time off work when you need to, you know, do certain things, you know, such as your, your research and projects and, and all that. Right. Speaker 1 (09:38): And when it comes to then your clinical affiliations. So at that point, do you have to leave your PTA job in order to do your clinical evaluation or your clinical placements? Speaker 2 (09:50): Yes. And I would say it was a little messy because we were, we were pretty much we work, we were kind of responsible for finding our placements. Right. so yeah, so then you are going off, you know, working someplace now you don't have the income. Okay. So you have, you have that to deal with. And there were Oh, I don't even know how many people in my class had children, some had young children but you know, somehow they managed, you know we got a big heads-up from the class before us, you know, like in our orientation, spoke to us and said, you guys are gonna need a team to help you get through this. You have to rely on each other. You have to rely on your spouses, your partners, your friends, you know, some things as basic as have a food plan. And I'm not even kidding because, you know, between, between working, coming home and studying, you're done, you're done. You know, so my, my husband, you know, I, I started out, you know, like with the food prepping and the making the healthy food and every, by the end, we're eating pizza. Speaker 1 (11:26): Yeah. I was going to say, are you going to be, yeah, Speaker 2 (11:30): Can you, can you please, you know, pick up, pick up something? Yeah, Speaker 1 (11:34): Yeah. It's it's pizza and take out at the end. So I think that brings up a lot of really important considerations for people. So if you are a physical therapist assistant and you are looking to become a physical therapist, we know there are maybe just two bridge programs in the United States. And that there are a lot of considerations that you have to think about before you go into that program. Like when did you do your clinical placements? You kind of can't work at your job as a PTA anymore. Right? Absolutely. And what did you do? What would be your best tips for time management? We know, obviously you just gave away that by the end you're it's pizza and take out now I'm just joking, but what, what are some good tips on, on time management, as you said, you have to study, do research, and you're still working as a PTA. Speaker 1 (12:33): My, my time management, I think number one you know, God love him. I, you know, I have cats, I don't have children, you know, on it, honestly, I didn't know how the parents did it. And I think they were even better time managers than I was. So for them, it was, you know, working around, okay, the kids, the kids are in bed or it's before the kids are up. And for me, it was kind of the same thing. Like if I wanted to, you know, spend time with my, with my husband, you know, occasionally it would be up, you know, first thing in the morning because I'm more I'm and it also depends, you know, if you're morning person, evening person, you know, cause I'm like out like a light, you know, if I've got something to do, I'm up at 5:00 AM, no problem. Speaker 1 (13:32): And I guess the thing that I'm taking away here, and this, this might be my like naive T here, but I thought like a bridge program going from a PTA to a PT would be, I don't want to say easier than your traditional program, but that, because you're already in the field, that it would be easier. Do you know what I mean? And that's clearly not the case. Like I didn't realize it was three years. I thought, Oh, maybe it's like two years and most of it's clinical. So I think this is really painting a clearer picture for people of like, no, this is still a three-year commitment, three years of financial commitments, perhaps loans, everything else that goes along with it. Was there anything about the bridge program that surprised you? Because I'm surprised number one, that it's three years and that it's, you know, I don't, I don't know what I was thinking, but this was not it. So I'm glad that you're bringing all this up. So is there anything about the program that really surprised you? Speaker 4 (14:35): And on that note, we'll take a quick break to hear from our sponsor and be right back with Gina's answer. This episode is brought to you by net health, helping you maintain strong relationships with your patients. The redox patient portal provides secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages, video conferencing for tele-health secure messaging, shared documents and photos and view health information, and appointments to learn more, contact them@redocatnethealth.com. Speaker 2 (15:23): Biggest surprise for me was for a program that had been a browned, as long as it had been that we still had to work around a university and kind of the cap, the system that I think really, really wanted us to be a traditional program, you know in the sense of, for example, I know after us clinicals were starting to be changed to, I think, get people into the field earlier, which was, which was, you know, once again kinda messing with people's employment. So they were, they were serving us, you know, would you prefer, you know, to do like two weeks at the beginning and we're thinking, well, how, how are we going to do that? If you know, our, you know, our clinic, our staff, you know, wherever we're working needs us. Yeah. Not that, not, not, not what you would have expected. Speaker 2 (16:32): And yeah, I guess the next question is and you sort of alluded to this when you said you were looking at other physical therapy programs and the woman said, Oh, well, you know, people are working later in life, but let me ask you, which is kind of an interesting thing to say, but what, what do you feel like, or would you feel that you're kind of coming into the doctorate of physical therapy, not coming straight out of high school or straight out of college? What advantage did that give to you? Coming into the field as a newly-minted DPT? I think it gave us a huge boost of confidence because I know that in, in my career, as a PTA, I worked for probably a dozen different PTs seeing how they worked you know, what what they could have done better, you know, what they did great how patients responded, you know, and plus you know, I've, I've got all my treating already, they're already in place. Okay. so I even, I even find it a little hard to imagine. Wow. If I were, if I were coming out of a traditional program and I've heard this spoken about a little bit of, you know, just trying to build that confidence in that first year. Well, I came out and it was kind of like, well, you know, I just had evaluations to what I'm doing. Speaker 1 (18:20): And when, let me ask you this, when you were a physical therapist assistant, what was your experience like as a physical therapist? Speaker 2 (18:31): It really depended on the PT. A lot of them, I felt had a lot of trust in me because they, you know, they saw that, you know, their patients were getting results and I had good rapport with them and, and so forth. Had a few, it became, it became a little more interesting once I was in school. Because I know there was, there was one particular person who he was, he was pretty fresh out of school and he seemed to want to challenge me a lot, like, you know, kind of like, you know, pop quizzes and, you know, things like that. It seemed a little light gatekeeping a little bit. But I mean, that was, you know, that was minor compared to, you know, the other the other PTs that I worked with. Speaker 1 (19:33): Yeah. Well, that's interesting. I know, cause I, I, I often wonder what that experience is like. And then, so for you moving from the physical therapist assistant to the physical therapist was all about having a little more autonomy and agency over your career, is that right? Absolutely. Yeah. And when you graduated, what were your, how did you feel then? So, you know, cause it's, it's, it was a difficult to make that transition. Did you kind of fall back into old habits after you graduated? Or was it more like I got this, I'm doing it, Speaker 2 (20:10): You know, I, I would think it, it really felt like I was ready for this. Now, the part that I didn't expect, and I think this was from my experiences in my clinical rotations as a PTA and then do it in doing it again as a PT and also couple of affiliations. They were kind of more in kinda more of those mill like settings. So I didn't go into PT school thinking I'm going to become a owner, but once I was finished, I was adamant that I needed to create my own career. Speaker 1 (20:57): And you knew that. So when did you graduate from physical therapy school? Couldn't get your DPT. Speaker 2 (21:03): So let's grow graduation was end of 2018. Yeah. And then test it for my boards in what was wow. May how, sorry, how soon we Speaker 1 (21:20): Forget. I know you seem to have blocked that out. Speaker 2 (21:22): Yeah. I'm sorry. April, April. Okay. Speaker 1 (21:25): Okay. So, so it sounds like the experience that you have previously really set you up to then say, I'm ready to, to become that entrepreneur. I'm ready to kind of do this. Speaker 2 (21:39): I think as far as mindset. Yeah. Still in our, our business class was kind of the classic. Okay. Let's write a business plan about how to build a brick and mortar clinic. So then the business knowledge some of, some of it I, you know, took away from the free resources on the AP TA website but being a solo clinician and cash based I felt that I needed to look for kind of more support, you know, as far as networking and, and all that. And because I was dealing with different issues than say a larger clinic with, you know, accepting insurance and several therapists and whatnot. Yeah. Speaker 1 (22:38): Right. So, I mean, and of course, like moving on through the business, that's a whole other discussion, which, you know, maybe one day we will have on here as well. But what I think it's important to note is that, you know, you mentioned it briefly is the mindset part of it. You're like, Oh, I had the mindset part and kind of skimmed over that. But that is so important because like I said, when I graduated from PT school, no way in hell, did I ever think I'd be able to own my own business? Just wasn't even on my radar, you know? So what advice would you give to, I guess, newer, newer grads, whether they're traditional or non-traditional like yourself who are thinking about starting their own practice Speaker 2 (23:25): To find people in and hang out with people who, who were doing what you would like to be doing, you know? Yeah, there were already folks in my class who, you know, they were, they were having their plans in place. Like one of them was going to be, become a partner in a clinic. You know, I mentioned several were directors of rehab someplace, another guy he already had, you know, his his athlete and sports training practice up. I mean, he was, I mean, he was running that well, he was doing everything else. Speaker 1 (24:07): Yeah. So it seems, I think what's so interesting is, is that sort of non-traditional path to physical therapy. It seems like it, you know, because people have already gone through so many life experiences or maybe different jobs and they feel like, boy, they're really ready to be in the space that they're in and own it. Yeah, absolutely. Yeah. Yeah. Speaker 2 (24:34): And I definitely, I definitely know that confidence was there. And even, and at the same time, I know of a few classmates, they were already looking at residencies, you know, they were looking at specialization. Speaker 1 (24:54): Yeah. So, I mean, I, so I think to my big takeaway here is to all of the more traditional PTs out there who maybe have a non-traditional student or a physical therapist in their class, or who are in class with people who may be were our, our physical therapists assistants and, and going for that DPT is to make sure that you seek them out and learn from them because they've got these life experiences that when you're 21 and 22, you just don't have, you know, and so seek those people out in your class and, and definitely learn more about them and learn where they're from and where they want to go. Because I think that as a, not as a traditional student, and when I say traditional, I mean, you know, you came out of high school, went to college and now you're in PT school is sort of straight linear track. That there's so much more that the non-traditional student can can offer because you've got some more life experiences under your belt. Absolutely. Speaker 2 (26:05): Let me add another point to that. As far as the confidence part, because especially working with older clients, they seem to have a little bit more comfort working with someone my age. Speaker 1 (26:23): Mm. Yeah. And yeah, that makes sense. Sometimes kind Speaker 2 (26:29): Of already assumed that I was a PT Speaker 1 (26:33): Working there even as you were a physical therapist assistant. Speaker 2 (26:41): Yeah. As I said, I was a student Speaker 1 (26:44): Yo, as you were a student. Yeah. Oh, that's interesting. That's interesting. Yeah, yeah, yeah. I didn't even think about that. So, so the, the confidence, not just that you exude, but that, that the patients can kind of feel it and yeah, that's interesting. Speaker 2 (27:01): Yeah. And also I think the the ability to quickly develop rapport and all those, all those good skills, you know, like listening and responding and, and hearing and seeing how people are presenting instead of, you know, being, you know, well, you know, I'm still learning these basic you know, I have to learn all the things I, I have to learn how to evaluate, you know, but also how to treat and progress and this, that, and the other I've already, I've already got the, you know, I'm already thinking ahead, you know, to what their course of treatment is going to look like, you know, because I've seen it. Right. Speaker 1 (27:47): Yeah. You've got the experience. Yeah. Yeah. And experience, as we know, is, is so important. So, so let me ask you as we start to wrap things up here. So I gave you what my biggest takeaway was, what's your biggest takeaway and what would you like the listeners to take away from, from our discussion of your journey of this, of being a non-traditional PT? Speaker 2 (28:10): My biggest takeaway. So you have the benefit of the non-traditional experience, you know, meeting all these people with different, you know, different knowledge bases and certifications and things like that. Also at the same time, there's a, there's a challenge to doing things such as, you know, say going to a conference, you know, like CSM, because you're, you have to think about, you're going to be in school when a lot of these events happen. So it's like you, if you really, really want to go, you have to plan, you have to make plans for it and, and, you know, get, get an excused absence, you know, for want of a better word. So that, that can really, I, I think you need to then really, really work on your networking when you're finished. I think because of that. Yeah. Speaker 1 (29:20): Yeah. That may be aware of that. Yeah. Yeah. Yeah. That makes a lot of sense. And then, you know, I'll ask you the same question I ask everyone, and that's knowing where you are now in your life and in your career. What advice would you give to your younger self? And let's not say when you graduated PT school. Cause that was like a year ago. So let's maybe go back little bit more like maybe when you graduated undergrad or something. Yeah. Speaker 2 (29:45): Back in the day. Not, not everyone who gives you advice knows what they're talking about. Speaker 1 (29:58): True story. Yes. Speaker 2 (30:00): Because that's how I ended up in computer science, which was not the right career path for you, which was not the right career path. Right? Yeah. So yeah, the thing, the thing that I wish I would have done a lot more of was extracurricular, so I could have, could have known myself a whole lot better. That's great. But to make, yeah. To make make a better guided choice. Speaker 1 (30:29): Mm great advice now, Gina, where can people find you? So first of all, talk about your podcast and then where can people find you? Speaker 2 (30:36): I would be happy to, so I am the producer and host of the medical necessity podcast where I help guide people through the flood of medical information out there. I love it. Yeah. Available on wherever you get your podcasts, pod, bean, Spotify iHeart radio at iTunes and my business is called my tree physio-therapy LLC. You can find me@maitri.physio. And I practice in Ohio. I'm licensed in Ohio. I bring a world-class world-class physical therapy to your home or via tele health. So you can, you can find me there and I would love to treat that Speaker 1 (31:36): Awesome. Well, we will have all of the links to everything at the show notes at podcast out healthy, wealthy, smart.com. So if you didn't, weren't taking notes, don't worry. One click will get you to everything, including your website and your podcast and social media as well. Jean has got a great Instagram page where she shares a lot of great free information with everyone. So you'll definitely want to check out her Instagram, what's your Instagram handle Speaker 2 (32:06): At medical underlying necessity. Speaker 1 (32:09): Awesome. So Gina, thank you so much for coming on. This was great. And I think it gives people a lot to think about, especially those physical therapist assistants out there who may be there on the edge, maybe they're thinking, Hmm. Do I want to go on? So I think you gave a lot of great information, a lot of great insights, so I appreciate it. Speaker 2 (32:30): Well, thank you. And I hope absolutely anyone who has questions about this bridge program, feel free to reach out to me. Speaker 1 (32:39): Awesome. Thank you so much. And everyone who's listening. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts  

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Sarah Smith, PT, DPT to discuss how women can cultivate their core confidence. Dr. Sara Smith specializes in assisting female leaders, healers & creatives re-activate their Core Confidence. Specifically, women who wear many hats and desire to leave a legacy with less burnout and greater personal joy.  In this episode, we discuss:   -How women focus attention on external approval and achievements/external successes.   -Why we need to be connected, aware and in tune with our pelvis.   -Messages the pelvis (and body) may be giving us that we are missing   -Core Confidence-what it is. why it is so important   -How does reducing urgency in daily life payoff- how the mental affects the physical body.   -How mental and spiritual Core Confidence and awareness of our Core can affect physical core strength.   Resources:    Dr. Sarah’s Facebook   Dr. Sarah’s Instagram   Dr. Sarah’s LinkedIN   Activate Your Core Confidence Workbook   Discover Your Joy Coaching Session w/ Dr. Sarah   A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.    More Information about Dr. Smith: Dr. Sara Smith specializes in assisting female leaders, healers & creatives re-activate their Core Confidence. Specifically women who wear many hats and desire to leave a legacy with less burnout and greater personal joy.  Her unique approach focuses on connecting women back to their Core which holds authenticity, choice and immediate solutions so one can thrive both personally and professionally in all life situations. This activation is vital so that women leading their families, communities and companies can stay fully present in all situations in order to Communicate & interact authentically and calmly Finally feel their private life & success matches their professional success with greater freedom, confidence, peace, focus and direction. Flow through daily tasks and commitments with more focus, ease and an organized plan Improve physical strength & major health gains Live Wild & Bright- meaning! connected to our true, authentic, soul calling She has blended her professional expertise as a Doctor of Physical Therapy- specializing in Women’s Health and Chronic Pain Management, Certified Yoga Instructor & Certified Wellness & Life Coach. With every personal & group experience Dr. Sara Smith offers, she is dedicated to the goal of assisting women of all ages to step back into their Core Confidence.   Read the Full Transcript below: Speaker 1 (00:01): Hey, Sarah, welcome to the podcast. I'm happy to have you on, Speaker 2 (00:04): Thank you so much for having me, dr. Litzy. It's glad to be here. Speaker 1 (00:08): Yeah. And so obviously I'm a physical therapist as are you, you have specialized in pelvic health and women's health, and then you have also kind of made that transition for at least part of your career into coaching, mainly other women from around the world. So before we get into the meat of the interview, I would love for you to share with the audience a little bit about your sort of career trajectory. Speaker 2 (00:40): Absolutely. Yes. So it's a, it's a little professional and it's a little personal, so it's the story tends to track with a little bit of both. I also went and got my yoga certification and that was actually the first thing that I did after physical therapy, you know, from, from physical therapy. A lot of that came because you know, in our profession we have a high turnaround and burnout ratio there at times. And I was a chronic fixer and helper and I was good at what I was doing to the point where I, you know, anybody came in and I was ready to, you know, help them with their issue. And so I went to my first yoga class, really just to chill myself out, get a little bit grounded and get, get real. And then from there it really almost overnight, it, it drastically shifted the way I was showing up and treating my patients at the time. Speaker 2 (01:42): I realized that kind of less was more, I realized that it was more important for me to listen instead of coming in with a plan and, you know, my own action sheet and really meeting people where, where we were, I think I was always empathetic, but it, it really enhanced that. And on top of that, I stopped getting sick. I was averaging, you know, a sinus infection once a month and just burned out already and young because I didn't want to, you know, you didn't want to fail having that syndrome. So really yoga kind of came first and then that solidified me for a while. I kept into the physical therapy world. I've always lived in rural areas in Virginia and I was on the Eastern shore of Virginia and I'm an only child. So I do like to be the only one doing something I like to be a little special. Speaker 2 (02:40): And, and so I realized nobody in the area was doing pelvic floor work. I had in all of my internships had some sort of connection to pelvic floor and women's health work. So I, I learned about it. I kind of knew about it. I didn't know if that was something that I wanted to get into. But I knew that it was a niche in the area that I was in. And so it was when I got into pelvic floor physical therapy work that I really professionally started to see this and, and chronic pain management has always been something that I just love helping people that have been to lots of therapists, physical therapists, and in there need assistance with that. But I was just seeing this mind body connection. I was seeing how with all of these individuals, and for some reason, I just happened to be working with a lot of leaders, professionals, directors, CEOs, you know, it just was kind of happening that way. Speaker 2 (03:41): Even some like rockstars lawyers, I don't know, Olympic swimmers, all these different people and stress was also happening mentally. You know, there were things going on either in their personal life or their professional life. That just seemed to be kind of also coming into what I was noticing in their physical body. So I was learning about it personally and just my own interest. And then I also was seeing it professionally and I was seeing when I started incorporating some of the yoga, you know, some of the mindfulness based practices and stress management breathing that I was getting better results. And I just am a result junkie. You know, I'm not interested in putting a patch on something. I want somebody to come back to me six or seven or 10 years later and be like, I'm still using what you did. So there was that. Speaker 2 (04:34): And then on top of that what I got into pelvic floor therapy, my started having children and my, our, our first child who's now seven was we found out at a very young age that he had an ultra rare genetic mutation. So it was de Novo. It wasn't for my husband or myself and severe speech apraxia. So I started getting, you know, deep into the world of executive functioning and,ureally learning more and more about kind of, I always loved the nervous system, but, you know, I became even more fascinated with how to manage that,uand, and work with it. And so that, those two things kind of happening simultaneously are what brought me into, into coaching. Umnd specifically working with female leaders, hecause that, I don't know, that's just like a deep within personal mission is I feel like women are here to make a major contribution. Speaker 2 (05:42): I feel like the time, the time is ripe, the time is now. But we've learned and write in it in a great way. We've learned from a very male dominated structure,uwhich doesn't always work for women. And,uit can, it definitely works. It's not that it's, you know, not working, but there, there are some things that need to slightly shift and,uI'm just, I really want to be able to contribute to women, being able to be in these leadership roles and do it without as much burnout do it without as much self-sacrificing,ufamily sacrificing community sacrificing. Uso yeah. Speaker 1 (06:32): Awesome. Well, thanks for that. Thanks for kind of letting the listeners get a little bit deeper into kind of who you are and why you do what you do, because it all leads into our discussion today. And it's, it's really all about as you say, why we need to be connected, why we need to be aware and in tune with our pelvis. So as a physical therapist, we can all agree that yes, we need to be in tune with that area. Everyone has a pelvis, everyone has that musculature and, and the functions of but coming from, I think your unique perspective of both physical therapist and coach and looking really beyond just the pelvic floor, which we should all be doing anyway. So, so give us your take on why we need to be connected. Speaker 2 (07:25): Yeah. You know, I've seen in, in the realm of success, leadership, entrepreneurship anybody who's, who's type a you know, th there's a lot of overthinking long to do lists. There's a lot of being up in our head, you know, w where do we go next? And I say, we, because this, you know, I've, you're only a great teacher if you've been there yourself, right. And, and are still in the depths of it. And so, you know, we th there's lots, that's constantly swirling up in our head, but we also know, and, and, you know, a variety of different resource research sources have shown us this, that we can't access all of the solutions to our biggest professional, personal life challenges. If we're in constant thinking mode all day long, not to mention, you know, roughly 80% of all thoughts are habitually negative, which is not very helpful for solving problems. And so the reason that I am so drawn to what I call, you know, well, it's not just me calling it a core confidence and getting people specifically into their pelvis and back into their body is, is reducing the overthinking so that we can access again, creativity, focus, productivity, you know, improved, sleep, stress, relieving, you know, hormone responses. You know, I could, I could go on and on. Speaker 1 (09:01): Yeah. And so you brought up the, the the words, core confidence. So can you explain what, what does that mean? Because I have a feeling it may mean a couple of different things to a couple of different people, but in the work that you do in helping people become more productive, improve their leadership, improve their life, what does that, what does core confidence? Speaker 2 (09:28): Yeah. I love how you said that, you know, it means something to, there's lots of different ways to describe it in there. There really is. You know, to me, and also the, the clients that I've worked with for many, many years now, it means freedom. It means expansiveness. It means seeking joy. It means effectively, you know, being effective at what they do. Meanings means also having more energy core confidence really is being able to go within yourself and access that wellspring of inner wisdom really access your, your yes or no. And a lot of times, and this is, this is actually comes from, from those in the research field. Core confidence also is a mixture of self-efficacy of hope of optimism and resilience. External confidence. I don't think we should be talking about core confidence without also touching on external confidence and external confidence is what the majority of us learn to, to seek after. Speaker 2 (10:43): And we're constantly seeking after it. The external confidence is, you know, does dr. [inaudible] Like me, or, you know, what I should be doing right now, or, you know, these are the, the, the dreams that, that others are doing. So this marketing strategy has worked for them. This app has worked for them, let me do this, let me, you know, follow this meal plan. And so, you know, we're constantly as humans chasing others, things that have worked for them. And, and we're very often, again, not realizing we're up in our head and we're not really checking in with the, the little voice that's like, that's kind of a waste of time. Speaker 1 (11:32): Yeah, totally. I, I always find that it's so much easier to look for that external validation and get our confidence from that external validation, then what we do than what we think we are doing. Does that make sense? Solutely yeah, so I, I mean, and, and we're all human and all humans fall into that trap. So can you kind of give us an example of how you might work with someone to help develop this core confidence and help to bring in more joy and help get them a little more grounded into themselves? Are there any sort of exercises or things that you do with people that you can give this as an example? Yeah, Speaker 2 (12:15): That's a, that's a great you know, I I'd say one of the main tips that I, that is probably ended up being my, my signature Sarah move,uhas been really, you know, so listening to somebody, I really love deep listening. I mean, I think when you start listening to someone, at least for me, I don't know this is, this is, h gift that I have is I start reading between the lines. Umnd actually I'm kind of diverting for a moment. A lot of times when I work with people, I don't do it over zoom. We don't do video. Umecause when you look somebody in the eye, sometimes it's hard to be a hundred percent truthful, you know, or again, you kind of fall into the, the external competence trap. Umnd so we do it all over the phone or, you know, with the video off so that I can really deeply listen. Speaker 2 (13:09): And what I'll do is, you know, if there's a belief in there for example, I was working with somebody the other day and she shared, you know, while we were talking about her personal life. And and she was like, you know, if I kind of keep having these, these, if I close the door on this relationship, I'm probably actually going to have to do a lot of hard work on myself to pick up the pieces. And what I asked her was, well, well, is that true? That working on yourself has to be hard. Speaker 1 (13:47): And when Speaker 2 (13:47): We, I call it, like, we've got to, we've got to go. I like going down the rabbit hole with somebody of like, really being like, why, why are we fearful about this? Like, let's, let's talk about it. Let's get to the root and let's shine the light on what, what the narrative is with this overthinking piece. Once we shine the light on it, half of the work is done because we've brought in awareness. And whenever you bring in awareness works time. Speaker 1 (14:18): Absolutely. Yeah. And it's, it's, you know, that you're right. Being able to listen and listen well is a gift, but it's also something luckily that can be practiced and can be worked upon as physical therapists. I think a lot of us, a lot of us are pretty good at listening. But when you work with, like you said, that chronic pain population, you really get, I think, a lot more in tune to what the person is saying. And you also learn how to ask those questions to draw out more thoughts. Speaker 2 (14:54): Absolutely. Yes. And here's the interesting thing that I've found. Okay. and, and I, a lot of this comes from like archetypes and youngian psychology is we have different aspects of our, of our psyche and of our personalities. Right. And a lot of times what you'll find is we learn these skills, we practice these skills professionally, but when it comes to the, behind the scenes for ourselves, we're almost like different people. I had a client the other day, you know, she is a director and has, has a large, very well-known board behind her. And and she's like, you know, if the board was to be a fly on the wall and kind of experience my personal life, they they'd be like what, you're not even the same person. Because suddenly things become matters of the heart. They're no longer again, the, the head, you know, so professionally relating people through this very well yet, we're not really sometimes having that, that advisor, that best friend, that we didn't even know we needed behind the scenes to help us hash out our own stumbling blocks. And that's where I think in, in leadership and entrepreneurship and being a CEO of, you know, your business and your life and trying to be healthy, wealthy, and smart, I think that's, we need that now. Speaker 1 (16:22): And why do you think that's so hard Speaker 2 (16:24): To, Speaker 1 (16:27): To confide in others of, you know, it's, it's a lot easier to say, Oh, you know, I, I didn't have any new patients this month. So, you know, I really w what do you think, how can I help? How can I get more patients? That's easy, right. To talk about our business and, and to talk about our our professional life. But why do you think it's so hard for people to confide in others on a more personal level? Speaker 2 (16:55): Hmm. I love this question. I really love it. Of course, I'm sure it's very multifactorial. I find that I don't, you know, I don't have any research on this, but I find that if you start looking back even into it and not like massively, but you start looking back into childhood, you know, where a lot of habitual patterns are formed and thought patterns are formed. A lot of times you'll see, you'll see trends there, but, you know, one vein of research shows that about half of all CEOs, those at the top are experiencing loneliness and loneliness in the sense that, you know, there has to be a level of healthy ego and confidence, right? B core confidence or confidence in order to want to succeed. You know, all sorts of people are teaching us out there and showing us that, you know, you gotta have some grit, you gotta have some resiliency if you wanna play this game. Speaker 2 (18:01): And it is a game. And so, you know, there there's factors of like, you can't trust everyone, right. If you have team members underneath of you traditionally that's really changing, I think, but traditionally we're taught, you know, you don't mix business and personal life. You don't do that. That's a no, no. Now you'll see that changing. And that's continuing to change because you know, many psychologists are beginning to study really resiliency and entrepreneurship and, and understanding more specifically how they're tied together, because it's, th that's really just a new field of, of understanding. He can't trust people, you know, and I think many have experienced, again, maybe it was in the past or more recently you know, you do share some of those personal moments and it might come back to bite you or suddenly the, the inner critic and other thought thought in the brain comes up and says, Ooh, that was not a good idea. You're probably that is going to backfire. You know, that could make you look weak. So I think it's very multifactorial. Speaker 1 (19:16): And I guess this is kind of where having someone, you know, outside of your direct business to have as a resource and to help you as a coach I guess I would, I'm assuming that that's where coaching comes into play, because you can kind of be that person to sort of help with the personal and the professional, because I can only assume that they're closely related. Speaker 2 (19:44): Right. They are way more closely related than people realize. And your professional self that like the way you act professionally is often different than the way you act and your personal life. Like, can you, can you relate to that? Speaker 1 (20:02): Yeah, of course. Okay. Speaker 2 (20:05): And so, you know, cause I, I, yeah, same thing for me too, but I'm always interested, you know, in what, what somebody, his answer would be. Speaker 1 (20:12): Yeah, no, there's, there's no question that, that we're a little different in our personal life than in our professional life. And, you know, it's funny to say, because I was having thoughts around that yesterday. Because you know, we're all human, right? Every once in a while, like we screw something up, we say something we didn't want to say we regretted afterwards. And yet you're vilified for being a human being. You're vilified for saying something that, yeah, like maybe what you said, wasn't the best thing to say, but you take ownership over it. You say, Hey, listen. Like, yeah. I mean, I, you know, I let my emotions get the best of me, which never ever happens in my professional life. Right. Right. In my professional life never happens. And yet all of a sudden you're demoted in the eyes of so many people, but all you did was you were just a human being and you said something, or you wrote something that you later like, ah, I can't believe I did that. And because it's not a podcast, we can't go back and edit it out. So I think that there is this, this weird kind of, if you start to melt the two together, you're going to be screwed. Speaker 2 (21:33): Yeah. It's a way or another, it's a belief. Absolutely. And I think that we need guidance to blend them appropriately, you know, because the answer is not, well, you'll see this as a marketing strategy now. Right. Where it's like, okay, show the behind the scenes and show yourself and be yourself and dah, dah, dah. Well, I think that there's always a, a middle ground to all of that, that we need to be aiming for. And again, it has to feel true to you, you know, like you have to get back into a state of checking in with yourself and not checking in with the head and the thoughts of like, okay, is this an alignment for me? And so, you know, in a lot of cases when you're blood, when you're, I like drawing on the professional self, like let's say, I might say, okay, what would professional dr. Speaker 2 (22:23): Litzy do when we're talking about something personal, because that's how the, the, the two aspects of you can really start blending together and start working together as a team and be like an integrated, whole healthy, beautiful person, right. Uwho can stay true to your individual values? You know, we get to like explore what those individual values are and being true to those,uin, in order to make it work for us, I've ever really cool example of a client who,ushe's in the hospital system and I'm pretty high up. And she was offered. We had been working for, I don't know, probably three to six months or something we'd been, she had been, and we were mostly working in the personal field, you know, but of course the professional always, always blends in. And she had been offered this incredible opportunity to lead this team. Speaker 2 (23:25): This was just in addition to her goals that she already professionally had for the year. And as she sat with that, and as I sat with that with her, she realized, you know, if this had been last year, I would have said yes to that. And I'm very flattered, but the truth is, is if I say yes to that, then all that I'm doing to take care of myself so that I can show up to meet my professional goals is actually going to be derailed. And so at that moment, it wasn't in alignment for her. And what was even better about that was then she was able to go to her boss and to communicate that I call it like, you know, communicating from the core, but communicate that not from up in the head like, Oh, no, I wonder what I'm doing. I hope, you know, hope I'm not really screwing this up, communicating it with authenticity, with crowdedness, with strength, right. With empowerment. And, you know, her superior was like best decision you ever made. I really appreciate it. Really championed to her now, how awesome would that be if we could have more of that in our small businesses and in all of our workplaces and all of our organizations, Speaker 1 (24:43): I mean, that's an ideal situation when the ideal situation, but I think it's hard when you're constantly kind of seeking out success and seeking to be quote unquote the best at what you do and to get that recognition and to build your business and to make more money. So you can live the lifestyle that you want to live and provide for your family or your friends or whomever is in your, your world. But how does, how does making these decisions, like you said, these sort of more grounded decisions where, where they are emotional versus making these decisions as strictly like pros and cons, like an intellectual pro and con list, you know what I mean? So how do you, how do you coach people in that tug of war? Speaker 2 (25:41): I hope I can answer the question of how do you coach people, because sometimes you just have to see it, you know, and experience it. But you know if you look, if you talk to anyone in the financial world, the stock market is emotional emotions drive everything. That's true. Right. And you know, if we're the faster, we're aware of that, the more tapped in that, that we're going to be. And so that's actually, what's happening is a, is a lot of times where we're making these leadership decisions, we're making these personal decisions when we're in a state of emotion. And often when we're, you know, emotions are coming from thoughts, right. You know, you know, the, the, the little wheel starts going and then suddenly, you know, we have these emotions with us. A lot of times you don't even know what the sensation is in the body, because we're, again, we're kind of more of in the head. Speaker 2 (26:36): And so when you can access, and what I do is often just really helping somebody with very challenging. Like I prefer the challenging situations, you know, where it's like, okay, why do I keep getting into this relationship? Why do I keep not, you know, being able to climb the ladder? Why is it I can't get, get know fit in the self-care pieces of it. And when we get to the root of it, a lot of times it's because things are happening in an emotional realm. And we've got to be aware of that, go down the rabbit hole of the actual, like fear and worry. And why, like, why are we responding the way we're responding? Why are we doing that? And then once you get to that, then you can actually get to the clarity piece where you get the clouds and the, you know, the fog out from your face. Right. You can go, okay, pro this con this dah, dah, dah, dah. Okay. Now I've got my marching orders go. And I, I don't know about you, but I like marching orders. I like to know the next step. Speaker 1 (27:37): Yeah, absolutely. And, and I think, you know, a lot of people who are in leadership positions or who are going out to be that entrepreneur, their dreams, like you are a type a person. I think you are a lot of just pros and cons. But I do think that the emotional segment of things does have to come into play because if your pros and cons from a very sort of robotic sense is, is okay, I guess, but then how is it going to make you feel, how is it going to affect your life? Are you going to be happy with your decision? Are you doing something because you feel pressure to do it because you have to do it, quote unquote. So I think being able to tap into that core confidence in that and your core values in order to help you make decisions is important. So it's like, I don't want to be on either pole, like purely emotional, purely cerebral, but you want to have, you want to be able to kind of get in there and go down that rabbit hole, which is not easy and takes a lot of self-awareness. Speaker 2 (28:44): Yes, no, it does. And that's why it usually takes a guide. Yeah, exactly. It really does. It takes a guide and you know, again, kind of that core confidence model that was not created by me, but having self-efficacy hope, optimism and resiliency, you know, these are things with, with a lot of difficult situations that, that our, our brain just has not been able to figure out the answer to. We tend to go down on the scale of those things, right? We're not trusting ourselves efficacy. We're not feeling very hopeful about it now, fascinatingly enough, you know, those that are fixers and types day and, and, and leaders if we can't fix something, if we don't know the solution to it, we're going to avoid it Speaker 1 (29:25): Totally a hundred percent. So it was easier and it's so much easier. Speaker 2 (29:30): We are to, to help and to show up for others and to fix the things that we know we can fix. And so again, then you see an imbalance and often times it's with the most challenging things that dealing with, again, personally, or professionally that we don't want to talk about. One of my clients, the other day was sharing,uyou know, this situation just resolved, but she was like, you know, I have been sitting on this,uspace like this, this land and space for the last 10 years. And I didn't know what to do with it. Now, when we got to the root of it, it was actually extremely emotional because she's in a family owned business. And it was something that a family member prior to her set up and, you know, really loved. And so it, it, it, it was way too. She couldn't make the decision because of the emotions connected with it. Uyou know, but she was like, I've been sitting on this forever and just avoiding it because I don't know what to do. So I can think of 50,000 other things to spend my time doing. You know, you can fix the kids, you can fix your friends, you can bring it into your professional career. And then meanwhile, some of the, you know, the other aspects are, are, are missing. Speaker 1 (30:44): I know I, when I get into those, those bouts of, Oh God, I can, I like will. And it's what I'm doing right now, which is why, when you said that you could do so, so many things to avoid. I'm like redoing my bookshelves, I'm doing some shredding of papers. I'm like crazy with the home edit. And now everything's in a rainbow, you know, I've got a lot of plastic bins hanging out everywhere. That's what I do when I'm trying to like, avoid looking at deeply at other things, you know? So that's what I've been doing for the past couple of weeks is I have been like cleaning out. Like my doorman was like, are you moving? I was like, Nope, not moving. Just, just finding stuff to do around the apartment. Speaker 2 (31:30): Exactly. Just being a great, you know, leader in the liver of life. Speaker 1 (31:35): Yeah, exactly. Cause I'm like, well, you know, if you come home to a nice clean apartment, it's better for your head. You can concentrate more when, you know, I probably need to go dig a little deeper and see, why am I doing all of this? And I know it's not just from watching the home edit, although it's a nice show. I'm sure it goes a little deeper. Speaker 2 (31:56): Well, it does, you know, and I'm glad you brought that up, you know, your, your personal situation, because I think that that helps all of us so much, you know, it's always nice to know when we're not alone. Right. And but you know, one of the biggest things that I've found in doing this work for as long as I have is people say to me, yeah. You know, I just, you know, everything you do sounds really great. Like that sounds awesome. It sounds like it really be helpful for me. And like, I don't really think I will, but I don't really think I want to go there. Uand we think, again, we think it's going to be hard, right? Like I was mentioning the client, the client earlier,u Speaker 3 (32:40): I have found that, Speaker 2 (32:44): And I think this is just my personality, but it's like, we got to make this fun and we gotta make this. Or action-oriented we kinda got to get the show on the road. So it's like, you know, again, if, if we're, if we're trying to leave a legacy, if you're trying to, you know, be productive and not give up on the idea that we have, you know, have success, then we are in a state in our country and in the world where, where we, we, yes, we can all, you know, afford to sit down on the couch with the weighted blanket and the wine and the ice cream, you know, but, but I just don't believe that, that we can afford too much of that anymore. I really don't, you know, like I, I need, I really feel so strongly that like, I need everybody to be functioning at a high level and it, it can be fun. Speaker 2 (33:40): It doesn't have to be like, Oh gosh, I'm, I'm, doesn't have to be so stressful. Yeah. Or like annoying, you know what I mean? Like, nobody really wants to like, look at themselves and see their shortcomings. And it's not about that. Like anybody that's trying to tell you it's about that. Th that's probably just perfectionist behavior showing up. It's not about that. It's about like, you've got to tap into your greatness. And when I say your greatness, meaning like just our essence, like our purpose of being here on earth, like something greater than ourselves, we've got to tap into that. We've gotten away from that. You know, that, that radical act of self-love that that's not just let me go draw a bubble bath. You know, that that is radically like, you know, we're all beautiful and we're here to share something great. Speaker 2 (34:37): One of the, one of the most upsetting thing, NGS, m don't know if you've ever experienced this, but, you know, as a physical therapist, when somebody has, host a limb or their pelvic floor is not working and they're upset with, you know, they have prolapse and they're like, Ugh, Ugh, this uterus, or, you know, gosh, my arm just looks awful. Now that pains me to my soul because I'm like, Oh, you know, like, gosh, your body has done so many miraculous things. I understand. And I empathize why you feel that way, but it, it makes me sad. And one of the things that has made me sad and being, you know, an advisor and a best friend to, you know, leaders who didn't even know if they needed that. Um,e of the things that makes me sad is when somebody comes to me and they're willing to just for a second share, I don't know if I can keep doing this anymore. Speaker 2 (35:35): I've thought about just giving it all up and going back to a simpler way of life and the same sort of thing. It makes me sad. Cause it's like, no, no, no, no, no, we don't. We don't have to do that. Like, you know, you, we don't have to, we just have to find some balance, right? Like you said, we don't need to be on one extreme. We don't need to be on the other extreme. We need to be somewhere in the middle and finding that is like super, super small finite changes. It's not the giant crazy things that changes that we like to make in our lives that we, you know, we think are going to be the solution. Yeah. Speaker 1 (36:10): I, I agree a hundred percent. And I think on that note, because I could keep talking about this all day. It's sadly, I don't know if the listeners want to listen to it all day. I'll do. I think they might. But I feel like we could keep going on and on here. But that being said before we wrap things up, just a couple of other things, number one, what, what are some of the big takeaways, or if there's one in particular takeaway that you want the listeners to leave this conversation with? Speaker 4 (36:46): Wow. Speaker 2 (36:47): I wasn't prepared for that. Dr. Lindsay. There is what I would say. The big takeaway that I really hope everybody understands is that when we get out of our head a little more often and start listening to the messages of the body, start listening to the messages of within then we really activate that core confidence. We step into a more effective way of leading and living and that's available to everybody and it's time to take it. Beautiful. Speaker 1 (37:26): That's a beautiful takeaway. Now you're welcome. And then of course, the last question that I ask everyone is knowing where you are now in your life and in your career, what advice would you give to yourself right out of PT school, a newbie. Speaker 2 (37:42): Ooh. Oh, this is, this is a fun one. So when I was in PT school, I knew PT was going to be a jump jumping off point for me. Ubut I, I didn't feel confident in that. And so honestly, what I would have said to myself then is, you know, yeah, you're a little bit of a fish. Speaker 1 (38:06): Yeah. You're doing things a little bit differently Speaker 2 (38:08): And it's okay. Just own, own your worst, keeping you which I'm sure I've always been doing, you know, but, but really telling myself that and gifting that to myself, that it's okay. It all starts lining up just one step at one step at a time. Speaker 1 (38:25): Awesome. And where can people find you? So social media or what's the best way? Yeah. So the best to get in touch with you, Speaker 2 (38:36): There are just so many ways to get, to get in touch with me. Of course social media let's see Facebook and Instagram is dr. Sarah Smith official. I'm also on LinkedIn, dr. Sarah Smith. It is Sara without an H. Usually people always are putting an H on my name, which is like, Speaker 1 (38:52): Denise is a Sara without an H. So I am very well aware of it. Speaker 2 (38:56): Thank you. And then www dot dr. Sara, D R dr. Sarah smith.com awesome. And website. Speaker 1 (39:06): Perfect. And we will have all of those links up at the podcast website podcast at healthy, wealthy, smart.com under this episode. And you saw, you also have an activate core confidence workbook that dr. Sara has so generously given as a free gift. So if you go to www.dot dr. Sarah smith.com/core hyphen confidence, did I get it right? You did. Perfect. And again, that will also be in the show notes, if you want your free gift from dr. Sarah, which is very generous. Thank you very much for all of the listeners, go and grab it from the show notes. So Sarah, thanks so much. Like I said, I could talk about this forever. It'll turn into a therapy session and that's not what you're doing here. I will not take advantage of you in that way. Speaker 2 (39:57): We can, we can do it at that. Speaker 1 (40:03): Thank you so much for coming on and sharing all of your knowledge. I appreciate it. Speaker 2 (40:07): Oh, you're so welcome. Thank you for having me. Speaker 1 (40:09): Of course. And everyone listening. Thanks so much. Have a great couple of days and stay healthy, wealthy and smart.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts    

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Helene Darmanin, PT, DPT, CSCS to the program to talk about physical therapy during and after pregnancy. Dr. Helene Darmanin is an orthopedic and pelvic health physical therapist with over a decade of experience facilitating healthy, empowering movement for her clients as a PT, and fitness and pilates instructor. Inspired by her own motherhood and ardent feminism, she specializes in preparing and healing pregnant and postpartum mamas. In this episode, we discuss: - Helene's experience with miscarriage, pregnancy, birth, postpartum - Body positivity in pregnancy and postpartum and how it can optimize outcomes - American College of Obstetrics and Gynecology guidelines for exercise while pregnant - Reasons to go to PT when pregnant  - Reasons to go to PT postpartum  - And much more!  Resources:  When & Why To See A Pelvic Floor Physical Therapist 10 Ways to Love your Body Helene's website Helene's Instagram Helene's LinkedIn Helene's Facebook  Danford Works  A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.  More Information about Dr. Darmanin:  I am an orthopedic and pelvic health physical therapist who specializes in preparing and healing new and expectant mothers. I am currently seeing clients virtually through Danford Works, and am also the creator of Quarantoned, body-positive HIIT at home. I practice guilt-free PT—physical therapy which fits easily into your day and improves your quality of movement and life. Research has shown that exercise and patient education are the two most effective interventions for positive long-term outcomes, and these can both be offered successfully virtually. I have over a decade of experience facilitating healthy, strong movement in my clients' everyday lives. I have a Doctorate of Physical Therapy from New York University, and a Bachelors in Exercise Science from Smith College, and am a Certified Strength and Conditioning Specialist, and a Kane School-certified pilates mat instructor. I give workshops and webinars about fitness, pelvic health, and being guilt-free in your pursuit of wellness; I am published in peer-reviewed journals, blogs, and have presented at national conferences. Most importantly, I am a proud mama to my one year old son, and my calico cat. Read the Full Transcript below: Speaker 1 (00:01): Hey, Helene, welcome to the podcast. I am thrilled to have you on welcome. Speaker 2 (00:06): Thanks so much, Karen. I'm so grateful to be here. Speaker 1 (00:09): And so today we're going to be talking about pelvic health or women's health after pregnancy, during pregnancy, which, you know, a lot of longtime listeners of this show will know that I've had a lot of episodes on this, but I'm particularly excited about this one, Helene, because you're going to, I think, bravely share a little bit about your story about your birthing experience and, and your experience with your body and how it changes and continues to change even after. So I'm just going to throw it to you and just kind of let you tell your side of the story. Thanks. Speaker 2 (00:48): Yeah, I know that in my, I have a my son is about to be one on Monday in just six days. So I know that in my time, since I gave birth or while I was pregnant hearing other women's stories always helped me to not, not feel alone, even though I knew what to expect because I specialized in pregnancy and postpartum long before I got pregnant. So I am really excited to share some of my story. The biggest, the biggest thing that, that happened when we first started trying to get pregnant was when we were trying to conceive and we got that positive pregnancy test. We were so excited. But then, and I remember, cause it was Thanksgiving. And all my family was so, so, so excited cause we shared right away. Cause I figured no matter what happened, I wanted to have the support of my loved ones. Speaker 2 (01:43): A few days after Thanksgiving, I started to have some bleeding and I started to have some cramping and it, it was before I had even gone for my first prenatal visit with my OB. And when I showed up for my first prenatal visit, she said, congratulations. I said, I'm pretty sure I'm having a miscarriage right now. And, and sure enough I did miscarry at about seven weeks which is early enough that some people don't even call it a miscarriage. It can be called a chemical pregnancy. My OB was incredible. And she said to me, they say, when it's this early, that you shouldn't be comforted because it was probably a chromosomal abnormality. And you know, it, it just naturally aborted itself. She said, but that didn't help me when I had two miscarriages. So I, I feel you that meant the world to me. Speaker 2 (02:36): Cause it was, it was it was a hard thing because we wanted the pregnancy so badly. And then actually I had a lot of trouble with continuing to bleed. And then I ended up needing an emergency DNC because I had a blood clot that was actually blocking the full shedding of the uterus. So that was, you know, in the midst of all the, the sadness, it was also scary and confusing. But I was really fortunate. I had some great practitioners and made it through, made it through. Okay. And then actually we were really lucky because we were able to conceive then the first month that we were allowed to start trying again, I had to get my normal period back, which took about six weeks and then we were able to start trying again. So I feel really fortunate that we were able to do that. And that time I texted my OB right away, I actually used progesterone depositories, which are really uncomfortable. They're like frozen popsicles of progesterone that you have to insert vaginally every night. There's really mixed evidence about them. There's nothing very conclusive, but my OB was like, it'll make you feel like you're doing something at bare minimum. You'll get that great placebo effect. Speaker 1 (03:50): And w what does it, what is the reasoning around using that? Speaker 2 (03:55): So there's some thought that the fetus won't implant, if the progesterone levels are too low, so you're causing a local increase in progesterone to help facilitate the fetus implanting. Got it. Speaker 1 (04:06): Got it. Okay. So sadly, you had a miscarriage, which, you know, for a lot of people listening to this, now, if you follow social media, we were talking about this before Chrissy Tiegen and John legend were very, very open about their miscarriage, which, which happened. I don't know how many months along she was, but enough. And that the comments were, Oh my gosh, I'm so glad you're, you're talking about this. No one talks about this. Women are so ashamed of it. Couples can be ashamed of it. Did you go through any of those feelings or was it like, okay, this happened full steam ahead. Let's keep trying, you know what I mean? I think you've got like both ends of the spectrum. Yeah, Speaker 2 (04:51): Yeah, yeah. I think I was somewhere middle of the road. I think I feel very fortunate that I'm was my awesome support network and my great care that I had from my OB and my acupuncturist to who I saw who helped me recover that I, I didn't feel guilty. I didn't feel like some I've I've heard people talk about feeling like their bodies had failed. But I did feel a lot of sadness. I didn't necessarily share right away, except for, with my very close circle. But I've certainly never kept it a secret. I've never felt like it was a shameful secret. And I I've always wanted to share it in case it does help someone else who has that experience, because as it turns out, the more I talked about it, the more women who I talked to said, Oh, yeah, that happened to me. Oh, that happened to me. Yeah. In fact, a lot of, a lot of my friends were like, I feel like over 30, the first one is like a trial run. And like, you kind of, a lot of women, their pregnancy was that chemical pregnancy or miscarriage. Speaker 1 (06:01): Yeah. So all of a sudden you're not quite so alone. Yes. Oh my goodness. Yeah. So, so now let's talk. So you get pregnant. So let's talk about your pregnancy, the birth postpartum, because all of this, part of your story, we're going to be tying into things that the listeners can do if they're in any of those phases. Speaker 2 (06:24): Yep, absolutely. So I was really lucky during the first trimester. I didn't have too much morning sickness, some slight nausea that usually eating a croissant helped. Unfortunately it was always a croissant. Well, Speaker 1 (06:36): Lucky you. Yeah. And Speaker 2 (06:39): But I was exhausted a hundred percent of the time. My first trimester, like I have always been super energetic. I've been a fitness instructor, like for my whole adult life. And I just wanted to sleep where I was standing all the time. So exercising was really difficult, which was hard for me because it's such a part of my life. And I would like put on an episode of Outlander and get on a stationary bike and be like, as long as your legs are moving, it counts. It's exercise, you know, was like no resistance on the bike. And that would be, I would get to my 30 minutes and counted as a win. So that, that was the first trimester. Second trimester is, was pretty awesome. That's kind of where it's at. Cause you're starting to show, which is fun. And then and energy levels come back up, but you're not like a whale yet, which is great. Speaker 2 (07:32): Well, by the end of the second trimester, when I was starting to get kind of big, then I started to have a very typical pregnancy symptoms of back pain. Interestingly my back pain was the worst kind of at that transition between the second and third trimesters. And then by the end of the third trimester kind of disappeared. My body kind of figured out how to be that size. I felt like I also had extreme swelling in my hands and feet. So I was wearing compression socks wearing wrist splints at night while I was having a lot of risk banks. I was actively working as a physical therapist on my feet and manually treating patients. So that was, that was hard to handle. I tried a cortisone shot, actually. I tried PT, of course. And then I tried a cortisone shot and none of that really helped. I had pretty bad carpal tunnel until I gave birth. And, and it would just like my hands and feet looked like little sausages, which was really pretty funny. And, and by the end of the third trimester, I was again, really tired, but I managed to work until I was 38 and a half weeks pregnant. On my feet demonstrating exercises, even though I gained well over the recommended amount and I gained 47 pounds, which interestingly was exactly what my mother gained with both her pregnancies Speaker 1 (08:51): Beard. And so what is the recommended? Isn't it like 20 to 35 or six 25 Speaker 2 (08:56): To 35 is the midline though. The most recent American college of obstetrics and gynecology recommendation is anywhere from 11 to 40. So there's a little more acknowledgement that now there's a broader range that can be considered normal. Got it. Speaker 1 (09:09): Okay. Great. And so I think it's also, it's also good to note that what you were feeling back, pain, swelling, these are all, like you said, these are pretty typical, right? It's not outside the realm of, of normal to have these symptoms when you're pregnant. Right. Okay. So then you go in, you give birth. Yup. Yup. So, Speaker 2 (09:30): So I I had one day of false labor, which was very frustrating. I wanted that kid out by 39 weeks. I was like, Nope, done out. And then a week later I went into real labor. I had a doula, I was just ready to have my vaginal unmedicated birth. That's what I always wanted. I got to the hospital and luckily I was six centimeters dilated, which is when they consider active labor is starting. So they were able to keep me at the hospital, but Oh my goodness, was I tired? I started having contractions on a Friday, late morning, went into the hospital by about 3:00 AM, Saturday morning. I had gotten maybe three hours of sleep. My duals recommended that I sleep more and I was, and of course that's what I recommend to all my clients. And I was like, no, no, no, I don't need to sleep. I'm going to keep walking cause that'll help my labor progress. So I walked around my block 1 million times. And so by the time I got to the hospital, I was so tired. That's mostly what I remember is just being exhausted. And I had, you know, I advise on changing positions during labor and, and how to best facilitate things. And my doula was like, let's get on hands and knees. And I was like, Nope, Speaker 3 (10:45): Not moving. I am not moving. Speaker 2 (10:49): And then actually did have some complications during labor where my son had a cord wrapped around his shoulder. So every time I would push the cord would become compressed and his heart rate would drop. But my actually it wasn't my OB. I went in just after she got off call that night at midnight. And I got into the hospital at 3:00 AM. And let the OB who delivered me was sent Hastick. She was really, really fantastic and knew that I was really committed to having an unmedicated vaginal birth. So there was never a moment where she was not where she was considering anything else. She just kept kept me charging. And I ended up giving birth in exactly the position I didn't want to, which is lithotomy position. So on my back with my niece, Fred and doing directed bowel salvia breathing, which I also didn't want to do. Speaker 2 (11:39): Cause both of those things increase the likelihood of vaginal tearing. But it was the only way that we were going to get that kid safely out with his heart rate dropping. And, and we did, as she was, she was able to cut his before he was fully out and were able to get him delivered vaginally on medicated and safely. So that was, that was quite an experience. And it was really funny actually, my husband was like, yeah, like that's how you do it. You, you unmedicated. And he like, we're all these sissies who need, who need epidurals. And my doula was like, no, no, no, no, no, no. You don't understand. 90% of women in New York city get epidurals. Like your wife is nuts. So I was like, yeah, you don't get to judge. That's not an experience you'll ever have. Speaker 4 (12:29): Exactly. yeah. So it was, it was, Speaker 2 (12:35): It was a roller coaster and then I still didn't sleep because I was so excited about having my son. And so that was really like a crazy up and down day then that Saturday when he was born that morning. Yeah. Speaker 1 (12:51): Wow. That's dramatic. That's a lot of, that's a lot of drama for, for one birth. But it's, it's also, I mean, I can, I can imagine the relief of having him born safely and there you are, you're in the hospital, you take your baby home, you know, you're, you've been teaching other women on how to work with their postpartum bodies for a long time, but now let's talk about you get home and, you know, a couple of weeks go by and you have the, we all talk about the dad bod, but you know, there's like you have like the mummy tummy or the mom bod. So how do you, what advice do you have for people to kind of stay body positive during this whole period, whether it be during the pregnancy postpartum and, and what, what being body positive can do for you? Speaker 2 (13:50): Yeah. so I have always been an advocate of body positivity and this was the time in my life where I felt like it really paid off. In general, I think that body positivity creates this cycle of self-care where if you take care of yourself, then you feel good about yourself. And if you feel good about yourself, then you're more likely to take good care of yourself. And it becomes a very positive spiral. So I've often used that with my clients and and it was definitely my turn to use it for myself. I was a ballet dancer, so I definitely have had an awareness of body image for most of my life. When I was pregnant, I, I kept, I felt like when I was pregnant, it wasn't as hard to have positive body image because everyone was just telling you how beautiful you are and you're glowing. Speaker 2 (14:43): And it's so exciting and the thrill so you get a lot of positive reinforcement from outside, but I feel like a lot of that ends after you give birth. In fact, just, I was, we were just talking about the New York times in her words newsletter today was a mom who was talking about her experiences postpartum and saying that a lot of times, even if you had a complicated birth that you were in a lot of pain, people say, Oh, well, at least the baby's healthy and they completely brushed aside the mother and her experience and her symptoms. And I'm very much of the thought that, yes, it's wonderful, the baby safe and healthy, but in order to be a good parent and effective caregiver, you need to put on your own oxygen mask first. So starting to take good care of yourself and feeling good about yourself is going to make you a better parent in my opinion. Speaker 2 (15:40): Plus it's just it, regardless of your status as a parent, it's important for especially women because we're often ignored in this regard to feel good about ourselves. So in terms of staying body positive after I gave birth, I actually strangely I found it very helpful to spend some time like with my body and kind of noticing the changes. So I took a little longer in the shower where I w I would kind of be grateful to different parts of my body while I was showering, like, wow, thanks to my stomach that was able to stretch and hold my son, like thank you to my breasts that are able to produce breast milk and nourish my son. We did have a lot of struggles with breastfeeding. So I was very grateful when we got it down, Pat. And you know, I've got rid of a lot of clothing because anything that was squeezing me or making me feel uncomfortable you know, instead of trying to squeeze back into my old clothes where every time I would shift or move, I would feel like the pinching of my old jeans or you know, like the bra cutting into my sides. Speaker 2 (16:52): I got rid of all of that, unless I really thought it was realistic that in which case I put it aside and I didn't even look at it. I lived in leggings and nursing tops for at least three months because it was comfortable. So I wasn't constantly reminded that I was a different shape that I wasn't it wasn't my old body. And I, and then I started moving pretty early in my recovery. I was discharged with the hospital with the very old school instructions of you know, wait six to eight weeks before you start exercising. And then about three weeks I was losing my mind and I was like, Hey, wait a minute. I can give medical advice too. And I can exercise under my own medical supervision. So I I started exercising. I started really gently. And, but there's even, there's at least one study. Speaker 2 (17:46): I believe there are a couple studies that have shown that even one bout of exercise increase, improves your body image. So getting moving and feeling like I was in control of my body and really starting to feel what it was capable of for myself, not just feeling what it was capable of in terms of giving birth to a human, which was also incredible. But, but starting that again, feel like, Oh, look, I can lift this weight. I can do this movement. And, and all the positive feelings that come from exercise definitely also helped. Speaker 1 (18:21): Yeah. And, and kind of again, taking agency over your, over your body. And I really love the, you know, giving yourself a little extra love in the shower. I think that's great advice for anyone, if you had birth, if you gave birth or not, you know, sometimes just getting older things change, you know, and being able to acknowledge that things change and that's okay. And you're still, you know, in love with everything that you have. I love that. That's great advice. So now you talked about exercising. You sort of went back about three weeks after, but let's talk about exercising while pregnant. So there can college of obstetrics and gynecology. They put out guidelines on exercise. So do you want to kind of fill us in on maybe what those guidelines are so that if there are women out there listening that are pregnant at the moment, they can have a better idea of what they can and can't do. Speaker 2 (19:20): Absolutely. I'm really excited about them actually, because there are new ones this year that are much more forward thinking in their recommendations. So there has been a lot of fear-mongering about exercising while you're pregnant in the past. And this year, the recommendations are that virtually everyone can exercise while they're pregnant, whether you exercise before you were pregnant or not. They do recommend that everyone obtain a medical clearance first with a, with a thorough exam to talk about any possible medical complications that could arise from exercising. But you know, there used to be the wisdom used to be that if you didn't exercise before you couldn't start, while you were pregnant and they have completely changed that and they, even to the point where if you are an athlete or someone who regularly exercise at high intensity, they say that you can continue to do that through the third trimester safely. Speaker 2 (20:20): And they recommend exercise because it actually decreases the incidence of diabetes, of gestational diabetes and other blood pressure complications while pregnant like three clamps SIA. It decreases the likelihood of pre of giving birth preterm and decreases actually the incidents of low birth weight, interestingly, and it also decreases recovery time postpartum. So it improves postpartum outcomes kind of sets you up for success, especially during time where you might not have time or might not be able to exercise yet right after giving birth. And it actually increases the likelihood of having a vaginal birth. So if that's something you desire, exercise can help you get there. And it decreases the likelihood of postpartum depressive disorders. So those endorphins that you get while you're exercising kind of carry through to the postpartum period. Well, that's a lot of positives for exercising while pregnant. Are there any sort of big no-nos and on that, Speaker 1 (21:18): No, we're going to take a quick break to hear from our sponsor and be right back. This episode is brought to you by net health, helping you maintain strong relationships with your patients. The redox patient portal provides secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages, video conferencing for telehealth, secure messaging, shared documents and photos and view health information, and appointments to learn more, contact them@redocatnethealth.com. Speaker 2 (22:05): A lot of it's on an individual basis and getting assessed by a PT who specializes is a great idea to see if you're able to still engage your transversus abdominis and see what positions might be best for you. If they do continue to recommend that you don't stay supine on your back for longer than two to three minutes, past 20 weeks of pregnancy, because you can become hypotensive because of the weight of the fetus on your on your blood supply. And they also recommend that you, they also really emphasize staying well hydrated. And if you're doing anything vigorous for more than 45 minutes to really make sure you have adequate calorie intake before maybe during and after to avoid hypoglycemia, which is not uncommon in pregnancy with my clients, I still recommend avoiding isometric exercises. So planks are awesome. Speaker 2 (23:01): Just make them dynamic somehow to help the body regulate the blood pressure, because it's just a lot of demand if you're holding a position and you're holding that tone in the muscles and you're trying to support a fetus it, it helps a little bit to keep those muscle pumps helping the blood pressure regulate. Besides that it's, it's on a very individual basis. It's what you're familiar with. It's how your pregnancy has been progressing. So it's really a good idea to talk to somebody. Okay. And speaking about talking to somebody, everybody who listens knows I'm a physical therapist, you're a physical therapist. So let's talk about reasons why women should go to a physical therapist when they're pregnant. I mean, it doesn't have to mean you, it doesn't mean you have to go every week of your entire pregnancy, but talk about why Speaker 1 (23:47): Every woman should be seeing a physical therapist when they are pregnant. Yes. Period. Speaker 2 (23:53): I love that. Yes, they should. So in the same guidelines this year, Aycock says that back pain has an incidence of about 60% in pregnancy, but that's extremely under-reported because most women just consider it a normal part of being pregnant. So I think back pain in pregnancy is pretty much universal. So that's one great reason to go to PT because it can help alleviate that back pain. And I did see a physical therapist myself when I was pregnant to help with the back pain. Also if you're having experienced experiencing things like sciatica wrist pain, which I had one kind of wrist pain while I was pregnant, different kind of risk pain after I gave birth, partly just because of the increase in fluid in the body. But then also changing joint mechanics because your ligaments are looser. If you have pelvic pain or pubic synthesis dysfunction, which you would know, cause your doctor would tell you, or you'd have a lot of fat in the front of your pelvis or even sprained ankles have a higher incidence in women who are pregnant. Because again, if those joint changes but also Speaker 1 (24:57): If you are having the perfect Speaker 2 (25:00): And see, which would be amazing and you have no pain whatsoever, you're that miracle person you can still help prepare for giving birth. There are PTs who specialize in helping with things like breathing, breathing techniques, preparing your pelvic floor muscles, and it might be a simple consultation. One time, two time to get some advice on, on what you can do to help yourself prepare. And also if you have any history of injuries or any current pain, then also PTs can help advise on what positions might be good for you and they can help coordinate with your OB or your midwife, whoever your burning professional is. Speaker 1 (25:36): Absolutely. And now all great reasons. Now let's talk about after you give birth the fourth trimester, right? So Aycock has came out with these guidelines about the fourth trimester. So first, can you tell us what the fourth trimester is for those who are not aware and then how, what is the physical therapist's role in the postpartum period? Speaker 2 (25:57): Absolutely. So fourth trimester kind of a tongue in cheek, a way of describing a three months after giving birth. Because the idea is that you're still, your body is still changing and your baby is also still changing a lot. There's some thought that when we were primates, our babies would have just dated for longer and come out further along, but our heads became too large and that's why babies started to be born earlier and earlier. So that's part of the reason that human babies are so vulnerable when they're born, as opposed to other species, like, you know, drafts who like pop out and run away from their mothers. And meanwhile, our kids can't, can't see, or Speaker 1 (26:40): Little blobs on my back. They're adorable blabs, but yeah, Speaker 2 (26:44): They, they can't do anything. So and one thing I hear a lot about the fourth trimester is women trying to get their bodies back which I need to bounce back quickly. I think it's just so depressing because, because you're not going back, why would we ever want to go backwards in your life? So why not take your body forwards with you? I love that. And, and you know what I, I will say just personally, like I, I gained, like I said, 47 pounds while I was pregnant. I have since lost all 47 pounds. I am still breastfeeding though. So we'll see what happens, but I am shaped totally differently than I was. And it's, it's not a good thing or a bad thing, at least to me, like it's just different. My body is totally different now. And that's, that's okay. Speaker 2 (27:38): You know, I, I'm really excited about what it can do. I love being a mom, so that's really important, but anyway, and physical therapy in the world of physical therapies. So again, it's a lot of similar reasons, usually back pain, but that can be again from a, it can be from how you gave birth. It can be from if you're, especially if you're still breastfeeding, you still have a lot of those quote unquote pregnancy hormones that cause the ligaments to be a little bit more flexible. Plus if you're breastfeeding the way that you're holding your child also if you're even just picking the kid up and down and getting on and off the floor and changing diapers, which can like, by the time they can turn over, sometimes it's like a circus you know, that that can cause back pain, wrist pain. Speaker 2 (28:30): And then of course you have your pelvic recovery, which I, for the first week, I, I don't think I was thinking about myself very much, but every once in a while I would realize that I felt like my vagina was on fire and sitting was horrible. It was the worst thing ever. I remember going, we were taking my son to his pediatrician, visit his first pediatrician visit. And I was sitting in the car like sideways on one butt cheek to try to avoid putting my perinatal area on the seat because it was so uncomfortable. So that, you know, that's normal for the first week, unfortunately even if you've had a Syrian birth that can you still have that huge change in, in your pelvis after it, no longer has this weight on it. And you have all these hormones released, so it could still be very uncomfortable and tender in your perinatal area. Speaker 2 (29:25): But yeah, that, that brings me to another point. Scars are big thing that should be treated. You would treat a scar from any other surgery or massive injury. So I don't know why it's not routine to refer for scar therapy after if you've had any vaginal tearing with giving birth or if you've had a cesarean birth those scars that can really cause a change in function. They're not as elastic as the tissue around them. And that excessive tissue that's there can disrupt the function and cause a lot of discomfort. So I had grade two vaginal tearing because of my birth experience. And I, I saw a PT myself to have my scar tissue manually worked on and work on some release techniques from my pelvic floor, which was super tense because it was trying to hold everything together during that postpartum phase. So I'm not, and that also for me, I had pain with penetrative sex after, you know, you go to the opiate and they're like, yup, healed, done. Yeah. You know, go back to doing whatever you want. And I was, I was terrified of resuming sexual intercourse and I'm very grateful for my PT who helped me figure out how to comfortably and safely get back to, to having sex. Yeah. Speaker 1 (30:52): You know, all these things, like you said, like so many women are experiencing these things and I think it's so important to just vocalize that and put that out into the universe so that women could be like, Oh, wait a second. Oh, I can go to a PT and they can help with that. Or I can go to PT and they can help with incontinence afterwards, or they can help, you know, like you said, have sex with my husband or my partner afterwards. I mean, wow, this is revolutionary for a lot of women, you know, to know that this resource exists. And you just have to find that physical therapist, preferably one who is trained in pelvic health and who understands understands the pelvis in a more intimate way. And, and that doesn't necessarily mean that they're, your therapist has to be a woman. There are also men who specialize in pelvic health as well. So I want to give a shout out to all of our colleagues doing that around the country as well. Speaker 2 (31:50): Yeah. Oh, go ahead. Sorry. I was just gonna say you know, also there are PTs who have been trained in helping support breastfeeding in terms of what positions to use treating clog ducks, or even just education on you know, effective techniques. There's also pelvic organ prolapse and incontinence, as you mentioned, which can happen regardless of if you've had a child or not. And that can also be treated with physical therapy. Again, some incontinence after giving birth is actually normal for up to a month or two, but if you're still leaking after that, then you should definitely seek help. And again, even, even like you said, it was pregnancy like why every pregnant woman should get PT. Everyone should get some advice, professional advice on how to safely return to movement, whatever movement you want to do, whether it's, you know a yoga class or a couple of group fitness classes or going back to playing a sport. And that's, that's something where we that's something we specialize in is movement. Yeah. Speaker 1 (32:51): And, and in many countries it's, everyone goes to standard care. It's a standard of care, you know, and, and hopefully now that these are part of the guidelines by a cog, that that is something that will become a standard of care. You know, I interviewed dr. Camila Phillips, who is an OB GYN at Lenox Hill and she recommends all of her patients to see a PT and I love it. And that was awesome. Brilliant. But I don't know. She might be in the minority. I'm not sure I think she is, but, you know, experience. Yeah. But I just, I just love that she is so forward-thinking, and, and for women to know that you have all of these resources, it's so empowering to kind of help you back, get back to not get back to, but help you move forward. I love that. I almost say get back to, well, get back to doing what you like to do. Yeah, yeah, exactly. Get back to doing what you like to do and whether that be any kind of movement or running or, or a high intensity sports, you know, just because you have a child doesn't mean that, that you can't return to the things you were doing before. And I think that's where the PT comes in. Speaker 2 (34:03): Absolutely. And with the help of my PT and like my own expertise at like five months, I was back to boxing and high intensity interval training. And I will tell you though, the first time I tried to do a jump after giving birth, I mean, I don't, I don't remember how long postpartum I was, maybe three or four months. I was like, Oh my God, I am an elephant. Like, I just felt like I had no pep, no spring whatsoever. I felt like every time I landed, I was like sod. It took a good few months for me to feel like I had my, my spring back, my like pep in my step. Speaker 1 (34:36): Yeah. Yeah. And, and again, you know, this is, I think this is all great for people to hear. Like we don't, I think women don't give birth and then, you know, go back to like walking the Victoria secret runway show like Heidi Clume, you know, like it's, that's not normal. No, do that like four weeks after you give birth, not normal. Like that is an exceptional human being there who has very good genetics, I'm assuming. And also it's her job. Speaker 2 (35:04): Yes. And a lot of expensive support Speaker 1 (35:07): And a lot of expensive support that us average Joe's just do not have. Nope. Don't have it. All right. So Helene, what would you like to leave the listeners with, if you could leave them with, you know, your, your top tip or your takeaways from this? From our discussion here, Speaker 2 (35:27): That's a tough one because there's so many good tidbits in there. Yeah, I think my top tip is, is just to love, love where you are. I would love your body, where it is, love it for what it's done, love it for what it can do right now. And, and get some help if you need help loving it. If you need help you know, getting it to do what you wanted to do, there is so much help available. It's just a matter of finding it, which shouldn't be as difficult as it is, but it is there. Yeah. Speaker 1 (36:01): Fabulous. And now last question that I ask everyone, given where you are now in your life and in your career, what advice would you give yourself as a new grad fresh out of physical therapy? Speaker 2 (36:15): Cool. Well, I would say trust your intuition. My program was very into evidence-based physical therapy, which is awesome and everything should be grounded in evidence, but never forget that clinical expertise in clinical experiences, also a level of evidence. Speaker 1 (36:36): And I've heard that many times from people on the show. Speaker 2 (36:40): Sure. You have that. I've heard it. I've heard it on your show too. Speaker 1 (36:43): Yeah. Many times. Well now, where can people find you? Where can people get in touch with you if they have questions or they want to know what you're up to. Speaker 2 (36:50): Ah, great question. I'm on Instagram at Halloween B underscore PT. That's the best place to find me I'm currently practicing at Danford works. And so you can find me there or I would love to hear from anybody via email, it's HD the pt@gmail.com. Perfect. Speaker 1 (37:10): And we will have all of those links in the show notes for this episode at podcast at healthy, wealthy, smart.com. So if you didn't have a pen on you, you didn't write it all down. Don't worry. One click will take you to everything Helene. And I will say she also on her Instagram account, really great exercises, advice, and support. So if you're looking for for that, then definitely follow her on Instagram because you give a lot of great XYZ and support, especially for women throughout an after pregnancy. So definitely give her a follow on Instagram. So Helene, thank you so much for coming on. This was wonderful. And thank you for sharing your story because I know it's not easy. Thanks, Tara and everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts    

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Sarah Haag to talk about exercise and urinary incontinence. This interview was part of the JOSPT Asks interview series. Sarah is the co-owner of Entropy Physiotherapy and Wellness in Chicago. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010. In this episode, we discuss: The prevalence of urinary incontinence Is urinary incontinence normal Pelvic floor exercises Pelvic floor exam for the non-pelvic health PT Sports specific pelvic health dysfunction And much more Resources:  Entropy Physiotherapy and Wellness JOSPT Facebook Page JOSPT Journal Page  More Information about Dr. Haag:  Sarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010.  Sarah has completed a 200 hour Yoga Instructor Training Program, and is now a  Registered Yoga Teacher. Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span. Read the full transcript below:  Read the Full Transcript below:  Speaker 1 (00:06:25): So, and hopefully it doesn't want to lose what we're doing here. We'll see. Okay. Going live now. Okay. Welcome everyone to JLS. PT asks hello and welcome to the listeners. This is Joe SPT asks the weekly chat where you, the audience get your questions answered. My name is Claire Arden. I'm the editor in chief of Joe SPT. And it's really great to be chatting with you this week, before we get to our guest. I'd like to say a big thanks for the terrific feedback that we've had since launching [inaudible] a week ago. We really appreciate your feedback. So please let us know if there's a guest that you'd like to hear from, or if you have some ideas for the show today, we're in for a very special treat because not only are we joined by dr. Sarah hake from entropy physio, but guest hosting [inaudible] asks today is dr. Karen Litzy who you might know from the healthy, wealthy and smart podcast. Dr. Lexi is also a new Yorker. And I think I can speak for many of us when I say that New York has been front of mind recently with the coronavirus pandemic. And I'd like to extend our very best wishes to everyone in New York where we're thinking of you. So I'm going to throw to Karen now. We're, I'm really looking forward to chat today on pelvic floor incontinence and exercise over to you, Karen. Speaker 1 (00:08:25): Hi everyone, Claire. Thank you so much. I really appreciate your giving me the opportunity to be part of J O S P T asks live stream. So I'm very excited about this and I'm also very excited to talk with dr. Sarah Hagar. Sarah is an educator, a clinician, and an author. She is also co-owner of entropy wellness and our physiotherapy and wellness in Chicago, Illinois, and is also a good Speaker 2 (00:08:56): Friend of mine. So it's really a an honor for me to be on here. So Sarah, welcome. Thank you so much. I was really excited that all this came together so beautifully. Yes. And, and again like Claire had mentioned, we're all experiencing some pretty unprecedented times at the moment. And the hope of these J O S P T asks live streams is to continue to create that sense of community among all of us, even though we can't be with each other in person, but we can at least do this virtually. And as Claire said, last week, we want to acknowledge our frontline healthcare workers and colleagues across the world for their dedication and care to those in need. And again, like Claire said before, a special shout out to my New York city colleagues, we are they are really working like no other. Speaker 2 (00:09:52): And I also want to acknowledge not just our healthcare colleagues and workers, but the scientists, the grocery store workers, the truck drivers the pharmacist, police, firefighter paramedics, they're all working at full capacity to keep the wheels turning around the world. So I just want to acknowledge them as well and thank them for all of their hard work during this time. Okay. So, like Claire said today, we're going to be talking about the pelvic floor, which is something Sarah loves to talk about because what I also, I also failed to mention is she is a certified pelvic health practitioner. So through the American physical therapy association. So she is perfectly positioned to take us through. And as a lot of, you know, we had, you had the opportunity to go onto Slido to ask questions. You can still do that. Even throughout this talk, just use the code pelvic that's P E L V I C, and ask some questions. Speaker 2 (00:10:57): So we do have a lot of questions. I don't know if we're going to get to all of them. So if we don't then certainly post them in the Facebook chat and maybe Sarah can find those questions in the chat below. And we'll try and get to those questions after the recording has finished. All right, Sarah. So like I said, lots of questions and the way the questions were, were written out, kind of corresponds quite well with maybe how you would see a patient in the clinic. So let's start with the patient comes into your clinic. They sit down in front of you. Let's talk about the words we would use in that initial evaluation. So I'll throw it over to you. Okay. So being a pelvic health therapist, obviously most people when they're coming to females, Things that happen in the pelvis, I like to acknowledge it, that there's a lot of things happening in the past. So I have Speaker 1 (00:11:54): Them tell me kind of what are the things that have been bothering them or what are the things that have been happening that indicate something might be going on? Like if something's hurting, if they're experiencing incontinence, any bowel issues, any sexual dysfunction. And, and I kind of go from there. So if the talk that's the title of the talk today includes incontinence. Continence is a super common issue that let's see in general might pop in. And if you would bother to ask there's actually, I think it's like one out of two people over 60 are experiencing incontinence of some kind. The answer is going to be yes, some, so you can start asking more questions. But starting out with what, what is bothering them is really what I like to start with. Then the next thing we need to know is after we vet that issue or that priority list of things that are bothering them in the pelvis, and it's not uncommon actually to have. Speaker 1 (00:13:00): So let's say they start with a discussion of incontinence. I still actually ask about sexual function, any pain issues, any bowel issues, just based on the innervation of the various, the anatomical arrangement of everything. It's not uncommon to have more than one issue, but those other issues might not be bothersome enough to mention. So it's kind of nice to get that full picture. Then the next thing we really want art. So there are times I've met women who come in and they're like, Oh yeah, you know, I have incontinence. And you're like, okay. So when did it start now? Like 25 years ago. Okay. Do you remember what happened then? Typically it was a baby, but sometimes these women will notice that their incontinence didn't happen to like four or five years after the baby. Hmm. So that's information, that's very help if they say my baby that was born six weeks ago, our interventions and expectations are going to be very different than someone who's been having incontinence for 25 years. Speaker 1 (00:14:05): So again, knowing how it started and when it happens, when the issues are happening, I just kind of let them, it's like a free text box on a form. Like just, they can tell me so much more excuse me. And when we are talking about things, we, I do talk anatomy. So when it comes to incontinence, I talk about the bladder and the detrusor, the smooth muscle around the bladder, the basically the hose that takes the urine from the bladder to the outside world. I do talk about the vagina and the vulva and the difference between the two. And then actually we do talk about like the anus and the anal sphincters and how all of that is is all there together and supported by the pelvic floor. Speaker 1 (00:14:54): Cause that's in physical therapy, it's going to be something with that pelvic floor or something. Drought, does it need to be more, more pelvic floor focused or does it need to be behaviorally focused, which is the case sometimes, or is it that kind of finding that perfect Venn diagram of both for those issues that the person's having? And let's say you're in a part of the world. One of the questions was what if you're I think this question came from Asia and they said, what if you're in part of the world where you have to be a little bit, maybe more sensitive around even the words that you use. I know we had gotten a question a couple of years ago about a woman in the Southern part of the United States that was from very conservative area. And do we even use these words with these patients? Speaker 1 (00:15:48): So what is your response to that? My response is that as healthcare providers, we are responsible, I think for educating people and using appropriate words and making sure people understand the anatomy like where things are and what they're supposed to be doing. However, definitely when I'm having this conversation with someone I want them to feel at ease. So like I will use the Ana vagina anus, anal sphincters Volvo, not, it's not a vagina, it's a Volvo it's on the outside. But then if they use different terms to refer to the anatomy, we're discussing, I'm happy to code, switch over to what they're most comfortable with because they need to be comfortable. But I think as, as again, healthcare practitioners, if we're not comfortable with the area, we're not going to make them feel very comfortable about discussing those issues. Right. Speaker 1 (00:16:43): And that makes a lot of sense. Thank you for that. So now let's say you, the person kind of told you what's going on and let's, let's talk about when you're taking the history for women with incontinence, especially after pregnancy, are there key questions you like to ask? Yes. So my, my gals that I'm seeing, especially when they're relatively relatively early in the postpartum period, are the things I'm interested in is did they experience this incontinence during their pregnancy? And did they have issues before pregnancy? And then also if this is not their first, tell me about the first birth or the, or the first two birth. So the first three birth to really get an idea of is this a new issue or is this kind of an ongoing marked by so kind of getting a bigger picture of it. Speaker 1 (00:17:49): And then also that most recent birth we want to know, was it vaginal? Was it C-section with vaginal birth? If there's instrumentation use, so if they needed to use forceps or a vacuum that increases the likelihood that the pelvic floor went over, went under a bit of trauma and possibly that resulted in a larger lab. And even if there isn't muscles, it's understandable that things might work well, if it's really small and if it's still healing you know, different, different things like that. So understanding the, kind of like the recent birth story, as well as their bladder story going back. So you've met first baby or before that first baby so that we know where, where we're starting from. And the, the reason why I do that is because again, if it's a longterm issue, we have to acknowledge the most recent event and also understand there was something else happening that, that we need to kind of look at. Speaker 1 (00:18:58): So would I expect it all to magically go away? No, I wouldn't. There's probably something else we need to figure out, but if it's like, Nope, this onset happened birth of my baby three months ago, it's been happening since then three months is, seems like forever and is also no time whatsoever. It took 10 months to make the baby. So it's you know, if you tear your hamstring, we're expecting you to start feeling better in three months, but you're probably not back to your peak performance. So where are we in that? And sometimes time will cure things. Things will continue to heal, but also that would be a time like how good are things working? Is there something else going on that maybe we could facilitate or have them reach continence a bit sooner. Okay, great. And do you also ask questions around if there was any trauma to the area? Speaker 1 (00:19:56): So if this birth was for example, the product of, of a rape or of some other type of trauma, is that a question that you ask or do you, is that something that you hope they bring up? It's, that's honestly for me and my practice, something, I try to leave all of the doors wide open for them to, to share that in my experience you know, I've worked places where it is on it's on the questionnaire that they fill out from the front desk and they'll circle no to, to any sort of trauma in the past. Speaker 1 (00:20:34): Yeah. They just, they don't want to circle yes. On that form. So and also I kind of treat everybody like they might have something in their past, right. So very nonjudgmental, very safe place, always making them as comfortable in a safe as possible. And I will say that there's anything I can do to make you feel more comfortable and more safe. We can do that. And if you don't feel safe and comfortable, we're not doing this w we're going to do something else. Cause you're right. That it's always one of those lingering things. And the statistics on abuse and, and rape are horrifying to the point where, again, in my practice, I kind of assume that everybody has the possibility of having something in their past. Okay, great. Thank you. And now another question that's shifting gears. Another question that came up that I think is definitely worthy of an answer is what outcome measures or tools might you use with with your incontinence patients? So with incontinence, honestly, my favorite is like an oldie buddy, but a goodie, like just, it's an IC, it's the international continents questionnaire where it's, I think it's five or six questions. Just simple. Like how often does this happen? When does it happen? Speaker 1 (00:21:58): There's a couple of other outcome measures that do cover, like your bladder is not empty. Are you having feelings of pressure in your lower abdomen? It gets into some bowel and more genital function. Can you repeat that? Cause it kind of froze up for a second. So could you repeat the name of that outcome tool as it relates to the bladder and output? Oh, sorry. I see. IQ is one and then, but like I see IQ vs which renal symptoms, right? So there are, there's a lot of different forms out there. Another one that will gather up information about a whole bunch of things in the pelvis is the pelvic floor distress bins questions about bowel function, bladder function, sexual function discomfort from pressure or pain. So that can give you a bigger picture. I'll be honest. Sometimes my, the people in my clinic they're coming in, and even though I will ask the questions about those things, when they get the, the questionnaire with all of these things that they're like, this doesn't apply to me. I'm like, well, that's great that it doesn't apply to you, but they don't love filling, filling it out. So sometimes what I will go with is actually just the pale. Speaker 1 (00:23:24): Can you say that again? Please help me. Oh yeah. Oh, so sorry. The patient's specific functional scale where, where the patient says, this is what I want to have happen. And we kind of figured out where they are talk about what would need to happen to get them there, but it's them telling what better. Right. Cause I've had people actually score perfect on some of these outcome measures, but they're still in my office. So it's like, Oh, I'm so patient specific is one of my one of my kind of go tos. And then there's actually a couple of, most of these pelvic questionnaires finding one that you like is really helpful because, because there's so many and they really all or discomfort. So if you have a really good ability to take a really good history, some of the questions on that outcome measure end up being a bit redundant. Speaker 1 (00:24:26): So I like, and you know the questions on there, make sure people are filling them out. You look at them before you ask them all the questions that they just filled out on the form for you. Yes. Good. Very good advice. So then the patient doesn't feel like they're just being piled on with question after question and cause that can make people feel uncomfortable when maybe they're already a little uncomfortable coming to see someone for, for whatever their problem or dysfunction is. So that's a really good point. And now here's a question that came up a couple of times, you know, we're talking about incontinence, we're talking about women, we're talking about pregnancy. What about men? So is this pelvic floor dysfunction? Is this incontinence a women only problem? Or can it be an everybody problem? So it very much can be an everybody problem. Incontinence in particular for men, the rates for that are much lower. And typically the men are either much older or they are they've undergone frustrate removal for prostate cancer. Speaker 1 (00:25:33): Fleur plays a role in getting them to be dry or at least dryer. And then it's like the pelvic floor is not working right. That can result in pain. It can result in constipation. It can result in sexual dysfunction. It can result in bladder issues. So it's, so yes, men can have all of those things. In fact, last night we had a great talk in our mentorship group at entropy about hard flacid syndrome. So this is a syndrome with men where everything is normal when they go get, get tested, no no infections, no cancers, no tumors, no trauma that they can recall. And, but the penis is not able to become functional and direct. And with a lot of these men, we're finding that it's more of a pelvic floor dysfunction issue, or at least they respond to pelvic floor interventions. Speaker 1 (00:26:30): So having a pelvic floor that does what it's supposed to, which is contract and relax and help you do the things you want to do. If, if we can help people make sure that they're doing that can resolve a lot of issues and because men have pelvic floors, they can sometimes have pelvic floor dysfunction. Okay, great. Yeah. That was a very popular question. Is this a woman only thing? So thank you for clearing up that mystery for everyone. Okay. So in going through your evaluation, you've, you've asked all your questions, you're getting ready for your objective exam. What do you do if you're a clinician who does not do internal work, is there a way to test these pelvic floor muscles and to do things without having to do internal work? My answer for that question is yes, there are things that you can do because even though I do do internal exams, I have people who come to see me who are like, no, we're not doing that. Speaker 1 (00:27:31): So, so where can we start? And so the first one is pants on and me not even touching you pelvic floor, I wouldn't really call it an assessment or self report. So even just sitting here, if you, if you were to call me up and and this actually goes into, I think another question that was on Slido about pelvic floor cues. So there is actually then it seems more research on how to get a mail to contract this pelvic floor then actually females. But I would ask you like like this is one that my friend Julie, we would use. So like if you're sitting there and you just sit up nice and tall, if you pretend you're trying to pick up a Ruby with your PA with your vagina is not on the outside, but imagine like there's just a Ruby on the chair and you'd like to pick it up with no hands, breathe in and breathe out and let it go. So then I would go, did you feel anything and you should have felt something happen or not. So if, if you did it, would you mind telling me what you built? You're asking me, Oh my goodness. Oh yes. I did feel something. So I did feel like I could pick the Ruby up and hold it and drop it. Speaker 1 (00:29:04): Excellent. And that's, and that, that drop is key. Excellent. So what I would say is this is like like a plus, like a, I can't confirm or deny you that you did it correctly, but I like, I would have watched you hold your, like she holding my breath. Is she getting taller? Cause she's using her glutes. Did she just do a crunch? When she tried to do this, I can see external things happening that would indicate you're might be working too hard or you might be doing something completely wrong. So then we'll get into, I mean, you said, yes. I felt like I pick up the Ruby, but if it's like, Hmm, I felt stuffed, but I'm not really sure we would use our words because they've already said no to hands to figure that out. But again, I can't confirm it. People are they're okay with that. Speaker 1 (00:29:48): And I'm like, and if what we're doing based on the information you gave me, isn't changing, we might go to step two. If you can send in step two is actually something, any orthopedic therapist honestly, should not feel too crazy doing. So if anyone has ever palpated the origin of the hamstring, so where is the origin of the hamstring facial tuberosity? If you go just medial to that along the inside part get, don't go square in the middle. That's where everyone gets a little nervous and a little tense, but if you just Pell paid around that issue, tuberosity it's pretty awesome. If you have a, a friend or a colleague who's willing to let this happen is you ask them to do a poll of our different cues with that in a little bit. You say that again, ask them to do what to contract the pelvic floor. Speaker 1 (00:30:44): Okay. And again, figuring out the right words so that they know what you're talking about. We can talk about that in a minute, but if they do a pelvic floor contraction, you're going to feel kind of like the bulging tension build, right there may be pushing your fingers. You should feel it kind of gather under your fingers. It shouldn't like push your fingers away, but then you can be like, well, you could test their hamstring and see that you're not on the hamstring and you can have them squeeze your glutes and you can kind of feel the differences. The pelvic floor is just there at the bottom of the pelvis. So you can palpate externally, even through BlueJeans is a bit of a challenge, but if they're in you know, like their workout shorts for yoga pants, it's actually very, very simple. And, and honestly, as long as you explained to them what you're doing and what you're checking for, it's no different than palpating the issue of tuberosity for any other reason. Speaker 1 (00:31:36): And with that, I tell them that I can, it's more like a plus minus, so I can tell that you contracted and that you let go. That's all I can tell. So I can't tell you how strong you are, how good your relaxation Wells, how long you could hold it for any of those things. And then I tell them with an internal exam, we would get a lot of information we could, we can test left to, right? We can, I could give you more of like a muscle grade. So like that zero to five scale be use for other muscles. We can use that for the pelvic floor. I can get a much better sense of your relaxation and see how was that going and I can even offer some assistance. So so we have two really good options for no touching. Speaker 1 (00:32:19): And then just as long as we understand the information we might gain from an internal exam, we can, we can, the information we gathered from the first two ways, isn't sufficient to make a change for them. And then as let's say, the non pelvic health therapist, which there might be several who are gonna watch this, when do we say, you know, something? I think it's time that we refer you to a pelvic health therapist, because I do think given what you've said to me and you know, maybe we did step one and two here of your exams. I think that you need a little bit more. So when do, when is that decision made to reach the point of, they have a bother that I don't know how to address so we can actually go to like the pelvic organ prolapse. So pelvic organ prolapse is, is when the support for either the bladder, the uterus, or even the rectum starts to be less supportive and things can kind of start to fall into the vaginal wall and can give a feeling of like pressure in with activity the sensation can get. Speaker 1 (00:33:39): So then we have two options, which is more support from below with perhaps a stronger meatier pelvic floor by like working it out to hypertrophy. So like if, if I had someone who had that feeling when they were running and we tried a couple are lifting weights, let's go lifting weights. No, like I feel it once I get to like a 200 pound deadlift. Okay, well, let's see how you're lifting when you're doing 150 and let's take a look at what you're doing at 200 in fresh with your mechanics or what's happening. And if there's something that is in your wheelhouse where you're like, well, can you try this breath? Or can you try it this way and see if that feeling goes away? I'm good with that. And if the, that the person who's having issue is good with that. Awesome. But if you're trying stuff or the incontinence is not changing, send them to a pelvic floor therapist, because what we love to do is we can check it out. Speaker 1 (00:34:41): We're going to check it out. We're going to give some suggestions. And then my, the end of every one of those visits that I get from my, from my orthopedic or sports colleagues is I'm like, excellent. So you're going to work on this, keep doing what you're doing. Cause another really common thing is like, is I don't really believe that they can make a lot of these things worse doing the things that they're doing. And by that, I mean, they can become more simple MADEC, but in many cases you're not actually making the situation worse. So if the symptoms seem to be not getting better or even getting worse, doing the things they're doing, they go come back to the pelvic floor therapist. And then that pelvic floor therapist also has a responsibility that the things I'm asking them to do, isn't helping them get there. Speaker 1 (00:35:29): You can try something a little more intense, still not helping. Then that's when I actually would refer for females, especially with like pelvic pressure. So Euro gynecologist for an assessment in that regard. Yeah. So I think I heard a couple of really important things there. And that's one, if you are the sports therapist or the orthopedic physiotherapist, and you have someone that needs pelvic health support, you can refer them to the pelvic health therapist and you can continue seeing them doing the things you're doing. So just because they're having incontinence or they're having some pressure, let's say it's a pelvis, pelvic organ prolapse. It doesn't mean stop doing everything you're doing. Speaker 3 (00:36:12): Okay. Speaker 1 (00:36:15): Correct. Okay. Yeah. It may mean modify what you're doing. Stop some of what you're doing, listen to the pelvic floor therapist. And I'm also seeing, well now we're, aren't we this great cause we're creating great team around this, around this person to help support them in their goals. So one doesn't negate the other. Absolutely correct. And I, and I think too often even, even within the PT world is people start to get kind of territorial. But it's not about what each one of us is doing. It's that person. Right. so telling them to stop doing something, especially if it's something they love it seems like a bad start. It's like, okay, let's take a look at this. Tell me what you are doing. Tell me what you want to be doing. Tell me what's happening when you do that. And let's see if we can change it. Speaker 1 (00:37:02): Cause like I said, like the, the other, that being something they're going to make worse and worse and worse is if symptoms get worse and worse and worse, but they're not causing damage, they're not causing, I mean, what they're doing and say leaking a bit. Got it. And now I'm going to take a slight detour here because you had mentioned pelvic organ prolapse. You had mentioned, there comes a time when, if that pressure is not relieving, you've tried a lot of different things. You would refer them to a urogynecologist now several years ago. They're so you're, you're a gynecologist. One of their treatments might be surgery. So there was pelvic mesh sweats. It's hard to say pelvic mesh surgery that years ago made some people better and made some people far, far worse with, with some very serious ramifications. So can you talk about that pelvic mesh mesh surgery and where we are now? Speaker 1 (00:38:04): Oh, the last bit cut out a little bit. So the pelvic mess, mess surgery and, and Oh, the most important part and kind of where we are now versus maybe where we were, let's say a decade ago or so. Awesome. Yeah. So, so the pelvic mesh situation certainly here, I think it's not a universal problem. I think it's a United States problem is if you're at home during the day, like most of us are now you will see law commercials, lawyers looking for your business to discuss the mesh situation on what's happening is there was there were, it was mesh erosion and the resulting fact that that was a lot of pain because they couldn't just take it all out. And it was several women suffered and are still sad. Speaker 3 (00:38:55): Mmm. Speaker 1 (00:38:55): But that was from a particular type of surgery with a particular type of surgical kit, which thankfully has, was removed completely from the market and isn't being used anymore and mesh surgeries, I would say at least for the last five to 10 years, haven't haven't been using that and mesh surgeries are being done with great success in resolving symptoms. So I think it's important that if a woman isn't responding Speaker 3 (00:39:27): Yeah. Speaker 1 (00:39:30): Well changing their breath or making a pelvic floor or changing how they're doing things is to have that discussion with the Euro gynecologist because they do have nonsurgical options for super mild prolapse. There are some even like over the counter options you can buy like poise has one where it's just a little bit of support that helps you. Actually not leak because if you're having too much movement of the urethra, it can cause stress or it can be contributing to stress incontinence. But so there's some over the counter things or there's something called a pessary, which I think about it. Like I'm like a tent pole, but it's not a pole. It's a circle don't worry or a square or a donut. There's so many different shapes, but it's basically something you put in the vagina and that you can take out of the vagina that just kind of holds everything back up where it belongs, so it can work better. Speaker 1 (00:40:21): And that it's not awesome. But there are also people who are like due to hand dexterity, or just due to a general discomfort with the idea of putting things in their vagina and living them there that they're like, no, I'd rather just have this be fixed. So, so there are, it's not just surgery is not your only option. There are lots of options and it just depends on where you want to go. But with the surgery, if that's what's being recommended for a woman, I really do. Some women aren't worried at all. They've heard about the mash, but they're sure it won't happen to them, but there are when we're still avoiding surgery, even with significant syndromes, because they're worried about the mesh situation. And I would still encourage those women to at least discuss us, to see if that surgeon can, can educate them and give them enough confidence before they move forward with the surgery. Speaker 1 (00:41:18): Because the worst thing I think is when I had one patient actually put it off for years. Not, not just because of the mesh because of a lot of issues, but the first time the doctor recommended it, she had a grade four prolapse. Like that means when things come all the way out. And she it was so bad. Like she couldn't use the pastory okay, so she needed it, but she avoided it until she was ready and had the answers that made her feel confident in that having the surgery was the right thing to do. So it might take some time and the doctor, the surgeon really should, and most of them that I've met are more than happy to make sure that the patient has all the information they need and understand the risk factors, the potential benefits before they move forward. Speaker 2 (00:42:03): Excellent. Thank you so much for that indulging that slight detour. Okay. Let's get into intervention. So there are lots of questions on Slido about it, about different kinds of interventions. And so let's start with lot of, lot of questions about transverse abdominis activation. So there is one question here from Shan. Tall said studies in patients with specific low back pain do not recommend adding transverse abdominis activation because of protective muscle spasm. What about urinary incontinence in combination? What do you do? So there is a lot on transfer subdominant as you saw in Slido. So I'll throw it over to you and, and you can give us all your share your knowledge. Speaker 1 (00:42:55): Okay, well, let's all do this together. So I don't know how many people are watching, but if we just sit up nice and tall and I'm going to give a different cue for the pelvic floor. So what I want you to squeeze, like you don't want to urinate, like you want to stop the stream of urine. Okay. So as we're pulling that in anything else other than the underneath contract, what did you feel Karen? Speaker 2 (00:43:24): Well, I did feel my TA contract. I felt that lower abdominal muscle wall started to pull in. Speaker 1 (00:43:32): Yes. So, so the, the way I explain it is that the pelvic floor and the trans versus are the best is to friends. And this makes sense when you think about when you remember the fact that the pelvic floor, isn't just there regarding like bowel bladder and sexual function. It's one of our posture muscles. So if we're totally like, like slacked out and our abs are off and all of that, our pelvic floor is pretty turned off as well. And then if I get a little bit taller and like, so I'm not really clenching anything. Right. But this is like stuff working like it should, my pelvic floor is a little more on, but not, I'm not acting. It's just but then I could like, right, if I'm gonna, if I'm expecting to hit, or if I'm going to push into something, I can tend to set up more and handle more force into the system. Speaker 1 (00:44:21): So I like to think about it in those in those three ways, because the pelvic floor, isn't just hanging out, down there and complete isolation it's, it's part of a system. And so in my personal, like emotional approach to interventions is I don't want them to be too complicated. So if I can get someone to contract their pelvic floor, continue to breathe and let go of that pelvic floor, then we start thinking about what else are you feeling? Cause I don't know that there's any evidence that says if I just work my transverses all the time, my pelvic floor will automatically come along for the ride. So a great quote. I heard Karrie both speak once at a combined sections meeting and she goes, your biceps turn on. When you take a walk, it's not a good bicep exercise. So just the fact we're getting activity in the pelvic floor when we're working other muscles, what's supposed to work. And also if you want to strengthen that muscle, you're going to need to work out that muscle. Speaker 1 (00:45:26): And that makes a lot of sense and something that people had a lot of questions around where we're kind of queuing for these different exercises. And I really love the can. You've made it several times comparisons to other muscles in the body. So can you talk about maybe what kind of queuing you might use to have someone on? I can't believe I'm going to say this turn on and I use that in quotes because that's what you see in, in a lot of like mainstream publications for, for layman. So it might be something that our patients may see when they come in. So how do you cue that? To, to turn on the pelvic floor? So honestly I will usually start with floor and I do if I'm able to do a public floor exam, that's usually, again, a lot more information for me, but I'm like, okay, so do that now. Speaker 1 (00:46:27): And I watched them do it or I feel them do it and I'd be like, Oh, okay. What did you, what did you feel move? And I start there. And then I always say it's a little bit, like I get dropped into a country and I'm not sure what language people are speaking. So sometimes excuse me, one of the first cues that I learned was like, so squeeze, like you don't want to pass gas. Okay. So everybody let's try that. So sitting squeeze, like you don't care and you got taller. So I think you did some glutes. Speaker 1 (00:47:00): It's like, OK. So like lift, lift your anal sphincter up and in, but activating mostly the back part. So if you're having fecal issues, maybe that's a good place to start, but most people are having issues a little further front. So then we moved to the, can you pick a upper with your, with your Lavia? I had a, I learned the best things for my patients. One woman said it's like, I'm shutting the church doors. So if you imagine the Lavia being churched doors, we're going to close them up. And that, that gives a slightly different feeling. Them then squeezing the anal sphincter. Now, if you get up to squeeze, like you don't want to like pee your pants, like you want to stop the stream of urine. That will activate more in the front of the pelvis. Look, men who are like if it gets stopped the flow of urine, I wouldn't be here. Speaker 1 (00:47:57): So what else do you get? What's really cool is in the male literature. So this is a study done by Paul Hodges is he found that what activated the anterior part and the urinary sphincter, this rioted urinary speaker, sphincter the most for men. What a penis or pull your penis in to your body now for women. So when I was at a chorus and it's like, so let's, let's think of like other cues and other words, but even if, so, I don't have a penis this fall that probably don't have a penis. Even if you don't have a penis, I want you to do that in your brain, shorten the penis and pull it in. Speaker 1 (00:48:42): And did you feel anything happen? Cause we do have things that are now analogous to the male penis, if you are are a female. So I'll sometimes use that. Like I know it sounds stupid, but pretend to draw on your penis and it works and it does feel more anterior for a lot of people. So I'll kind of just, I'll kind of see what's, like I said, sometimes it's like the 42nd way of doing it that I've asked them to do where they're like, Oh, that, and you're like yeah. So then also just another, it's a little bit of like a little bit of a tangent, but so as you're sitting, so if you're, if you're sitting I want you to pick the cue that speaks most to your pelvic floor, and I want you to slouch really, really slouch, and actually to give yourself that cue and just pay attention to what you're feeling. So when you squeeze, give yourself that cue, breathe in and breath out and then let go, we should have felt a contraction, a little hole and a let go. Now, the reason why I say breathe in and breathe out is if you breathe in and out, that's about five seconds and also you were breathing. Cause another thing people love to do when they're trying to contract their pelvic floors, just basically suck it in. Speaker 1 (00:50:10): And so that's, that's not great, but we want to feel the contraction and we want to feel it, let go. And that's super important. I think that was another question on the Slido is that yes. For any muscle we're working, you should be able to contract it and let it go. There's not a muscle in our body where I just keep it contracted. It's going to do much. It might look great. Eventually, but like I couldn't get my coat on, like getting a drink of water would be a little weird. It's not very functional muscles have to relax so that they can contract. So that's a big, yes, it's just as important that the contraction pelvic floor that cue and we felt where it happened, not tall, like, like you're sitting out at a restaurant and you just saw someone looking at you and you're like, Oh, what are they looking at? And then you're going to do the exact same cue and you're gonna breathe in and breathe out and let it go. Speaker 1 (00:51:07): And then did it feel different than menu or slouch that it did it change position? I feel like Karen's Miami. It feels different. Now what I want you to do is if you can, depending on how you're sitting really give me like an anterior pelvic tilt, really happy puppy and then do the exact same thing and then let it go. And so again, some more EMG work from, from Paul Hodges is that when you're in a posterior pelvic tilt, you tend to activate the posterior portion more, which is fine. And if you're not having problems in the front, if you're having problems activating and maintaining continence in the front, actually increasing that lordosis can favor the front a bit. So this is, that's really awesome when people can feel that difference. Because I want you to think about, if you start to leak on your fourth mile of a half marathon, there's no way, no matter how awesome you are, but you're going to be able to squeeze your pelvic floor for the rest of that race. Speaker 1 (00:52:15): Like there's just, there's no way. But sometimes if, because remember your pelvic floor is still doing its thing while you're running is if you're like, well, hold on, when you're at your fourth mile, are you starting to get tired or hopefully not if it's a half marathon, but you know, like is something changing and how you're using your body. And can you, when you get to that point, remember to stay tall or lift your tail a little bit, or is there a cue or something they can change that will help them favor the front instead of going about four steps with the contracted pelvic floor and then losing it anyway. So there's, there's a lot of different ways you can actually make that your intervention for the issue you're having and then let's just get it functional. Perfect. And since you brought up running a question that's been, got, gotten a couple of likes on Slido is how would you approach return to running after pregnancy? Speaker 1 (00:53:15): Do you have any tips on criteria for progress, timeframe and a recreational runner versus a full time athlete? Because I would think the majority of physiotherapists around the world are seeing the recreational runner versus the professional or full time athlete. So first, how would you approach return to running any tips for progress? So that's going to be after pregnancy, sorry. After pregnancy. Yeah. So this is where I was really excited. So just last year I'm going to say her name wrong, but Tom goom Gran Donnely and Emma Brockwell published returned to running postnatal guidelines for health professionals managing this population. And the reason why I was super excited is because even though it was just published last year, it's the first one. There was definitely a lot of emotion and feelings about, about women getting back into sport after having a baby, but to be perfectly Frank, there's very few actual solid guidelines for recreational or others. Speaker 1 (00:54:30): So I have not personally had a child, but I will tell you of all the women I've seen over the years, basically doctors are like, it's been six weeks ease back into it, see how it goes. I'm not really even mentioning if you have a problem come back so we can figure it out. It's just kind of like good luck with that. And as a result, what happens is a lot of women don't get back into exercise or they get back into exercise and and kind of freak themselves out because stuff feels different. So to get back to the question of what do I do, actually this this guide from Tom and team really, really helpful. I think, and, and it's just basically it's it does have a series of exercises that I've actually started to use with my postpartum moms to go like, look, if you can do these things without feeling heaviness, you're good. Speaker 1 (00:55:30): You're good to start easing back into your running program, but get up, get walking because I'm going to post Sandy Hilton and like, you can't rest this better, like just waiting, isn't going to make it all go away. But it can also be deceiving because again, with polo, you don't feel that heaviness and you don't leak. And so I'm just going to stay right here where everything is fine. So that's obviously not a good option longterm option for a lot of reasons. So, so what do I do? I do look at the patient's goals, their previous running history, and if they're having any options I recently had a patient who she was runner exercise or sr after baby number two for a bit, some feeling of happiness that got completely better, baby number three came along. So I saw her a bit while she was pregnant because she got, I think two thirds of the way through pregnancy before she started to feel that heaviness. Again, she was still running, Speaker 1 (00:56:38): Tried to see if we could change that feeling while she was running. And she could until about the, when did she start? I think she didn't stop running to her 35th week, which is pretty impressive. But then she wanted to do a half marathon. I think it was just three months postpartum. Right. So this is like going from having baby to running 13. You think that a lot of people would probably feel that was too soon, too much too fast, but she was able to do it completely symptom-free. So as she was training and she was really fast, she was timing it so that she could get back in time to breastfeed. Like I was like, Oh my gosh, like I, that would disqualify me. Like, there's no way I could run fast enough to make that happen. But she was able to, to work it out where she could perform at her level without symptoms. And I was really happy that I was able to support her in that she did all the hard work. For general people recreational, where you a runner before, or is this completely new and are you having any symptoms and is there any thing you're worried about? Again, a lot of women are worried about giving. Speaker 1 (00:57:53): It's actually really hard to perhaps to give yourself one baby babies are a great way to do it. But that's like the risk factors I look up for something else a couple of years ago, I haven't looked recently, but like you really have any prolonged lifting. So not like your CrossFit three days a week, but like your, your physical labor for eight, eight hours, 10 hours a day every day could eventually do it also having babies. So like once you get to every baby increases your risk of pelvic organ prolapse, which makes good sense. And that, and that is what it is. So kind of looking at what are their risk factors, are there any, and letting them know that if they feel it more, it doesn't mean they made it worse. They just made it more symptomatic. Got it. Great. Speaker 1 (00:58:40): All right. So we have time for maybe one or two more questions, and then I'm going to throw back to Claire. Cause we're coming up onto an hour here, maybe time for one more it's so w what am I going to ask? I think I'm going to go with the gymnasts I work with all believe it's normal to leak a little urine during training or competition. And this is something we talk about a lot. It might be common, but is it normal? You already gave me the answer. What is it, Karen? No, no, no. And so, yeah, so the, the short answer for that is no. Or I agree with the question where it is very, very, very common, and it is still, I would say, not to leak urine. Unfortunately, so there's any researchers out there who want to get together. Speaker 1 (00:59:26): Let me know. We haven't, we have information on athletes and incontinence, but mostly it's prevalent that it happens a lot and gymnastics and dancing and volleyball. There's, there's even some swimmers who have it, right? So there's, there's incontinence across the spectrum, which basically tells me, yep. People have incontinence. Some of the some of the sports are more likely to have urgent continents. A lot of them though, we're looking at stress incontinence, however, for none of the athletes, have, we really had a great study that says, this is what we're finding. We're thinking, this is the cause of this incontinence. And we certainly haven't gotten to the point where it's like, and this is what we should be doing for these women in particular. So I'm, I'm pretty curious as to what we would have to do as, as a profession, as, as a team with researchers to figure out what do we need to look at in these athletes, especially the female athletes, because most of these are also they've never had babies, right? So a lot of these athletes are the liberos. And so we can't, we can't blame them. There's something with how things are working. That seemed to be the situation it's not necessarily trauma or anything like that. So what do we need to look at? What do we think is happening? Can we measure it and assess it? And then can we get an intervention? Speaker 1 (01:00:56): My brain, obviously, something isn't working as well as it could. So could something like that improve their performance, even I don't, I don't know. I'd like to think so. Yeah. That would be distinct study. Yeah. But we ultimately don't know. So if anyone has any ideas for studies or doing studies, let me know, because I can't wait to read them. But I think maybe the first step is to let coaches and parents and young gymnast know very common. Don't be ashamed. Don't let it stop you from doing what you want to do. But also don't just ignore it. Maybe we can figure this out. Speaker 2 (01:01:30): All right. One more question with a short answer, if you can. So, and I'm going to ask this question because I feel like the person who posted this I think posted this in earnest. So that's why I'm asking, this is the last question. So a female patient age, 20 years still bedwetting from her childhood, otherwise she is normal, no incontinence. So other than this, just while sleeping, she tends to urinate any thoughts on this or any place you can direct this. Speaker 1 (01:02:04): Yeah. So I did, I was like, Oh, great question. And I did actually do a little research for this specific question. There's a lot of reasons why nocturnal enuresis, which is what bedwetting is called in the literature happens. And I think it's really important. So I don't know what kind of tests or studies this person has had done or what other issues they may be having. So things like sleep apnea is is something that could be related if there's any medications, any sort of diuretics, any kind of sleeping medications. Again, the fact it's kind of carried on since childhood, I, I would really wonder about how, how is the bladder functioning? The fact that it's working fine throughout the day makes me wonder what's changing at night. And I did find a study where it talked about when they look compared adolescents or adults who were bedwetting to people who weren't, they did have like detrusor overactivity. So like basically like an overactive bladder that they could see on the testing. So I would, I would really encourage this person to find a urologist that they trust if they haven't already and really to maybe investigate some of those other, other factors that could be contributing so that they can get some better sleep and not have that problem anymore. Speaker 2 (01:03:28): Excellent. Excellent. Oh, okay. Claire says we can go for one more question. So I'm going to listen to the boss here. Speaker 1 (01:03:36): And, Oh boy, are you ready? Because this is a question that did kind of get a lot of thumbs up. Okay. So we spoke about Speaker 2 (01:03:44): Briefly before we started. Speaker 1 (01:03:47): So let's see treatment of nonspecific, pelvic girdle pain, not related to pregnancy, which strategy with no susceptive pain mechanisms and which strategy with non nociceptive pain mechanisms would you incorporate with this patient? Okay. So I would say in the clinic, it's, it can be pretty hard. Like, I don't know how I would distinguish being nociceptive and non nociceptive or what even like non nociceptive might be if we're talking more central issues or stuff like that. I don't, I don't know. But honestly I would just look at, so in Kathleen's Luca has a great book about looking at the different types of pain or the different categories of pain and the most effective medications for it. Right. So we're really good in pharmacology. Like if you had this inflammatory process and, and inflammatory and anti-inflammatory should help, if you're having neuropathic pain, you want a drug that addresses that when we get into like physical therapy interventions, what's really cool is exercise is in all the categories. Speaker 1 (01:04:59): And it's one of the things we have the best evidence for. So regardless of pelvic girdle pain in pregnancy or not pregnancy, and regardless of how it may have been labeled by somebody else is I would, I would mostly want to know when did the pain start? Is there anything that makes it better? Anything that makes it worse and see if I could find a movement or change something for that person. Or that made me sound like I was going to do a whole lot of work. If I could find something for that person to change for themselves to have that hurt less and have the I tend, I would tend to keep it simple, mostly cause in the clinic again, we could do a lot of special tests that might say, Oh, Nope, they definitely hurt there, but it's still, if we're looking at what's going to be an effective intervention, that that patient is going to tell me what that is. Speaker 1 (01:05:54): Sorry. It would help a fire mute myself. So looks like we have time for one more. And I, I really, Claire was not clarity did not pop up yet. So we've got time for one more and then we're going to work. We're wrapping it up. I promise stroke patients, dementia patient. We just got the no go. Yes, no, it's a super short answer if you want Claire super short answer. Okay. So stroke dementia patients with urinary incontinence, any useful ideas for the rehab program? Yes, but not get an idea of their bladder habits, their bowel habits, their fluid intake. Because a lot of that's going to end up being outside caregiver help with the, with the stroke, it's much different. It depends on the severity and where it is and all of that. But for people with dementia is if you just get that, like if you can prompt them or take them to the toilet, a lot of the times that will take care of the incontinence. Speaker 1 (01:06:48): It's not a matter of like Cagle exercises. It's more management. All right, Sarah, thank you so much. I'm going to throw it back over to Claire to wrap things up. Thank you both for a wonderful and insightful discussion. Sarah and Karen. So many practical tips and pointers for the clinician, especially I was loving learning about all of the things that I could take to the clinic. So I hope our audience find those practical tips really helpful as always the link to this live chat will stay up on our Facebook page and we'll share it across our other social media channels. Don't forget. You can also follow us on Twitter. We're at Dow SPT. You can also follow us here on Facebook. Please share this chat with your friends, with family colleagues, anyone who you think might find it helpful. And if you like JSP T asks, please be sure to tell people about it at that what we're doing so they can find this here, please join us. Speaker 1 (01:07:46): Next week when we host our special guest professor Laurie from the university of Southern California, Larry is going to be answering questions on managing shoulder pain. We'll be here, live on Wednesday next week. So Wednesday, April the eighth at 9:00 AM Pacific. So that's noon. If you're on the East coast of the U S it's 5:00 PM. If you're in the UK and at 6:00 PM, if you're in Europe, before we sign off for the evening, there's also really important campaign that I'd like to draw your attention to. And it's one that we at Joe SPT supporting and it's get us PPE. So we're supporting this organization in their quest to buy as much a, to buy much needed personal protective equipment for frontline health workers who are helping us all in the fight against the coronavirus pandemic. So if you'd like to support, get us PPE, please visit their website, www dot, get us ppe.org, G E T U S P p.org as always. Thanks so much for joining us on this stale SPT asks live chat, and we'll speak to you next week. Bye. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!