Healthy Wealthy & Smart

LIVE from the APTA NEXT Conference in Chicago, I welcome Duane Scotti on the show to discuss gymnastics medicine.  Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance. In this episode, we discuss: -The most common injuries in the youth gymnastic population -Differential diagnosis for low back pain -Key features of a rehabilitation program following an ankle sprain -How to enhance communication between athlete, coach and clinician -And so much more!   Resources: Duane Scotti Twitter Duane Scotti Instagram Spark Physical Therapy Facebook Spark Physical Therapy Website    For more information on Duane: Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance. Duane is currently the founder of Spark Physical Therapy, providing prehab, rehab, and performance optimization services either onsite or in the comfort of your home within the Cheshire/Wallingford CT region. He also is a clinical assistant professor in the Department of Physical Therapy at Quinnipiac University responsible for coordinating and teaching musculoskeletal examination, intervention, and advanced manual therapy within the orthopedic curriculum. Duane received his Bachelor of Health Science degree and Master of Physical Therapy degree from Quinnipiac University in 2001 and 2003. He then went on to receive a clinical Doctor of Physical Therapy and a Ph.D. in Physical Therapy from Nova Southeastern University in 2017. Duane is a board-certified Orthopaedic Clinical Specialist, Certified Mulligan Practitioner, certified in dry needling and has advanced training in spinal manipulation, dance medicine, gymnastics medicine, and rehabilitation for runners. Duane has been in clinical practice working with orthopedic, sports, and performing arts populations since 2003. He has strong clinical and research agendas in screening, injury prevention, and rehabilitation for runners, dancers, and gymnasts. Duane uses an integrative model of manual therapy including manipulation, mobilization, and soft tissue treatment including dry needling and the Graston technique for the management of musculoskeletal dysfunction. Duane is a physical therapy advocate and is actively engaged with the American Physical Therapy Association and serves as Vice President of the Connecticut Physical Therapy Association.   Read the full transcript below: Karen Litzy:                   00:00                Hey everybody. Welcome back to the podcast. I'm coming to you live from Chicago, Illinois at the APTA Next conference. And I have the great pleasure to welcome back to the podcast. Dr. Duane Scotti physical therapists. And today we're going to be talking about gymnastics medicine. So Duane, welcome back. Duane Scotti:                00:19                Thanks for having me Karen. It's good to be back Karen Litzy:                   00:21                And I have to tell you, gymnastics is something near and dear to my heart. I was a gymnast for many, many years as a child. And luckily I didn't have any major injuries, but what we're going to be talking about today are kind of the most common injuries you might see in a gymnast. And this is something that Duane is so passionate about. These are the people he sees. So if you're a physical therapist out there, and maybe you have the off chance that you might see one of these young athletes, I think this'll be really helpful for you to give us your insight. So Duane, tell us what are the three most common injuries one might see in a gymnast? Duane Scotti:                01:02                Well, I think first off is I definitely do have a passion for this area. Like you state because I have a daughter who's a gymnast. So that is one of the things that I kind of in my career from a clinical standpoint, kind of focused a little bit more in this area is spinning off of like dance medicine and got into the realm of helping gymnasts out because I did see there was a need in the local club in our region. So in terms of the most common injuries I would say, you know, definitely low back pain, in gymnasts and specifically extension based low back pain. So because of all of the kind of back bends you think about, they do like bridges, back walkovers, back handsprings all of those, especially in the young developing gymnast. So usually the smaller ones like the level fours and fives, they're doing a lot of those skills. A lot of times you'll tend to see that occur as well as a lot of the compressive loads that happen especially during your floor passes in gymnastics, there's a lot of compressive loads as well as shear loads that get transmitted to the spine. Karen Litzy:                   02:11                And can you kind of briefly tell us what exactly you mean by when you say a compressive load and can you give an example of when a compressive load might happen and a shear load? Same thing. Duane Scotti:                02:23                So it's really the compressive load is if you think of landing, right, so you're landing, your body weight is coming down. So we know that actually landing, you know, there are some studies that look at between 12 to 17% of your body weight is actually, or times your body weight is actually being loaded through the spine. So that's that compressive load as opposed to like a shear load, which would be something like if you think of doing that back bend or that bridge where you're getting one bone kind of shearing on the other. And in the young developing gymnast who is still growing, that can be problematic. And then that's where we start see things such as stress fractures. So that's kind of really the most you know, important thing. And the thing that I tried to intervene and educate because a lot of times most gymnasts have the perception that maybe back pain is normal with gymnastics due to the training and it's going to happen. But being a young gymnast with their bones developing, if they develop that stress fracture that could be detrimental to their long-term health if it goes undiagnosed. Karen Litzy:                   03:28                Oh that was my next question. So let's talk about differential diagnosis of that stress fracture. Cause I think that's really important to think about. And I would imagine that a lot of therapists aren't thinking stress fracture when they're thinking of a young girl or a young boy. Most of the time we think stress fractures in our older adults with osteoporosis, osteopenia. So how do you differentially diagnosed that stress fracture from other causes of back pain? Duane Scotti:                03:59                Yeah, so the stress fractures are, they call spondylolysis and it is really diagnosed based upon the history. So kind of taking a report, is that something that typically it can occur acutely from like a specific landing where they felt an acute kind of sudden onset of back pain, but usually it is something that's developing over time and it's not getting better with rest and it continues to get worse over time. And then there are some things on the physical exam that we can evaluate whether they have pain usually commonly with extension. So they're, you know, doing a standing extension test or a stork test standing on one leg, bending back. You can look at the irritability based upon if they have pain with that or if they don't have pain with like a press up on their stomach, then I feel pretty confident that this person doesn't have a stress fracture, that it is more muscular. Duane Scotti:                04:50                But you always have to kind of make sure and rule that out and then looking at confirming that. So you, you know, you send them to a specialist, a spine specialist. It's not going to show up on x-ray unless it's chronic by that point that they'll see the callus formation on x-ray. But it's really an MRI or a bone scan. And a lot of times, you know, if it is kind of consistent with the history, then even the specialist may not even recommend an MRI just because it's sometimes not necessary. So sometimes it just requires that kind of protection phase and avoiding the extension based activities. And then that allows that to heal. Karen Litzy:                   05:26                And how long is that protection phase? Duane Scotti:                05:29                So it's around, you know, everyone's different but around six weeks. So that's the most common timeframe you'll see. And there are some that recommend bracing. So they call that like the, the Boston braces, the Bob braces where they will brace them. So that athlete is actually preventing any back bending at all. So they're not going into any extension and forces them. So it's a hard kind of turtle shell brace. And they'll wear that for six weeks to really make sure that it heals up. Cause some of these young kids don't even realize and they don't understand the severity of it. I actually just had a girl recently who, you know, tried not bracing at first and then wasn't getting better and now she's braced and it will allow things to heal. Karen Litzy:                   06:10                Mm, Nice. And my next question was actually going to be how do you communicate this to a young boy, a young girl, young gymnast, that it is of utmost importance to not move into these motions. And then I'm sure you're reinforcing that with parents, guardians, coaches, etc. So talk to us a little bit about the communication that needs to happen around this. A child with a stress fracture. Duane Scotti:                06:38                So I'm lucky in the fact that I'm on site, so I have these relationships with the coaches already. So I'm seeing a lot of the gymnast actually within the gym and I have those relationships with the coaches as well as with the patients. I see the parents are always there during the evaluation. After every visit, I'm always communicating, you know, even if they're not there for the visit, we do the visits in the gym and then I communicate all my findings on each day with them. That being said, it gets challenging, especially during competition season. So this is where the difficulty comes in. And I think it is a very important role we play as healthcare providers where sometimes we have to be the bad guys because we're looking out for their health. So I had a girl this year before regionals, it was, you know, big competition for her and we have to make that decision and there are tough decisions and if things are sounding and going down that route that you think stress fracture, then it's like you have to take care of your long-term health. Duane Scotti:                07:36                And it's, you know, one of the hardest conversations, honestly, I've had, I go, you know, home at night thinking about these decisions. I have these long conversations with their parents and, but in the, you know, in the long run, when I reflect back, I'm like, okay, this was the right decision because you know, I don't want this, you know, female to have persistent low back pain for the rest of her life and she wants to have kids one day and grandkids and be able to move later in life. So you know, you want to make sure that you're thinking for their long term health. Karen Litzy:                   08:04                Yeah, I think that's very well said. And you know, I used to work at the lion king in New York and I remember it was like their last performance at the new Amsterdam theater before they moved to the Minskoff. And one of the young simbas was limping around, limping around. So they brought him in and he was not fit to dance that day. And so I had to make the professional decision to call in stage management, call parents, call tutors, call everyone around this huge production of he can't go out and dance because I'm looking out for the longterm house. So it is a lot of tears, which I'm sure you can attest to, but you're right, it's being a good health care professional. It's not about just that moment. It's looking out for these young kids. Duane Scotti:                08:53                And you know, I definitely pride myself on, you know, getting the recovery for injuries as quick as possible so they can get back out there doing what they love, being able to compete. So when something like that happens, you know, you almost feel like, oh, was I a failure or in, you know, but you have to think about the bigger picture and their long-term health versus that short term gain. Karen Litzy:                   09:14                Yeah. That's when you take yourself out of it, right. As the therapist, as we should all be doing, we check our ego at the door. It is not us. Sometimes things happen. Timing sometimes sucks and we have to make decisions based on what's in front of us. And I think if you're making what you feel is the best decision at the time for the health of that patient, then it's the right decision. And all right, so outside of stress fractures in the low back, what are there other common types of low back pain? Is it muscular and mechanical, low back pain. And what do you then do for those gymnasts? Duane Scotti:                09:54                So very good. Mainly there's not a huge amount of mechanical low back pain that I tend to see when we think of disk related low back pain, sometimes some facet joint. But these kids are a lot younger so it is usually muscular in nature. I kind of see that common pattern, but it is usually due to an underlying instability in the lumbar spine. But honestly more importantly that I'm seeing is the contributing factors. So specifically looking at hip flexibility, so limited hip flexibility specifically the hip flexors, is going to cause more lumbar extension as well as kind of a weakness or inactivation of the glutes. So these girls are doing these leaps and they're doing these movements where they are extending their hip but they're really not turning on their glutes and their using, you know, if they do have flexibility issues. So I found, you know, addressing those issues. Number one from a treatment standpoint is going to be helpful in the long run, but also for Prehab standpoint. So in prevention. And that's what I kind of do in the gym with all these girls is take them through a full screening help to identify those risk factors and then get them on plans to address the soft tissue care because they are doing a lot of strength and conditioning their front of their hips get really tight and that causes that excessive shearing in the lumbar spine. Karen Litzy:                   11:13                Great. So I think for me a big take home here is when you're looking at these young kids, you're not, they're not just tiny adults and so we're not necessarily looking for disc issues, but rather we really need to look above and below to kind of see, well is the back pain, this muscular back pain a result of compensation from other parts? Right? Duane Scotti:                11:36                Absolutely. Yes, definitely. And then even the core stability aspects of most of these gymnasts, like super strong, but sometimes there's still these little muscle imbalances that you can find with like a good examination that they're not using the muscles you think they're utilizing. And a lot of, you know, even physicians and you know, these athletes will go to a, you know, a pediatrician or primary care provider or an Ortho and then you're like, oh well there look at them. They're Jacked, you know, like you've seen gymnasts there, Jacked, like really, really good conditions. Yeah. So they, they're like, oh, there's no way they could be weak. But no, like when you actually watch them move and you watch their movement patterns, then you pick up on some of these weaknesses and then you know, having them get into, when they're doing their extra, it's like, okay, well where are you feeling this and this. I go, if they're not feeling they're glutes at all. They're like all of their feelings and their hamstrings. So I find a lot of that they're kind of using your hamstrings to extend their hip joint and not using their glute. So you kind of work on correcting some of those kinds of muscle imbalances. Karen Litzy:                   12:34                Perfect. All right, so let's move off of low back pain. What's another common injury that you see in your gymnasts? Duane Scotti:                12:44                So definitely you know, the most in terms of the research is ankle and foot are kind of the most common region or you know, area to be injured. And most of that is due to traumatic ankle sprains. So they get their classic inversion ankle sprain while they're beam landing from a pass on the floor, dismount off bars, everything vault like you name it, you know, an ankle sprain can happen. And it usually happens in practice. Not so much in competition. We know that the majority of gymnastics related injuries happen during practice. So I do see a lot of ankle sprains. I do a lot of triaging, especially because I'm onsite. So I need to make that clinical decision on, you know, do we send them out for a radiograph? So utilize the Ottawa ankle rules, and seeing, you know, if they can't put weight on it, then they're definitely getting a radiograph. If they're having pain and they have that bony tenderness, then sending them out for a radiograph. And again, this is where I see us as physical therapists being able to make an impact in our communities in being that point person and make that decision so the athlete goes to the proper place versus just putting ice on it and then going home. And then, you know, so I've been able to kind of streamline that process for a lot of the athletes that I see. Karen Litzy:                   13:56                Fabulous. And I don't think we need to go into the ins and outs of ankle sprain rehab. But have you found amongst this population, what is one thing you can tell another therapist if you do nothing else to rehab these gymnasts after ankle sprain, you must, must, must include this in your program. Duane Scotti:                14:20                Can I say two things? So first is one thing that I see overlooked a lot is mobility issues. So a lot of people have the assumption that you sprained your ankle, you have a loose ankle and we need just stabilization, stabilization. And that is important. Don't get me wrong. And kind of proper stabilization going from your balance activities proprioception to plyometrics. Definitely necessary need to do the plyometric training with your gymnast before you release them to do gymnastics training. But also checking for mobility issues, specifically lack of Dorsiflexion during like a weight bearing dorsiflexion test. And I've seen that where there's, you know, asymmetries on both sides and that's going to be important because when these gymnast land from their floor passes a lot of them, sometimes land short and if they land short, that requires more Dorsi flexion motion. So that can in turn cause you know more limitations of Dorsiflexion, anterior ankle pain. So you really want to make sure you normalize the joint mechanics and the talocrural joint and do your manipulation mobilization techniques to kind of restore that. So that's one thing. And then, especially if someone's been immobilized. So if there are mobilized in the walking boot or in an air cast, a lot of times you'll find stiffness in those joints as well as the distal tibiofibular joint. Karen Litzy:                   15:35                Perfect. Thank you. That is great. I would have thought your firsthand, so we would have been propioception exercises, which are important, but I'm glad that you brought up the mobility stuff. Great. All right, let's talk about one more common injury that you see in this population. Duane Scotti:                15:51                So this is more your kind of growth plate injuries. So the kind of growing gymnast as they're growing, they go through that growth spurt. So commonly in the younger gymnasts, so like the nine 10 year olds, you're going to see like the Seavers, so they're going to have heel pain. The calcaneal apophysis and then as they get a little older, usually around 12 ish, you're going to start to see knee pain. So whether or not it's Sinding-Larsen-Johansson Syndrome, which is the inferior pole of the Patella or the more common one that everyone knows about osgood schlatters which is at the tibial tubercle. So you will tend to see these kind of growing pains if you will. The big thing is to educate the parents, the gymnast, and there are things that they could be doing at this time. Duane Scotti:                16:38                They don't just need to train through pain and usually it relates to soft tissue flexibility. So for Seavers, it's really the calf, the Achilles, make sure they're on a good mobility flexibility program for those structures. And then for the knee, a lot of rectus tightness I tend to see, so working on some of the flexibility mobility during this time period and watching load management, so maybe not doing their rigorous training and if they're going through that kind of gross spurt and they have some pain and now let's say like summer conditioning starting, then they might need, be able to kind of do a modified practice, especially when it comes to the jumping and the plyometric training. So they're not doing because we know that's what really caused it. And that's why the incidence is so high in gymnast is because they're going through this rapid growing and they do a lot of jumping, a lot of contraction of the Achilles and contraction of the quads. So that's why you tend to see pains in both the ankle and the knee area. Karen Litzy:                   17:35                Perfect. Yeah, I had a patient a couple of months ago Seavers disease, she was nine and she was a gymnast. And what was really interesting is I would have her, because I needed to see how she jumped and how she landed. And I don't know if this contributed to it or not. In my line of thinking, I felt like maybe it did, but when she landed she tended to land in a very valgus position of her knees. And I don't know, can that, so looking at the biomechanics of the landing, can that help in the treatment of Seavers disease? Cause then we kind of worked on that so that she wasn't landing in quite such a valgus position. So that in my line of thinking was that if we can help to normalize her landing a little bit more, that she’d be able to more effectively use her calf muscle in order to land instead of being at this very sort of sharp valgus angle. Duane Scotti:                18:33                Yes. I think that's definitely important. And then even I guess going one step further than that is looking sagittal plane and with ankle Dorsi flexion. So if they're limited there because their Achilles is tight and their gastric is tight, I see that even more so. But maybe like you said, if even if they're weak hip muscles, so your abductors external rotators are weak and they're going into that dynamic Valgus, you know, could that be a contributing factor to different mechanics going down at the ankle? Possibly. Karen Litzy:                                           Interesting. Yeah. There's so much to think about with these gymnast's that you would not think about in your ordinary population. Duane Scotti:                                        Right, right. No, absolutely. And it is as you said that they have such high levels of training, you know, the girls I see, you know, once they get up to level six and above, they're in the gym for 24, you know, 25 hours a week. Duane Scotti:                19:21                So it's a lot of training. The only get like two weeks off a year. So it's like at the end of the season befor summer starts and then before a fall starts. So it's a lot of training, a lot of wear and tear on their bodies. And that's why it's so important to be able to pick up on, you know, contributing factors. Cause every gymnast is different too. So someone's going to have maybe a tightness in the front of their hips. Someone's gonna have some tight calves, so I'm just going to have maybe week shoulder muscles and they're starting to get shoulder pain with bars or tight lats. So that's a common thing where they're limited with overhead mobility with reaching. So you kind of need to identify what each one does. And that's what I like to do is to get them on like a customized kind of program and it's like, okay, here are your like top five exercises you should be doing before practice every single day. Duane Scotti:                20:03                So as opposed to just like chatting with your friends, like, let's prime the body, let's get, you know, warmed up. If it's rolling the front of your hips, doing some glute activation exercises, make sure they're turned on before practice starts. That's what they need to be doing. Karen Litzy:                                           And you know, I was just going to ask you, what advice would you give to, let's say, any physical therapists out there listening to healthcare practitioner who maybe doesn't have the amount of experience you have with the gymnastic population, but like I said, maybe they've got a gymnast coming in and I feel like you just kinda answered that. Do you want to add anything to it? What advice you would give to that PT? Duane Scotti:                20:48                Don't be afraid to reach out and talk with the coaches. I think a lot of the gymnastics world and culture, I tend to see a little bit of kind of medical professionals on one side, coaches on the other. The coaches think that the medical professionals don't understand their sport and vice versa. The medical professionals think that the sport is just bad for them and they shouldn't be doing it almost that it's too much and it's not good for their bodies. So I think we need to kind of meet in the middle and actually communicate and have these conversations and you know, try to meet in the middle. And that's what I tend to do with the coaches and cause they, I could see where their mindset is. And I, you know, with my years of experience coming from the kind of clinical mindset and injury side, and I've shifted a little bit in some of my thought processes as well. Being able to actually be on site and see some of the training that they do and to see some of the practices. Duane Scotti:                21:32                So just don't be afraid to communicate and I guess reach across the aisle and be able to say, okay, this is what I'm finding, and even just letting them know that, hey, this is pretty irritable right now, but it's a minor problem, but if she can do a modified practice today and tomorrow and then she has off on Sunday, that will give her three days of this kind of protected rest phase and the next week she'll be able to do full practices to have you kind of frame it like that. Then the coaches are like, okay, I could, I could deal with that. Versus the coaches being like, no, they can't modify practice right now. We have a competition in two weeks. But if you've kind of framed it that way and say like, Hey, if we just allow these couple of days and then next week they're going to be able to have full practice without limiting themselves at all, then they're more likely to kind of go with your recommendations versus, you know, everyone being on kind of different sides. Karen Litzy:                   22:20                Perfect. I think that's great advice. Communication is vital and everything we do with our patients from all the different stakeholders that are involved to the patient themselves, to parents and caregivers and to each other. So I think that's great advice. Thank you so much. And I have one last question for you and it's the one that I ask everyone and that's knowing where you are now in your life and in your practice. What advice would you give to yourself as a new Grad right out of physical therapy school? Duane Scotti:                22:51                So this is a tough question because I hear this all the time because I listened to all your podcasts and you would think I would have the answer right off the top of my head. But I would probably say, there's a couple things is one, just not be afraid to fail. Failure is good because we learn from that and then don't abandon certain techniques or philosophies early on if you're not getting it right. Continue to learn and grow, evolve. And that's how we all get better in what we do. Karen Litzy:                   23:22                I think that's wonderful advice. That's perfect. Resonates with me. Very much so. Thank you, Duane, for coming back on the podcast again and educating us all around gymnastics medicine, so thank you. Duane Scotti:                23:32                Awesome. Thank you for having me. This has been great. Karen Litzy:                   23:35                My pleasure. And everyone out there 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 iTunes!  

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Megan Sliski and James Nowak on the New York Physical Therapy Association Student Special Interest Group. Megan is the NYPTA SSIG President, National Student Conclave Project Committee Chair and NYPTA Central District Conclave Committee Chair. James is the NYPTA SSIG Vice President. In this episode, we discuss: -The roles and responsibilities of the President and Vice President of the NYPTA SSIG -A few of the highlights and accomplishments of the SSIG this term -What Megan and James look forward to in their future leadership roles -And so much more!   Resources: NYPTA SSIG Website Megan Sliski Twitter James Nowak Twitter                                                                      For more information on Megan: Favorite PT Resource: PT Now School: Utica College: DPT 2020; Utica College: Health Studies, Healthcare Ethics “I’m excited to see the team grow & work together to create opportunities for DPT/PTA students around New York.”   For more information on James: Favorite PT Resource: New Grad PT School: Utica College: DPT 2021; Utica College: Health Studies “I’m so excited to be a part of a growing team that has the opportunity to truly enhance the student physical therapy experience in New York State.”   For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt   Read the full transcript below: Jenna Kantor:                00:00                Hello, this is Jenna Kantor here with healthy, wealthy and smart. And I'm here to interview Megan Sliski and James Nowak. First of all, thank you so much for coming on and agreeing to speak about drum roll please. The student's special interest group. You're here in New York and you two are a power duo and Megan here is the president and James is the vice president and you're halfway through now. Is that where you're at? About halfway through. So I would love for those who don't know, when people say, what does this SSIG do? That’s the student special interest group. Could you start from the elections? Don't worry about taking me through the whole year. I'll ask you questions as we go through. So you got elected. What happens next? I'm going to hand it to Megan and then when you need help you can pass it over to James. Megan Sliski:                00:57                So when we first got elected, Jenna, a lot of it was just trying to figure out what the dynamic of the new team was going to be and how we were going to encompass the goals of the SSIG into the individuals that we were introducing into the SSIG. And so the beginning of the term involved a lot of transitioning and a lot of, of trying to make sense of, you know, what we were going to do and how we were going to progress forward. And the SSIG being just only in its infancy, only two years old at this point. You know, we had a lot to consider. We had to, to figure out, you know, what had worked the previous year, what hadn't worked, how are we going to move forward? How are we going to make this organization successful? How are we going to pair with the NYPTA and, and really make this an organization that was going to succeed. Megan Sliski:                01:44                And so at the beginning we really focused on trying to get to know each officer individually as well as trying to get to know the positions individually. And so the nominating committee chair from last year did a wonderful job slating candidates. And we were very fortunate that the candidates that we had were so wonderful and that all of the individuals who are elected were just so great for their positions. And you know, we're really lucky for that. And so what we did was move forward. We got to know the individuals on an individual basis and we figured out how we were going to make the organization work for us. That being said, you know, there were times where there were hurdles, but when aren't there hurdles will a new organization, especially when the organizations only in it’s second year. And we were fortunate enough that, you know, James and I actually go to the same school. Megan Sliski:                02:32                And so we were able to meet almost weekly to talk about some of the challenges we were having in some of the successes and how we were going to make sure that the successes continued. But at the same time, how are we going to approach the challenges that we were having? Again, with it being a new organization. And I happen to think that we're very lucky that James and I went to the same school because in the second year of this organization, we were able to work through some things that were a bit challenging that we hadn't maybe thought about before, that maybe weren't issues the year before. And I think that we've been very lucky so far with the caliber of people that we've had and the team that we've had. And I think that the rest of the year it's going to be so wonderful. I love that. Jenna Kantor:                                        So, James, for you, when you got elected, what happened? Was there a meeting? Was there, I mean, you already knew Megan, I'm assuming. I would love to know. James Nowak:               03:26                It's actually a really funny story. So I'm wrapping up in my first year of DPT school and I remember, It's the fall with heavy musculoskeletal stuff. And then this girl by the name of Megan comes in and does a little introduction on this state organization, state student special interest group called the NYPTA SSIG. And immediately within, probably within a couple of minutes of her presenting it, I said, oh my God, this like, like this is for me, this is what I want to be a part of. And at the time, I probably saw Megan around a little bit, but I had never talked to her. And I gathered up the courage and I introduced myself and I said, you know, this right here is something I want to be a part of. James Nowak:               04:13                I want to make a difference, not only at my school, but on the state level I want to interact with students and professionals both throughout the state, you know. And so I said, I went up to her and I said, how do I get involved? And then she kind of talked me through the election process and how that was gonna be coming up. She did a little presentation right before elections ran. And so from there I decided to apply. And thankfully I got slated. Luckily, luckily enough, I got elected as the vice president. And I was very, very thankful for that. And I think my process after that really my first initial thought was, okay, so now I'm a part of the state organizations, such a phenomenal opportunity. I wanna be able to work with students throughout the state. James Nowak:               04:58                I'm here in central New York. You know, if you think of a map of New York state, you put a dot right in the middle. That's where I am. And I'm going to get to work with people who are all the way down south in the city and all the way up towards Canada. And getting to being able to really get the wealth of knowledge and experience from them. It was very exciting to me. I hadn't had the opportunity to interact with the students yet. So I think my first thing was really getting to know my team, you know, getting to know the people who were elected. So initially it was phone calls, just to get to know them. Eventually as the year turned to the start of our term. James Nowak:               05:41                We had a nice transitional meeting, so we had a transitional meaning from our board from the previous year and the people who are elected for this year that we're currently in. And that it wasn't just a phone call on the phone, it was face to face through the computer. Really, it's almost like Skype, but they use, it's a platform called goto meetings that we use. And I got to see the past president of the SSIG and I got to see all the people that I was working with throughout the year and it was such a unique opportunity to be able to interact on that level. Even though I'm sitting in my apartment in Utica, New York, I got to talk with students who were from, you know, places like Columbia all the way down in the city. And that was such a unique opportunity. Jenna Kantor:                06:25                I love that. So for you, James, what have you been doing? Cause you look over all the regional reps. So for those who don't know, I was part of the SSIG, so I'll educate you guys on this. So there are regions within New York in which there is a student that represents several schools and we'll handle the communications with several schools because New York is huge and we have a lot of schools here. So when you're working with the regional reps, how often do you meet and how do you run those meetings? James Nowak:               07:00                So I think that's a great question Jenna. As of right now, we try and meet on a monthly basis. And with that being said, coming up towards our midterm here where, you know, something we really put at the forefront is getting immediate feedback on things and we're going to get feedback from students and see is that something that's working? Is this something that's not working? You know? So that's something we're going to see. But as of right now, that's kinda how we do things and enables us to really, on a monthly basis be able to say, okay, so these are the things we're working on. How can we contribute? How can the representatives throughout the state really add various ideas to your advocacy dinner? Let's say for example, that you're planning, you know, how can we bolster this? How can we support you to make this a reality? Jenna Kantor:                08:11                I love that. I love that. So they're not thrown to the wolves. Megan, for you, we went a little bit backwards because I jumped to the interactions with the regional reps. You're working with the board. So I always forget because there's the main board and then there's the extension people. What are the terms? The advisors and the advisory panel. I should know this because I was on the advisory panel but, but so in these meetings with the advocacy chair, somebody who's in charge of volunteering and somebody who's in charge of events. What do you guys discuss or what even did you guys discuss and how was it passed along to James to be passed along to the regional reps? I mean just throwing out 5 million ideas. Megan Sliski:                08:56                So I think that that was something that was a challenge last year. We were trying to work through how do we communicate from the executive board and advisory panel to the Board of Representatives. And that's something that James and I did not take very lightly this year. We worked very hard to figure out how we were going to communicate with the board representatives. The Board of Representatives and the liaisons are our main contact with the schools. And without them, our structure falls apart. We need them, we need the communication with them. They need to know what's going on. And so the way that we worked through this was yes, we had our executive board meetings where the executive board talked with the advisory panel and we figured out the plans for everything and we figured out, you know, what we were going to do for the rest of the term or even for just the upcoming months. Megan Sliski:                09:53                Not even extending until the end of the term and just focusing on the now. So we would talk through that. But what we added this year, Jenna, that I think you'd be very happy to hear is that the board of Representatives were invited to every single executive board meeting. And so not only do they know what's going on at the executive board meetings, they have active voices in what's going on at the executive board meetings. So the board of reps have become this voice for us, the voice of we know what's going on in this region, we understand our schools, we can give you the information that you need to help the SSIG be successful right now in these regions, in these schools. And I think that that was what was crucial and that's what we added in, that's really been beneficial to our organization is that we've been able to encompass all of our officers and we've been able to involve all of those officers in the decisions and we've been able to hear all the different perspectives and I think that's been great. Jenna Kantor:                10:55                How did you narrow down exactly what you were going to be doing this year, Aka advocacy dinners or even conclaves? Megan Sliski:                                        We haven't actually, we haven't narrowed that down and I think that maybe that's one of our strengths is that we're trying to figure things out as we go. I talked earlier in the podcast about how this organization is in its infancy and how we don't actually know exactly where it's going. And I think maybe that's the best part of this organization right now is that we don't know. You know, so we've thrown off ideas, we've talked, we figured out what everyone's strengths are. We figured out where we can go with the ideas that we have. And from that we've decided that, you know, we have a very strong advocacy chair who's really great at working with the student assembly and working with you as the past advocacy chair. Megan Sliski:                11:47                She's had wonderful mentorships. Which I can say for a lot of our officers, actually all of our officers, they've had wonderful mentorship to be able to guide them to what we've done now. I think that talking about the strength and talking about, you know, what succeeded last year, you know, what we can do better from last year. We had such a strong board last year and they left us with such monumentous advice and you guys were so wonderful in guiding us to where we needed to be for the next year. And we've taken that and we've run with it, you know, and everyday we may not have the answer to what we're doing tomorrow, but I think that right now the plans that we have in place are wonderful and I think they're great for enhancing the student experience. Megan Sliski:                12:36                And I think that as the term continues, we're just going to keep coming up with more ideas and we're just going to be able to keep invigorating students to be able to get involved with the special interest group. And personally, that's what I love about it. I think that every day we just grow more and more as an organization and I love that. Jenna Kantor:                                        So what have you guys accomplished this year so far? You share some and you share some split the mic. Megan Sliski:                                        So I’ll start. I don't want to sell so much of James’ thunder, but I think so far one of the wonderful things that we've come up with is that we've voted in the establishment of an advocacy task force. And we've also voted in the establishment of a service task force. Megan Sliski:                13:21                The advocacy task force is going to promote legislation nationally and statewide to help students become more informed on the issues that really pertain to us as physical therapists and physical therapist assistants. And the service committee, the service Task Force, I'm sorry I should use the right language, is going to really focus on helping our service chair with implementing a really great day of service project. Something that we really hold to high standards in New York state. And I am so excited to see what they accomplish. So I'll give the mic to James and I’ll let him talk about more of our successes. James Nowak:               13:55                Well, without further ado, so I think really two things stand out to me early on. One first is it's really a continuation of last year and it's really implementing the advocacy dinners. We've really tried to put a focus on students networking not only with themselves but with professionals as well too, to really advocate for our profession out always. PTs with PTAs as well with one common goal of, educating folks, educating just our regular public along with educating our legislators. You know, that's put a focus on is initially, you know, extending that to things such as lobby day.  And really just letting students know that, hey, this is something, you know, your classroom education has relied on. It's very important, but you also should be concerned about some of the legislative issues that are going on cause it's really going to impact your future. James Nowak:               14:48                So we've already had a couple of advocacy dinners. We've had some standout speakers such as former NYPTA president, Dr. Patrick VanBeveren. He gave a phenomenal presentation at Utica College. And really I want to say with that is a huge shout out, not only to our advocacy chair Liping Li for, for really making these things happen, but also, our regional representatives, down to the liaisons at each individual school. Really Planning and being our boots on the ground. We're making these things happen. They did a phenomenal job. And I would say our second accomplishment of this year, which I really feel strongly about is connecting with the NYPTA and specifically the NYPTA districts. Something we've really made a push for is to start to really try in and promote similar events, you know, and get students involved in mingling with the professionals in their various regions. We had our regional representatives actually reach out to the district chairs and the NYPTA and really trying to foster that relationship. So then you know, in the future we have that great connection with professionals who are in the field, and that will really provide students with phenomenal networking opportunities that they might not be able to get at their individual programs, but they can receive that from us. Jenna Kantor:                16:16                I freaking love that. Okay. So I am going to move you both forward into the future. The future of when your term ends. What are you going to miss most? Megan Sliski:                16:36                I think what I'm going to miss the most is being able to inspire the students in New York from my leadership position as the president. I'm going to miss talking with them on a weekly basis and you know, hearing their thoughts and hearing their opinions on how we're going to better things for the physical therapy profession in New York state. But I say I'm going to miss that. Although I have a feeling that those relationships aren't going anywhere and I have a feeling that knowing myself, I'm still going to be reaching out and talking to all of those individuals I think I’m going to miss inspiring the team. I think I'm going to miss the SSIG. This being my second year involved I think the SSIG has really given me an opportunity to grow and I think it's helped me realize who I am as a person and who I want to be as a professional. And although I'm eternally grateful to the SSIG for what it's given me in my role as a graduate student, I'm gonna miss that. I think I'm gonna Really Miss Interacting with the people that I've met, but I also know that that's not the end of what I plan to do. And although it'll be a little bit of a bittersweet ending, I'm excited for what comes after the SSIG for me. James Nowak:               17:58                Just got to wipe away my tears after that one. I don’t know how I’m going to follow that. What I think really going off what Megan was saying, our organization, one of the things were really true is we try and do is deliver the experiences to students throughout the state. And that I think I would miss a lot is hearing feedback from schools saying, did you know, did you like this? You know, and stuff like that. And really being able to implement things that, you know, and give students the experiences that they might not be necessarily getting in the classroom directly. But I think just Kinda like what Megan was saying, working with the team, you know, when you're in an organization like this and you're able to network with students throughout the state, you really do build close bonds, you know, and there's something about that atmosphere of, you know, coming together, collaborating, sort of to deliver those experiences and really make a difference. You know, what we're doing here is we are inspiring and we are educating the future professionals of our field and to really be at the forefront of that is something that I think I'd miss greatly. Megan Sliski:                19:09                I want to comment James on what you just said. So I happen to think that our dynamic duo of leading a team isn't quite over yet. And so our sounding all somber here and sad about leaving, I have a feeling that James and I are going to continue our little teamwork and leading teams and things are just going to get a little bit better. So look out for the dynamic duo. Jenna Kantor:                                        I love it. Well, thank you so much dynamic duo for coming on. Take care everyone. Thanks for tuning in.     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 iTunes!

LIVE from Graham Sessions 2019 in Austin, Texas, Jenna Kantor guests hosts and interviews Lisa VanHoose, Monique Caruth and Kitiboni Adderley on their reflections from the conference. In this episode, we discuss: -The question that brought to light an uncomfortable conversation -How individuals with different backgrounds can have different perspectives -How the physical therapy profession can grow in their inclusion and diversity efforts -And so much more!   Resources: Lisa VanHoose Twitter Monique Caruth Twitter Fyzio 4 You Website Kitiboni Adderley Twitter Handling Your Health Wellness and Rehab Website The Outcomes Summit: use the discount code LITZY                                                                     For more information on Lisa: Lisa VanHoose, PhD, MPH, PT, CLT, CES, CKTP has practiced oncologic physical therapy since 1996. She serves as an Assistant Professor in the Physical Therapy Department at University of Central Arkansas. As a NIH and industry funded researcher, Dr. VanHoose investigates the effectiveness of various physical therapy interventions and socioecological models of secondary lymphedema. Dr. VanHoose served as the 2012-2016 President of the Oncology Section of the American Physical Therapy Association. For more information on Monique: Dr. Monique J. Caruth, DPT, is a three-time graduate of Howard University in Washington D.C. and has been a licensed and practicing physiotherapist in the state of Maryland for 10 years. She has worked in multiple settings such as acute hospital care, skilled nursing facilities, outpatient rehabilitation and home-health. She maintains membership with the American Physical Therapy Association, she is a member of the Public Relations Committee of the Home Health Section of the APTA and is the current Southern District Chair of the Maryland APTA Board Of Directors. For more information on Kitiboni: Kitiboni (Kiti) Adderley is the Owner & Senior Physical Therapist of Handling Your Health Wellness & Rehab. Kiti graduated from the University of the West Indies School of Physical Therapy, Jamaica, in 2000 and obtained her Doctorate of Physical Therapy from Utica College, Utica, New York, in 2017. Over the last 10 years, Kiti has been involved in an intensive study and mentorship of Oncology Rehabilitation and more specifically, Breast Cancer Rehab where her focus has been on limiting the side effects of cancer treatment including lymphedema, and improving the quality of life of cancer survivors. She has been a Certified Lymphedema Therapist since 2004. She is also a Certified Mastectomy Breast Prosthesis and Bra Fitter and Custom Compression Garment Fitter.   For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly YouTube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt   Read the full transcript below: Jenna Kantor:                00:00                Hello, this is Jenna Kantor with Healthy, Wealthy and Smart. And here I am at the Graham sessions in 2019 here. Where are we? We're in Austin, Texas. Yes, I'm with at least. And we're at the Driscoll. Yes. At the Driscoll. Yes. I'm here with Kiti Adderley, Monique Caruth and Lisa VanHoose. Thank you so much for being here, you guys. So I have decided I want to really talk about what went on today, what went on today in Graham sessions where we were not necessarily hurt as individuals. And I would like to really hit on this point. So actually Lisa, I'm going to start by handing the mic to you because you did go up and you spoke on a point. So I would love for you to talk about that. And then Monique, definitely please share afterwards and then I would love for you to share your insight on that as well. All right, here we go. Awesome. Lisa VanHoose:             00:52                So first of all, thank you so much for giving us this opportunity just to kind of reflect on today's activities. And so, I did ask a question this morning about the differences in the response to the opioid crisis versus the crack cocaine crisis. And I was asking one of our speakers who is quite knowledgeable in healthcare systems to get his perspective on that. And he basically said, that's not really my area. Right. And then gave a very generic answer and as I said earlier to people, I'm totally okay with you saying you don't know. But I think you also have to make sure that that person that you're speaking to knows that I still value your question and maybe even give some ideas of maybe who to talk to and this person would have had those resources. But, I guess it was quite evident to a lot of people in the room that they felt like I had been blown off. Lisa VanHoose:             01:48                So yes. So that was an interesting happenings today. Jenna Kantor:                                        And actually bouncing off that, would you mind sharing how this has actually been a common occurrence for you? You kind of said like you've dealt with something like this before. Would you mind educating the listeners about your history and how this has happened in your past? Lisa VanHoose:                                     I think, anytime, you know, not just within the PT profession but also just in society as general when we need to have conversations about the effects of racism. Both at a personal and systemic level, it's an uncomfortable conversation. And so I find that people try to bail out or they try to ignore the question or they blow the question off and ultimately it's just, we're not willing to have those crucial conversations and I think they almost try to minimize it. Right. Lisa VanHoose:             02:41                And I don't know if that comes from a place of, they're uncomfortable with the conversation or maybe they just feel like the conversations not worth their time. But, I can just tell you as just a African American woman in the US, this is a common occurrence. As an African American PT, I will admit it happens a lot within the profession. But I do think that there are those like you and like Karen and others that are willing to kind of move into that space because that's the only way we're going to make it better. Jenna Kantor:                                        Thank you. Thank you for giving me that insight. Especially so because people don't see us right now, so, so they can really get a fuller picture of it. And now, Monique, would you mind sharing when you went up and spoke, how that experience was for you, what you were talking about and how you felt the issue that you are bringing up was acknowledged? Monique Caruth:           03:37                Well, as Lisa said, we're kind of used to talking and it going through one ear and out the next day and our issues not really being addressed. I think it comes from a point where a lot of Caucasians think that if you try to bring it up, they would be blamed for what was done 400 years ago, 300 years ago. So it comes from a place of guilt. They don't want to be seen as they have an advantage. And I think as blacks we had a role to play in it by saying, oh, you’re white and you’re privileged. So you had an advantage, which structurally there is an advantage. There is structural advantages as I was discussing with Lisa and Kiti last night that as an immigrant, even though I'm black, they're more benefits that I've received being here than someone who was born maybe in Washington DC or inner city Chicago or maybe even, Flint, Michigan. Monique Caruth:           04:51                I can drink clean water, I can open my tap and drink. What I don't have to worry about, you know, drinking led or anything like that. I can leave home with my windows open, my doors open and feel safe that my neighbors will be looking out for me and stuff that I can walk my neighborhood. So there are privileged even though I'm black, that some people that can afford and would I be ashamed of being in that position? No, acknowledge it. And even with an all black community, there are a lot of us, we may not have been born in a world of wealth. I wasn't, my parents sacrificed a lot to get me where I am today, but not because I have somewhat made it means that I have to ignore the other people that have struggled. Monique Caruth:           05:43                And this is a problem that I'm noticing in a lot of black communities, like when someone makes it or they become successful, Aka Ben Carson, Dr Ben Carson, we feel that if I can make it, why can't you? And because some of those people were not afforded the same privileges that you were afforded, and it's kinda not fair to make that statement that if I made it. So can you, and you can't tell people that you worked your butt off and pull yourself up by your bootstraps when you were afforded welfare stuff. Your, you know, your mom benefited from stuff. I was afforded scholarship so that I don't have to have $200,000 in debt. So I could afford to purchase a home after I graduated and all that stuff because I was not in debt. Monique Caruth:           06:47                And a lot of people do not have that luxury. So I can tell people if I can do it, you can do it too. I have to try to find ways to address their concerns and see how I can better help them to move forward and live better. And the problem within our profession is that many in leadership, even though they see themselves as making it, they don't want to have acknowledge that not everyone comes from the same place. It's not a level playing field. And they try to dismiss those by saying, Oh, if I can make it, everybody else can as well. Jenna Kantor:                                        Thank you. Well said. Well said. Kiti. would you mind sharing in light of what everybody said, some of your thoughts on this matter? Kitiboni Adderley:         07:30                While it was interesting to watch the conversation, listen to the conversation today. I have a unique perspective in that I don't practice in the United States. I don't live in United States, but I frequently here taking part in education, but also watching the growth and development of the physical therapy profession. So I'm from The Bahamas and it's predominantly African descent population. Right? And so some of the issues that people of color in the United States deal with, we don't really deal with those in terms of that limitations and privileges. And you know, it's more of a socioeconomic for us. And once you can afford it, then you go and do. And, and I think we're pretty fortunate if we talk about while across the board that most people can afford some form of education and get it. Kitiboni Adderley:         08:30                So I'm in a unique position because I look African American, it was, I don't open my mouth. You don't know. And so I'm privy to some conversations on both sides of the role, you know, and if people are probably, so what do you think about this and how do you feel about that and how does it bother you? And you know, so while I'm not the typical African American and they see them start to take a step back and it sort of gives you the understanding that they don't truly understand that every person of color does not have the same story. And so you can approach us expecting us to have the same story. Right? Cause your three x three women of color here, one's born and bred African American ones born and bred Trinidad and transplanted United States and one's born and bred, still working in The Bahamas and the Caribbean. Kitiboni Adderley:         09:17                Good. So we all have different perspectives that we all come from different backgrounds and different experiences. But it was interesting and when Lisa asked a question and you know like, you know, people say you will, you know you need to bring it up if we don't talk about these things enough. And it's almost like, okay, you bring up the conversation. So the balls in play, it's tossed from one play at an accident and be like, Oh shit, we can handle, listen to bar this draft again. And so the conversation shuts down and you're like, but you didn't answer the question and you're like, you know, well, yeah, okay, well we'll throw the ball up in the air. And at another time, and I think this is where the frustration comes in for people of color that live in United States because you want us to have these conversations were given quote unquote, the opportunity to ask questions or have these discussions and the discussions come up and at the end of it it's like, okay, we just gave you the opportunity to discuss where do we go from here? Kitiboni Adderley:         10:14                What's done, what's the recourse, what's our next step? What's our plan of action? And when we talk about inclusion and diversity, if you're not going to take it to the next step, if you're not going to have a call to action, then what's the point? And this is why probably people of color don't come back out again because what's it's a bit, it's a bit annoying. It's like frustration because you stand there, you're waiting for a response. And I was like, oh, well, you know, this isn’t my field and I appreciate the honesty, but then let’s address this at some point we have to address this. So do we need another meeting just to address this? Do we have to have, you know, just, let's pick the topic and work on it. So like I said, it was a very unique perspective. Kitiboni Adderley:         10:57                I sort of like watching the response of the other people in the room and see how they respond to it, but the conversation needs to keep going for those of us who can tolerate it or have the patience to deal with it at this given time. And, it was a great experience. It was a good experience. Jenna Kantor:                                        I love it. So I would have just one more question for each of you and it's what would you recommend we do as a profession, both individually and as a collective in order to grow in this manner? Monique Caruth:           11:37                Well, piggy backing off of what Kiti mentioned, I was sort of blown away too when he said that that's not his field because he's a reporter, he does documentary stuff all you was asking was one opinion you want asking for, you know, an analysis or anything. It was just an opinion and he refused to give that. And his excuse was, I don't know much about it and what was, it wasn't surprising but no one else in the crowd said well we then address her concern and immediately he was, she didn't put it in a way that made it seem or the crack epidemic was black and the opioid crisis as white. He was the one who drew it up cause I was actually praising her for how skillfully she worded it. I'm learning a lot of tack from obviously Lisa I'm not that tactful and my family tells me I need to be tactful, but it's that no one else said, okay, let's discuss it. Monique Caruth:           12:51                Really. Why, why is APTA making such a big push choose PT. Now. Versus in the 80s when the crack and the crack epidemic was destroying an entire city because DC was known for being chocolate city on the crack epidemic, wiped it out and it got judge all. Alright, it rebuilt it. But now again, it's trying to find like I went to Howard University, you know, I could walk around shore Howard and I'm like, am I in Georgetown? Because you don't recognize, you know, the people live in that. It has driven out a lot of blacks that were living in drug pocket. You know, it's now predominantly, young white lobbyist living in the area. So if we don't have the support of our colleagues, how can we address inclusion? How can we address equity if they're not willing to put themselves out there to say, Hey Lisa, I got your back. Monique Caruth:           14:05                We need to talk about this. We need to discuss it. Let's have a discussion. Your question was not answered. It wasn't even to say that it was acknowledged with a dignified response because we're spending millions of dollars under choose PT campaign. Why is it because the surgeon general is saying, oh there needs to be another alternative because Congress is trying to pass bills to lower the opioid crisis. Why? If you asking people to choose PT what makes it different? Okay. Even with the Medicaid population, the majority of people who receive Medicaid are black and brown. Are we fighting to get make that people have medicaid coverage or other stuff. Or are we fighting running down Cigna and blue cross blue shield and Humana and all those other types of insurances? Because we think the money is in these insurances. When they could dictate whatever they want, then you could provide a service and say you're providing quality service. Monique Caruth:           15:14                But if they say, oh, we're just gonna reimburse you $60 we are getting $60 and people on our income. So people complain on Twitter and on social media about, you know, insurance stuff. But if I see a medicaid patient in Maryland, I am guaranteed $89 and that person has the treatment. They’re being seen, they're getting better. It's guaranteed money. But a lot of people don't want to treat the Medicaid population because they think they're getting blacks or Hispanics. And I hear complaints like I don't really want to treat that population because we are going to have no shows and cancellations and all that stuff, which is bs. It's excuses. And we have to do better as a profession to acknowledge or biases and work on ways to help work with the population that we serve. Because let's face it, America is not going to remain white? It's gonna get mixed. We're going to have some more chocolate chips in the cookies. Okay. All right. It's going to be more than two chocolate chips in the whole cookie next time. Jenna Kantor:                16:33                Before I pass it to you, Kiti, I really like where you're going with this, Monique, and I think it's important to acknowledge why, which I didn't at the beginning. Why, why, why we're tapping on this one incident and really diving in and it's because what I learned today from my friends is that this is a common occurrence in the physical therapy industry. It's not just it and it's not just within our industry. It's what you guys deal with regularly. And if we are talking about our patients providing better patient care, we need to really, really be fully honest with where we are at. Even as they are speaking, I'm constantly asking myself, what are my things that I'm holding within me where I'm making assumptions about individuals? There's always room for growth. So please as you continue to listen to Kiti speak next, just keep letting this be an opportunity to reflect and grow. Kitiboni Adderley:         17:50                Okay, so I recognize that incident was uncomfortable. It was an uncomfortable conversation to have and it's okay to have uncomfortable conversations. As physical therapists, we have uncomfortable conversations with our patients all the time. We have uncomfortable conversations with our colleagues and we have to call them out on some mal action or when they call us out on something that need to do. And because the conversation is uncomfortable, it doesn't mean that we don't have it. We probably need to talk about it more. And so if there's anything that I want to say, I think we need to have more of these conversations and have them until they no longer become uncomfortable until we could actually sit down with, well no, I shouldn't say anybody but, but the people of influence, cause this is what it's really about. We were sitting with very influential people today and all of us there, I'm sure where people of influence and you know, this is what we need, this is what we need to use. And don't be afraid to have the conversation. As uncomfortable as it may make you feel. Why are we having this conversation? We want inclusion, we want diversity, we want a better profession. And those are the goals of the conversation. We shouldn't shy away from it. Jenna Kantor:                                        Thank you. I'm gonna hand this over to Lisa for one last one last thing. Lisa VanHoose:             18:43                So I just want to talk about the fact that part of the conversation was this dodging right? Of a need to kind of have this very authentic and deep conversation. The other part of today's events that I'm still processing is this conversation about the need for changed to be incremental, right? Comfortable. And for those of us that are marginalized to understand that the majority feels like there has been significant change and that was communicated to me in some side conversations and I was challenged by one person that was like, well, I think you have this bias and you're not recognizing the change that has occurred and how that this is awesome that we're even in a place to have this, that we're having this conversation today. Lisa VanHoose:             19:46                You know, that you need to acknowledge that success that we've made. And so I do agree that, you know, what all work is good work and I will applaud you for what has been done today. But I also would say to people who feel that way, step back and say, okay, if the PT profession has not really changed as demographics in the last 30 years, and if you were an African American and Hispanic and Asian American, an Asian Pacific islander or someone of multiracial descent would you be okay with that? Saying that, you know what, I started applying to PT school when I was in my twenties and I'm finally maybe gonna get in my fifties and sixties. How would that feel? Right? That wasted life because you're waiting on this incremental change. And I think if we could just be empathetic and put ourselves in the other person's shoes and say, would I be okay with waiting 30 years for a change? Lisa VanHoose:             20:53                Would I be all right with that? But I often feel like when it is not your tribe that has to wait, you okay with telling somebody else to wait? Right? And so, I want to read this quote from Martin Luther King and it was from the letters from Barringham where he criticized white moderates and he said that a white moderate is someone who constantly says to you, I agree with your goal, with the goal that you seek, but I cannot agree with your methods of direct action. Who believes that he can set the time table for another man's freedom. Such a person according to King is someone who lives by a mythical concept of time and is constantly advising the Negro to wait for a more convenient season. And that's how I felt like today's conversation from some, not all was going. King also talked about the fact that that shallow understanding from people of goodwill is more frustrating than the absolute misunderstanding from people of ill will. Luke warm acceptance is much more bewildering than outright rejection. And I say that all the time because I would prefer that you be very honest with me and say, I don't really care about diversity and inclusion, but don't act like you're my ally. But then when it's time to have a hard conversation, you say, I can't do that. I'm like, choose a side, pick a side. There is no Switzerland. There is no inbetween. Jenna Kantor:                22:25                Thank you so much you guys. I'm so grateful to be having this conversation to finish it with a great Martin Luther King quote, which is absolutely incredible. I'm just full of gratitude, so thank you. I'm really looking forward to this coming out and people getting to share this joy of learning and growth that you have just shared with me right now.   Lisa VanHoose:                                     And thank you for being an ally. We really appreciate that. So we're not, I just want people to know, we're not saying that the African American or the immigrant experience is different from the Caucasian experience. I think we all have this commonality of being othered at one time or another, but yes, with being a white female LGBTQ, I think the complexities of who we are as a human, there's always going to be a time where you're an n of one or maybe of two and you get that feeling that, Ooh, am I supposed to be here? But I think what we're talking about is being empathetic and if we're going to talk about being physical therapists, being practitioners and compassionate, and we're going to provide this patient centered care, how can you tell me you're going to provide patient centered care when you can't even have a conversation with me as a colleague, right. When you can't even see me. So I just want the audience to know, that we're not coming from a place of being victims were coming from a place of really wanting to have collaborative conversations. Monique Caruth:           23:59                I like to view my colleagues as family members. There are times, as much as I love my family, my mom and my dad and my sisters and my brothers in law, there are times we will sit and have some of the most uncomfortable conversations, but at the end of it it’s out of love. It's all for us to grow as a family. And Yeah, you may not talk to the person for like a day or two, but you're like, shit, you know, that's my sister, that's my brother in law. You know, I have to love him. But you know, you try to hear their perspective, you try to make sure they hear your perspective and you come out on common ground so that the family can grow. And we don't treat this profession as a family, the ones who are marginalized are treated as step children. Monique Caruth:           24:57                And that's a bad thing because stepchildren usually revolt. And when they revolt, the ones who are comfortable with incremental change and are afraid of chasing the shiny new object. Because when I heard that comment today, I felt like the shiny new object was diversity, equity and inclusion that people were trying to avoid without saying it outright. And, someone who feels like they have been marginalized. It was like a low blow. So I, for one, appreciate people like you, Ann Wendel, Jerry Durham, Karen Litzy, and stuff. Who Have Sean Hagy and others, Dee Conetti, Sherry Teague reached out to us and say, how can we help? And you need people like that to be on your side. Martin Luther King needed white people. Okay. Rosa parks needed white people. Harriet Tubman needed white people to get where they're, even Mohammed Ali needed white people to be as successful as he is. We all need each other. If we are saying championing better together, how can you be better together if you're not willing to hear the reasons why you feel marginalized or victimized, it's not going to work. Stop turning around slogans or bumper stickers and start working on fixing the broken system that we have. That's all I'm asking for and we got to start working as a family, as uncomfortable as it may be. All right, we'll get over it and you're going to like and appreciate each other for it later on. Jenna Kantor:                26:44                Thank you guys for tuning in everyone, take care.     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 iTunes!

LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Greg Lehman on the show to preview his lecture for the Third World Congress of Sports Physical Therapy in Vancouver, Canada. Greg is a physiotherapist, chiropractor and strength and conditioning specialist treating musculoskeletal disorders within a biopsychosocial model.  He currently teaches two 2-day continuing education courses to health and fitness professionals throughout the world.  Reconciling Biomechanics with Pain Science and Running Resiliency have been taught more than 60 times in more than 40 locations worldwide. In this episode, we discuss: -Common misconceptions surrounding the source of pain -Do biomechanics matter? -Promoting movement optimism in your treatment framework -What Greg is looking forward to at the Third World Congress of Sports Physical Therapy -And so much more!   Resources: Greg Lehman Website Greg Lehman Twitter Third World Congress of Sports Physical Therapy David Butler Sensitive Nervous System Alex Hutchinson Endure                                                                      For more information on Greg: Prior to my clinical career I was fortunate enough to receive a Natural Sciences and Engineering Research Council MSc graduate scholarship that permitted me to be one of only two yearly students to train with Professor Stuart McGill in his Occupational Biomechanics Laboratory subsequently publishing more than 20 peer reviewed papers in the manual therapy and exercise biomechanics field. I was an assistant professor at the Canadian Memorial Chiropractic College teaching a graduate level course in Spine Biomechanics and Instrumentation as well conducting more than 20 research experiments while supervising more than 50 students. I have lectured on a number of topics on reconciling treatment biomechanics with pain science, running injuries, golf biomechanics, occupational low back injuries and therapeutic neuroscience. While I have a strong biomechanics background I was introduced to the field of neuroscience and the importance of psychosocial risk factors in pain and injury management almost two decades ago. I believe successful injury management and prevention can use simple techniques that still address the multifactorial and complex nature of musculoskeletal disorders. I am active on social media and consider the discussion and dissemination of knowledge an important component of responsible practice. Further in depth bio and history of my education, works and publications.   Read the full transcript below: Karen Litzy:                   00:00                Hey everybody, welcome to the live interview tonight with Doctor Greg Lehman. And we have a lot to cover tonight. So for everyone that is on watching, oh good. And we're on. Awesome. Just wanted to make sure, for everyone that's on watching and kind of throughout the interview, if you have any comments or you have any questions or you want to put Greg on the spot, feel free to do so. We can see your comments as they come up. Greg, if you can't see them, just know I'll kind of let you know. But one thing we do want to know is if you're watching, say hi and let us know where you're watching from. And that way when you start asking questions, at least I'll have a better, kind of know who you are a little bit. Now before we get to the meat of the interview, I just want to remind everyone that if you are watching this, this is not on my page and it's not on Greg's page, but instead we are on the Facebook page for the Third World Congress in Sports Physical Therapy and that is going to be taking place on October 4th and fifth in Vancouver, Canada. Karen Litzy:                   01:20                So hopefully we're going to be doing more of these throughout the year talking to a lot of the presenters and Greg is one of the presenters at the congress. So that's why he's here. Greg Lehman:               01:31                Not just me every time Karen Litzy:                   01:35                Although I have to say, I bet people would really enjoy that. Greg Lehman:               01:39                Yeah, I'll fill in for whatever speaker it is and I'll just learn their stuff and then pretend like I know Karen Litzy:                   01:46                Okay. So I'd like to see you fill in for Sarah Haag. Greg Lehman:               01:50                Done. I’ll shake my pelvis. Karen Litzy:                   01:53                Pelvic health and stuff like that. That would be amazing. I would actually wouldn't mind seeing that. Now before we get started, Greg, can you talk a little bit more about yourself, just kind of give the listeners, the viewers here a little bit more of a background on you so that they know where you're coming from, if they are in fact not familiar with you. Greg Lehman:               02:13                Okay. Well, leading into that, I'm a generalist. I'm not a specialist. I have a background in kinesiology and then a master's in spine biomechanics and I was really into spine biomechanics for a long time. But you know, I became not, sorry, I was going to say dissolutioned. That's a little too strong. I've always been skeptical, skeptical of everything that I've known, and that's probably why I got accepted to my master's in biomechanics because they liked the questions I asked. And then my research there was in mainly exercise, like EMG and manual therapy, what manual therapy does. And I was pretty lucky because I was with Stuart McGill and two chiros named Kim Ross and Dave Breznik, who I always have to mention. And I should give a big shout out to Stu because he took on Kim Ross Dave Breznik who were chiros at the time and they did like amazing research that challenged so much of what we know about, you know, spine manipulation. Greg Lehman:               03:19                And they also challenged me to think about what I thought about low back pain at the time. So my master's was really helpful for me because it challenged so much of what I thought. And so that's when I was first introduced to the bio psycho social, not actually first, cause I used to read John Sarno when I was like 19 years old. I was a bit of a nerd when I was a kid. But definitely the occupational biomechanics at Waterloo, even though they love biomechanics, even back then they knew that psychosocial factors were important for your pain and injury. And then I went to chiro school, actually I went to, that's like in quotes. I like was registered, but I didn't go to class, but I had a research program and they were awesome. They funded me to do more biomechanical research. Then I was in practice for a long time and then I went back to physio school and then I was in practice for a long time and didn't do a lot of research. And then I just started teaching with John Sarno who's running the conference with the running clinic and they were great. And at the same time I also started teaching my course which is about biomechanics and pain science. How do we like bring them together? And you've hosted me. Karen Litzy:                   04:38                I've taken that course. Yes. Greg Lehman:               04:41                For you is like an echo chamber. Just it was confirmation bias. Yeah, yeah, yeah. We know this shit, Greg. But thanks for confirming what I already know. And my course does that a lot, which I don't mind. So that's me. There you go. That was fun. Karen Litzy:                   04:56                Excellent. Very good. And, you know, just as a side note that I spoke to John Sarno a couple of years, like when I was in the middle of like all my neck pain, I reached out to him via email and he said, you need to call me. Greg Lehman:               05:11                Oh, interesting. Karen Litzy:                   05:12                So I called him and I spoke to him. I never saw him but I spoke to him and he was like, you're a young chickadee. I was like, what? And like crying and all this neck pain. I'm like, who is this guy? And he said, well, just get my book. Read it. If it doesn't work, come in and see me. Greg Lehman:               05:30                Yeah, that's funny. I had a patient, he was very famous, very rich, and he bought like a hundred of his books and gave them out to his friends. He thought it was amazing. Sarno was interesting because and this happens, this is the issue with biomechanics sometimes is he had physios working with him for a long time and then he realized that doing physical medicine conflicted with the message he was giving about where pain came from, meaning like predominantly emotional, I'm probably bastardizing my sense in a long time since I thought about them. And so, which is funny that he had the problem that I had for a long time and so many of us do where we think it's bio-psychosocial, but often our biomechanical ideas will conflict with their psychosocial. So we have to be careful in how we navigate all the multidimensional nature of pain. Karen Litzy:                   06:26                I think that's the important part is that it's multidimensional and that you can't have that pendulum swing too far in either direction. And you know, now that we're on the topic of pain, let's go in a little bit deeper, so what would you say are the biggest misconceptions or common misconceptions around pain and it's, I'll put this in quotes, sources, quote unquote sources. Greg Lehman:               06:53                Yeah. The biggest one. And I really like to focus on this because it helps me in practice, it's this idea that, and I like this cause it's how our practice is that we don't always need to fix people, right? And I kind of mean, I don't just mean that in the biomechanical way. And I would have meant that in the biomechanical way five years ago where I would have said, well, you don't have to fix that posture. You don't have to fix that strength or that weakness or we don't fix strength. We're gonna have to fix that weakness or tightness. And I believe that although I do think strength and weakness and range of motion can be relevant sometimes, but I also don't think we need to always fix catastrophizing and depression and anxiety and worry, and so that criticism goes both ways. Greg Lehman:               07:53                It started out for biomechanical with me, but I would also say psycho social and we see that in the literature where people recover and they still have these, you know, mediators of disability and pain. It could be high catastrophizing but they still do really well because maybe they built up their self efficacy and they got a little bit of control and they were able to do something and something to control their pain or do something that they loved or they had some sort of hope. And so that's the biggest one, that idea of like fixing and if you want to be more technical or mechanical, it's the same idea. Like I don't think you have to get rid of nociception. So like your tissue irritation stuff, you can have shit going on in the tissues, but it's how you kind of respond to that stuff. That’s exciting. Karen Litzy:                   08:45                Well why would want to get rid of nociception. Greg Lehman:               08:49                Yeah. Well I mean I don't, well I know what you mean. Like, we don't, you don't want to, cause when you sit down you want to get an ass ulcer. Right. You definitely want to move around. So, but that now we get into crazy stuff with that. Karen Litzy:                   09:03                Well do you mean the sensitivity around it? Greg Lehman:               09:05                Yeah, it'd be like you definitely don't want like a raging disc herniation that's pressing on a nerve root and you have chemical inflammation, things like that. It’s worthwhile getting rid of. But you know, other things, you know, you can have tendinosis and a muscle strain and it can definitely hurt. But it's the idea that sometimes maybe what our rehab does is helps us cope with those, with those things, right? That's at a peripheral level and more central level. You can have anxiety and worry and those might magnify your pain response, but you can also cope with them as well. And so I love that message because I think it's just positive. Like people think I'm so messed up, I got scoliosis, I'll never got pain. And I'm like, dude, like it might contribute. I don't think the research actually supports that. Perhaps. Perhaps it does, but you can have that and still be doing awesome. Karen Litzy:                   10:00                Right. So just cause you have chronic, let's say persistent pain or you've had pain for x amount of time, it doesn't mean that that should be the thing that defines what you do or defines whether you're happy or sad or anxious but that it's a part of your life that perhaps you can cope with or like in my case I had many years of chronic pain. Now I have pain every once in awhile. But there are times where it's more severe than I would like it to be. And there are times when I want to fix it or I need to fix it. And then there are other times where I feel like I can cope with it and it's not horrible. Karen Litzy:                   10:45                I think it's context dependent. So like I had pain last year, like pretty severe for like a week or so, and I knew that in another couple of days I had to get on a flight to go to Sri Lanka. And so I needed it. So what I did for myself was I decided to get medication to help bring those pain levels down and that's what I needed at the time. But I felt so guilty about it. I would like say is this the bio psycho social way? Is this the way I should be handling this? Greg Lehman:               11:20                I would think so. I’m going to mansplain you for a second. Cause I'm guessing that you knew that this was just a flare it was going to go away and that you've managed it before, but you're just giving yourself a break for a few days. Yeah. I don't think there's anything wrong with taking Tylenol for a few days. I've talked off topic, but it's how you do manual therapy, I don't do a lot of manual therapy, but I don't begrudge people that do. And it's, especially at an athlete level, I brought this up with some of the people who are going to be at the congress and I'm like, I find it ironic that all of us who teach a running course, none of us really teach manual therapy at our running courses and no one would ever say that manual therapy is a strongly evidence based, you know, modality for running injury. Greg Lehman:               12:16                It's not, we would all talk about load management and exercise and blah, blah, blah, blah, blah, all of these things. Yet when you're a physio or a chiro training like elite athletes and you're working with them the day before their competition, what are you doing? You're probably doing some manual therapy. And so I just found that ironic that we do that, that when we're traveling with the team, I don't travel with teams, but I do have athletes come to see me the day before an event or I've been working with them for months and here I am doing what people would call low value care. But I'm like, no, sometimes it's a bandaid, but sometimes bandaids help and that's the only solution. Well, the solution that works then. Karen Litzy:                   13:08                Well again, it's context dependent, right? So if, and I saw this conversation on Twitter about, you know, what are we doing race day and race day yeah you probably are doing some sort of manual therapy. Greg Lehman:               13:30                You’re treating that little niggle and this things tight and sore and you treat and people feel better. And if fatigue is psychobiological, which it is, then our intervention is probably psychobiological and it could certainly be more psycho based. Yeah. Karen Litzy:                   13:48                Right, right. It’s still real. And you know, in the context of athletes and being, this is the Third World Congress in Sports Physical Therapy. So there'll be a lot of, we can assume, I don't know, physios there that probably work with an athletic population. And so I think it's important to bring that up. All right. I digress. Greg Lehman:               14:14                I did, you were the professional. Karen Litzy:                   14:20                So one common misconception is that we don't have to fix everything and not just the biological part, but the psychosocial part as well. Is there any other, maybe one other common misconception around pain and its sources that you hear a lot or you see a lot? Greg Lehman:               14:40                I mean if I had to say anything, it's like it's the relationship between bio motor abilities, which would be like strength and flexibility and pain. I think that it’s over sold. You know, I don't think posture is relevant. I don't think strength or motor control is irrelevant. I just think it gets over done in that, that to me is that kinesio pathological model, which I have a big issue with, which would be like your knee goes into Valgus, you're going to pay for it later and you're going to get knee pain or hip pain. And, I'm like, well if your knee hurts and it goes into Valgus it's certainly a reasonable option to avoid that for a little bit. And then you might recover cause it's an avoidance strategy and build yourself back up and you'll do great. But I think what often happens is we then say, well, you went into valgus and it hurt, therefore valgus is inherently wrong and we need to make rules for everyone on how they should function. I hardly saw you when we were in Denver together, but I gave that whole, I forgot about that. We just saw each other, sorry, I was with Betty the whole time. I couldn't hang out with you guys. And so that I gave that example of limping, like when you sprain your ankle. Karen Litzy:                   16:06                That example was great. Greg Lehman:               16:08                Yeah. You sprained your ankle and it feels better to limp. That's totally reasonable. But no one would then conclude that we all should be limping. That that's the right way to move. When I see like people I really respect, like Shirley Sahrmann or Jill Cook who will, you know, say avoid hip abduction, right? It's so horrible on the tendon, on the outside of the hip or is so bad on the knee. And I'm like, yeah, it's reasonable for symptom modification but I don't want to make a general rule and that happens too much and then we're too quick to be like, well just cause someone got better with exercises that try to change those movement patterns. That doesn't mean that's why that treatment was successful. Often those rehab programs that try to change movement patterns are like amazingly comprehensive and excellent rehab programs. And then you have like awesome therapists like you know, Stuart McGill or Shirley Sahrmann who just like build in this graded self efficacy and pump them up and they tell them you can do whatever you like. Let's just change your movement patterns and start doing this stuff you love again, may have nothing to do with the movements. It's just like the person was like, wow, I'm awesome, you're awesome. Let's do it. Karen Litzy:                   17:26                I think you can’t sort of parcel out one part of that complete treatment program and say this is the thing that worked. This is why this worked. I mean, you can't do that. I think that's impossible. Greg Lehman:               17:37                No. And it's certainly the same with the people who I really love, like Peter O'Sullivan and that whole group when they help people, like I don't really agree. I'm such a jerk. I don't always agree with their mechanisms because when I see Pete treat, he's just so confident. It's like, you can do this, you can do this and bend over and do this and do this. And like, and I would never practice that way. I just couldn't pull it off. But I can imagine how much he helps people. That's actually why I really respect him. What he does really well. When he tests RCTs, he doesn't test himself. He trains people and other people do it. So, I actually shouldn't, I'm not knocking his research. I can't get to his style because he's so confident. It's absolutely really honorable what he does where he's like, I'm not going to be the dude that's in the RCT and train people and then we'll do the studies on them, which is just, that's nice science. Karen Litzy:                   18:34                Yeah, for sure. And all of those people you mentioned also have great reputations. People are referred to them when nothing else works. And so as the patient, you're like, well I know this person's the expert. Karen Litzy:                   18:49                Right. So I think in the patient mind they're thinking, if anyone can fix me, yeah, it's going to be this person. And I think that that also plays into it. Greg Lehman:               19:00                I just opened my own little clinic out of my house. We have like a little gym. It used to be a workshop and now it's a clinic gym and I have nothing on the walls. And I'm like, how can I placebo the hell out of this? So that's my answer. I like art. I want to put up like, no, I should put up like placebo shit. Like what was like going to make me look amazing? Karen Litzy:                   19:25                Yeah. Well you can put up like awards you've gotten put up your degrees. People will be like, look at how many degrees he has. Look at all of his qualifications. He must be amazing. Greg Lehman:               19:37                Yeah. Maybe, I don't know. Karen Litzy:                   19:41                You see that a lot in the US like when you walk into an office, the degrees and the licenses and certifications, right? Greg Lehman:               19:46                All that weekend certifications, all that nonsense. After I teach, I always tell everyone, like, whenever you want me to write on your certificate, I will write levels six fascial blaster done, master Fascia blaster. I don't care. It's all bullshit. Karen Litzy:                   20:03                Biomechanics. Does it matter? Greg Lehman:               20:07                Since the sport conference let's start. They definitely matter for performance. We got to listen to our coaches and the physios. But biomechanics and technique matter for performance. So if you want to tell someone to sit up straight, yeah, it's totally reasonable to do that if you're thinking how they're going to function 30 years from now. So that's great advice. And then, it's like a question of when they matter after that. And so I kind of Parse it into a few different areas of when they matter. The big one for me is like what's more important, is it's not how you move, it's that you're prepared to do what you're doing. So make the mechanics and the loads on the person matter. Greg Lehman:               20:59                But it's the movement preparation. So my pithy expression is preparation trumps quality, right? Something like that. And then the other way or the other area where they matter is this symptom modifications. So if it hurts to do something, like if you're a runner and your knees hurt and you heel strike and you have a long stride, it's totally reasonable to shorten your stride, maybe changed your foot strike, although that's debatable, but it could serve it is certainly is an option. And if it feels better, keep running like that. So the mechanics there help but it doesn't prove, you know, the thesis that there's a right way of running. It's just that you're running differently cause another run or you're going to be like stop forefoot striking and actually lengthen your stride. I've done that plenty of times. So you're just symptom modifying. Greg Lehman:               21:45                So mechanics help a ton for symptom modification. And then you know there's probably under high high loads, there's probably better ways for your tissue to tolerate strain. You know, like if you're landing and cutting you can go into valgus but you probably don't want to go into Valgus if your knee's not flexed. Right. So high loads where the tissue gets overloaded matters. And then after that with that principal there, it gets more difficult because you start thinking of the spine and you're like, okay, is there a better way for the spine to tolerate loads? And that's where we have been debating biomechanical principles here because certainly the bio does drive nociception sometimes. And so those are the big areas for me where biomechanics matters. Sorry I went over that fast. Karen Litzy:                   22:39                I think that makes perfect sense. And I mean, I don't know if you saw this since you are probably more into tumbling and gymnastics than I am.  I haven't seen this yet. But did you see yesterday a gymnast broke both of her legs or something. Greg Lehman:               23:01                I saw that by accident. I won't see it again. Karen Litzy:                   23:02                But I don't know what happened there. Greg Lehman:               23:07                I think it may have been in a double Arabian or a double front tack and she landed and then hyper extended. And what freaked me out a little, only saw it once and I'm not gonna see it again, is I don't think she landed with straight knees. They were like bent and then they went into extension like, which freaks me out because my daughter's learning front and I'm doing them with her front tuck step outs, and you kind of land on that one leg and it's straight ish. And I was worried of extending. Karen Litzy:                   23:46                Yeah. I mean I haven't seen the footage of that, so I was just wondering if that would be a time when biomechanics mattered or just an accident. Greg Lehman:               23:55                It certainly did. But here's the problem with all the biomechanics mattering stuff, is it the mechanics mattered and caused the injury. It's just whether you can prevent it. Yeah. It's like so many ACLs. Someone might cut 10,000 times with their knee in valgus. Well, that's proof of principle, that they're safe and then they do it one way that's slightly different and then they tear their ACL. But it doesn't mean that the way they were doing it before was unsafe because they could have had less valgus pattern before and then they could have done that too. Like, yeah, I don't know. It's difficult. Karen Litzy:                   24:34                Yeah, and I think when you're talking about injury prevention, I mean that's a whole other conversation. But I think that so many factors go into that as well. It's sleep, it's nutrition. It's what did you do the day before or was the beginning of the game, the end of the game? Are you fatigued? Are you not? I mean, so much can go into that. So yeah, you can cut 10,000 times and one time you have an injury. It doesn't mean that the way you did it was incorrect. It doesn't mean that the preparation leading up to it, it could have been that day. It could have been what you did the night before. I mean, so many factors and elements that go into something, some sort of accident or injury like that, which is why injury prevention programs are difficult. Greg Lehman:               25:25                Yeah. And, and we see them running, you know, like we've been saying the same thing for years. So you don't have training errors, which just means don't do too much too soon. And then you try to nail it down in the research and you say, well, what's too much and what's too soon? And then there's no real good research on that, right? Because there's so many different variables that influence that. So my joke tonight, we're arguing not we were talking on Twitter about this. I'm like, well, we can probably all agree when it's like just looks ridiculously like too much too soon. And that's the pornography test, right? Which is your old Supreme Court justice is either pornography or obscenity and they're like, I can't define pornography, but I know when I see it. And so when a movement pattern or a training load is pornographic than maybe you avoid it or depending on your personality. Karen Litzy:                   26:17                Right. Well, you mean it just gets a point where it's so obscene. Greg Lehman:               26:20                It's so obscene. You say, ah, that's probably some of them. But it has to be that and who knows? That's the worst part is there's probably people who can handle that obscenity. And I stopped this analogy because I dunno, they're built for it. They prepared to handle. Karen Litzy:                   26:41                All right. Let's talk about being a movement optimist. Yes. So for those of people watching and listening that aren't familiar with this, can you talk about it a little bit more and how this came about? Greg Lehman:               27:02                Well, I mean, I have already, I've already said all the good stuff I've run out of material. Karen Litzy:                   27:08                I can't, I can't even believe for a second. That's true. You're not like your greatest hits album. Greg Lehman:               27:18                I was in Denmark and they gave me this little bobble head that you've pressed the top of and the whole thing like bounces. And it's funny, I was in Scandinavia three or four years ago and they gave me the same thing. It's like this thing that I would get there, but it's called a hop to mist. I loved it. My kids have it anyways, so what it means is like we need to stop vilifying like certain movements. You know, like when you look at someone's skateboarding, their knees are going to cave in and it's amazing and it's a successful movement pattern. If you rock climb and you were just at a birthday party. Karen Litzy:                   28:01                I was  at a rock climbing birthday party yesterday for my 10 year old niece. Greg Lehman:               28:05                Well, I doubt they were doing it, but there's something called a drop knee, which is what I do on a climb is, is you can do it. I'm not doing it. You put your foot up behind you almost and drop your knee down into valgus and then stand up on that and you go into that. Karen Litzy:                   28:24                There are actually some more like real climbers there and they were doing that. There are a couple of people doing that move. Cause I remember my friend that I was with was like, oh my God, look at that person's knee. How is she doing that? Greg Lehman:               28:37                Yeah. And so Alex Honnold is a famous rock climber. They just won the Oscar for Free Solo Yosemite without a rope. But I have sometimes he's in another documentary about Yosemite. I've filmed it when he's in it because he sits like me. He's like super hunched forward with the super forward head posture. And here he is climbing, you know, these massive granite walls and that's a movement optimists, it says you can do all these weird funny things with your body and still be fantastic. You can be a paralympian where you're missing a limb than have induced, you know, assymmetry that you can have scoliosis and make it to the Olympics. You can have scoliosis and lift five times your body weight. And so that's the optimism. It's this revolt a bit against the kinesio pathological model, which to me is certainly has value. Greg Lehman:               29:39                It's certainly has treatment efficacy because I like the treatments that are associated with it, but the fundamental ideas behind it that there's like bad ways to move or better ways to move for injury and pain, that's what I would challenge. I'd be like, let's be more optimistic about how we move, you know, we don't have to always fix these things right now is go and anytime someone like me talks and says to people, all you can move this way, you always want to look for exceptions, right? When you're in practice, like, when should I, you know, disregard what I think, like when you know, when is how someone moves. Like when is that important? You know that and that'll help him be a better clinician. I think. I always challenge challenging whatever you think is true. It makes it difficult. Karen Litzy:                   30:40                Yeah. But I think having that as a clinician, having that sense of doubt is not a bad thing. Greg Lehman:               30:48                Yeah. I mean, I'm going to want to agree with you. Sorry. It was like, why am I listening to this guy? It's like, but then there's those clinicians that get people better by sheer force of personality. They have that utmost belief in what they do, even when they may be full of shit. And so that's how it was hard. Karen Litzy:                   31:16                I have a great example of that, I'm not going to go into it right now. Greg Lehman:               31:25                Now you also have to wake up in the morning and be happy with yourself, so. Karen Litzy:                   31:29                This'll be an easy one for you. What is the most common question you get asked by other physio therapists? If you could say whether it's maybe they private message you or at your courses or lectures. What is the most common question that other physios or healthcare providers ask you? Greg Lehman:               31:59                Oh, that's funny. I didn't read this one before, but a few things. But usually it's like what's the paper that you mentioned? And then I have to like come up with a name and I usually know it, but the bigger one is this is what I do with people. This is not what you talked about, but tell me why it's helping them. That's, what I get a lot, they want validation and then they want to like, you know, tell me their theories of things, but really tell me they want me to tell them why it's great. It's like what the mechanism is. Karen Litzy:                   32:47                That's why it's okay. Looking for just your confirmation. Greg Lehman:               32:54                Confirmation and then like, and then trying to like find out why it works. Like they want me to do the research behind it, I'm going to go. Okay. So what do you say? I mean it depends. Like I probably do like the motivational interviewing thing where I roll a bit with towards distance and I just probably, it's pretty bad, but I probably just read say are actually depends if I've met them before, I'll just talk about the general things that help pain and I'll say maybe it's working this way, but I don't, that's all I do if I think they're totally off base. I don't think I ever really say that. I don't know if I've ever done that. Karen Litzy:                   33:49                Now, and you kind of alluded to this in your answer there, but if you could recommend one must read book or article, what would it be? And if you want to say one book and one article, but just one. Greg Lehman:               34:06                Yeah. You know what I'd go old sounds funny saying old school, but I would read David Butler's the sensitive nervous system. So good. Yeah, it is. Cause it's not only good in like a pain, but if when you read that he's just throwing out little ideas all the time. Like it would be nice for me to reread and just pull out his anecdotes and like little things that he says to do because there's things that I do and I thought, oh, this is kind of neat. And I thought I'd discovered them myself. I thought I'd, you know, you know, found it myself and then I'm realizing here at, he said it 20 years ago or something like that. Yeah, yeah, yeah. That, and then like his former partner would been Louie Gifford and I've only read parts of his books, but I've read some of his other writings and I like his stuff too. But David Butler's the central nervous system, which is just, and it's what, 15 years old, but it's still plenty accurate. Karen Litzy:                   35:07                Yeah. Yeah. And for people who are listening or watching, I can plug that into the comment section, when this is done. All right, so let's move on to the conference. October 4th and fifth in Vancouver, the Third World Congress is sports physical therapy. So can you give us a little bit of a glimpse into what you're going to be talking about? Greg Lehman:               35:32                Not really. I am talking with Alex Hutchinson who's kind of a friend of mine here in Toronto, like the same kind of know those same people. Karen Litzy:                   35:46                You run in the same crowd. Greg Lehman:               35:53                Like, you know, like we rock climb together. We've been to some similar weddings. I've known Alex for awhile and I love his stuff and I always pump up his stuff in my courses. That's what's funny. And then when they put him with me, I was like, this is awesome. Because I always talk about the psychobiological model of fatigue, which is that fatigue is kind of a nice analog for pain. That it's not just purely physiology, that there's a psychology component to fatigue. And I'm like, Whoa, we should talk about this because look how this area of function relates to pain. But so we're talking together on like this massive nebulous talk topic of pain science and athletes. Karen Litzy:                   36:44                Yeah. Yeah. That's a heavy one. I listening to his book Endure right now. Greg Lehman:               36:48                Yeah. See I like the breath holding stuff in there. Karen Litzy:                   36:55                That's the chapter I'm on now, which I can't even fathom. Greg Lehman:               37:13                So go, go online and find David Blaine's breath holding stuff. He needs to have the breath holding record. He did. But he could also do like eight minutes without that. I used to hold my breath in church all the time to pass the time. But breath holdings interesting because if you just hold your breath right now, you might make it 30 seconds, but you can train yourself to make it for four minutes. And so within like a few days if not an hour. So it means your physiological reaction to try to breathe is way over cooked. And that often happens with persistent pain. We do this protective response. So I've been talking about breath holding for years and then Alex's book came out and I'm like perfect. Now I can refer people to that way better down. But so like finding analogs between weird things about pain and then interesting things about performance or breath holding is really nice. Greg Lehman:               38:04                So we've been talking, we were probably going to go rock climbing and then we're going to try to maybe come up with something that parallels each other. I will probably, I'm guessing talk about like how we, I like doing something really practical, like instead of saying this, which might have a negative connotation to some patients, like set them up to have some, you know, less than good expectations say this instead. So, you know, like the diet stuff, don't eat this, eat this. Well it would be the same idea with explaining common running injuries. Which we'll probably talk about, cause Alex’s a runner and I'm a slow runner. So mine will probably be something like that. Just met her way to phrase things. And because everyone always says to me like, okay, well what the hell do I do then if I don't tell them that they have SI joint pain cause it's out of place than what the hell do I say? No, no, not yet. Yeah, I think. And then that's really fun and it's a nice end. We'll have time to talk about it too because there'll be a lot of wisdom in the room and hopefully we'll maybe pull that out. Karen Litzy:                   39:22                Yeah, that sounds great. And I really appreciate those kinds of conversations because then I know that I can kind of take that and use that with my patient population on Monday. Or Tuesday, whatever day. But you know, the next day in clinic. Greg Lehman:               39:38                That's the idea. I don't want to hammer people with research. I know I won't do that. That's for sure. That's easy. I could do that. And it'll be entertaining by your life. Go. Well I got some more research, but it'll probably be more practical. Right. And we're real, more practical story. Karen Litzy:                   39:52                Nice. And I look forward to, you know, the two of you speaking together, I think we'll be entertaining and educational and I look forward to that kind of play that you guys will most likely have off of each other. I’m reading his book and you brought the bread holding, which is exactly where I am. And it reminded like in the breath holding chapter, you know, he said like the people who had like, who broke these records or who could really hold their breath the longest are the people who knew that someone was there to pull them up if they needed it. Yeah. And so when I think about that as it compares to pain, like especially persistent pain, I wonder if you knew like you had an out, would that pain still be as persistent? So that's what got me thinking listening to this chapter was like, hmm, if you knew your pain had a safety net, how would that change your view of your pain? Greg Lehman:               41:03                Oh, that's interesting. No, and I think what you're talking about has actually more ramifications for the negative aspects, right? Because most people think, oh, this will pass, but there's some that think that this won't pass. And Yeah. And that's why there is no optimism. And that's of building that where, there's no reason for them to think that it will change. And that's kind of what we have to do is build that model that there's a possibility for change. Karen Litzy:                   41:35                Yeah. And before we're going to wrap things up in a second, but Kate Pratt said, well, I find one of the greatest sources of misinformation to patients about pain and biomechanics is their MD/ortho. As PTs we hopefully consistently educate our patients. Do you think it's possible to educate MD’s or orthos regarding pain and how would you begin to approach such a scenario? So I think she means as the individual clinician with, you know, the referring physician or the physician who's seeing that patient. Greg Lehman:               42:11                Yeah. I mean in general, I think that's a problem across the board of all professions. How we change our colleagues, view the docs, like our colleagues. And I'm not really sure cause you would assume that has to happen at a school level, right at the training there and at a conference level. So it's really conferences in schools who are open to, you know, providing the different messages there. But I would say, and we've talked a lot about this is when you do have patients who have these beliefs from their doctors or other healthcare providers, which is super common, there are routes that you can, you know, still address those beliefs without throwing the doctor under the bus and that’s what you have to figure out. So often it's more like acknowledging yeah, that's, you know, you have hip pain because he has OA or something you can say that's part of it. Greg Lehman:               43:15                This is the my optimism approach. Yeah. The hip OA is part of your hip pain, but you can still do great even though you have those changes on the scan. And that often really helps, especially with when physios and like we're navigating referral sources. And it's so funny that you bring, I just got, I just like 10 minutes ago before we started, I got a referral from a sport MD who was in the course. I taught with JFS school. On running five years ago and said, are you seeing patients? And like it was so funny that she was in the course because you don't normally see MDs. Yeah. You know, taking courses with the PTs. Great to do that. And so that's how we have to change. You use it somehow get into that educational system. Karen Litzy:                   44:01                Yeah, I agree. And from a one on one. I think it's difficult. I mean Karen Litzy:                   44:11                What I've done once that worked with the referring physician was, you know, I said, hey, you know, we're doing this, this, this and this, but I found this article, do you want to take a look and let me know what you think? Cause I'm thinking of incorporating it. And it was like an, I don't know, I think it was an article, Moseley or Peter O'sullivan. And so I sent them that and then he was like, oh yeah, that's really interesting. Yeah, definitely start doing that. So that's a way you can kind of maybe start. Greg Lehman:               44:44                Yeah. O he or she just rolled with your resistance maybe. No, I totally agree. Yeah. I think we're good. Karen Litzy:                   45:00                It's so hard, but it's a way to be diplomatic. It's a way to say, you know, I don't know. Greg Lehman:               45:08                I really liked that you just sold a good treatment plan and then you gave them other research behind it. That's nice. Yeah. That's probably better than saying you're an idiot. Karen Litzy:                   45:20                Yeah. Well, yeah. But I mean I also find that like I had one doctor that came back to him and he's also a good friend of mine. He was like, that's really interesting. Like we need to talk more about it. Oh, that's cool. Which is awesome, you know? But he's also a friend began, you know, we played softball together. So it's like the different opinions. Karen Litzy:                   46:01                Chris Johnson said to say thanks for carving out the time you need to stop picking your eye. Always exercise diplomacy and avoid creating a disconnect. It doesn't accomplish anything. And that's in regards to Kate's question that we just tried to answer. Like I'm bringing a course to New York City and we're going to have like a free two hour preview of it and just invite doctors. Greg Lehman:               46:44                Wow. Karen Litzy:                   46:45                That's, you know, one way to do it if you want to get them involved in the educational process with Physios, which I think is great. Greg Lehman:               46:52                One of my best course ever in Toronto here was, we had three physiatrists that came and they were fantastic. That's awesome. Go into this stuff. It was a bit, some of it seemed a bit new, but they're open and like, and then the email to everyone after and they share their experiences. I love when you have multi disciplinary people at the course. There are some, I mean I'm not throwing MDs under the bus. They certainly, it's so hard. I have a friend who was an MD and he's like the best motivational interviewer. He was so good. Like he knew this thing is that as patients had to do, but you know, in Canada you only have eight minutes with them. Yeah. And there or whatever. Anyways, so I'm off topic. Karen Litzy:                   47:42                So let's wrap things up here. Are there any presentations you're looking forward to seeing at the conference? Greg Lehman:               47:48                Rob Whiteley. Yeah. I really like is like career and that the stuff he's done and what he's doing there, you know. I'm a socialist I like exercise for everybody and I like the name to change things. But I have trouble like arguing with exercise. It's amazing. It's jam packed like there, there's so many. So that's one of the reasons I wanted to go cause you know, I would have, it'd be nice to go to that conference as well. Karen Litzy:                   49:22                Well, I am looking forward to your talk with Alex. I will obviously finish his book within the next week, so that's very exciting. And I've already taken your class and read your free resource. So I feel like I'm like ready for it. Greg Lehman:               49:39                I'll bring something new. Karen Litzy:                   49:42                I'll come armed with lots of questions. All right. So before we hop off, where can people find you? Greg Lehman:               49:49                Just my website I guess, which is Greglehman.ca. Which I hardly do anything on and then Twitter, same thing. Twitter is my favorite. I like the discussions on Twitter, even cultivate them, trying to keep them polite and nice and you know. So Facebook, Nah, it's for the trolls. Karen Litzy:                   50:15                I think. Yeah, I guess it depends anyway. Again, a whole other conversation. Yes. Greg Lehman:               50:21                No, I'm doing a big thing on Facebook right now. I shouldn't say that. Greg Lehman:               50:29                Yeah. Cause we have like a podcast with me and Oh, I have a podcast, I guess. Never. It's, well it's Adam, it's Meakins podcast, but I'm the cohost so I guess is mine. I don't know. When do you get part of that? I've done three with them. I'm just baggage. I'm a carry on. Karen Litzy:                   50:52                Yeah. I think, I think you need, you need a little bit more. I don't think that three really qualifies as like a permanent cohost. Greg Lehman:               51:01                Oh yeah, yeah. I don't think I want that. Karen Litzy:                   51:03                No, no, no. You're still like a guest cohost, give it a couple more and then I think you're in. Greg Lehman:               51:08                Okay. Well we're doing like a thing on neurodynamics like their dynamic techniques. And so I wanted to poll people and see what people thought. You know, I was curious what people thought, what the hell we were doing when we do them for that. Karen Litzy:                   51:27                I use them, I use them. And oftentimes in people who are a little fearful of movement. Greg Lehman:               51:33                Yeah. So what does that tell you what you're doing? Or you really like manipulating the nerve to, you know, feed them more oxygen or something. Getting someone moving again? Karen Litzy:                   51:45                I think you're getting someone moving again, I think you're taking them to a place where they can stay within a relative comfort zone and you can kind of see, I think what I use it is because you can see some changes pretty quickly. And so I think patients then get a little more confident that they can move because they can see those changes pretty quickly. So that's why I like to use them is to give people some hope. Greg Lehman:               52:15                It’s a modification. Karen Litzy:                   52:18                So that's why I use them, but I use them quite a bit just because I think, I think that they work very well. The only time I don't use them was really with like one person who said I was doing all these nerve glides and now it made my arm so much worse. Greg Lehman:               52:37                It's like everything. Karen Litzy:                   52:38                You know, but I don't know how many, what they were doing, why they were doing them, what explanation they were given. I have no idea that I just sort of held off for a little bit and had the move a different way. But yeah. So that's why I use them. Karen Litzy:                   52:59                So if no one else has any questions. So Agnes said that she'll play softball with me in Vancouver. Greg Lehman:               53:08                Tell her I’m going trampolining and rock climbing. Karen Litzy:                   53:15                I would go trampolining but I really just like bungee trampoline. Greg Lehman:               53:19                Let's do stuff. Karen Litzy:                   53:20                Well you're attached to a bungee and then you obviously go down and then you can go up and flip like two, three times in the air and come back down again. You can't twist, but I did do a double layout. Yeah, it was pretty cool. But yeah, I would definitely play softball. I will bring my glove and I can do some trampolining. I wouldn't have done it 10 years ago or five years ago because of my neck, but now I can do it. Yeah, totally can. Karen Litzy:                   54:14                Just so people know when Greg and I were at the align conference a couple of weeks ago in Denver, Colorado and he had his daughter Betty with him cause it was her birthday weekend and she was his personal photographer just so that it made him look better than everyone else because he had personal Paparazzi. And she was just super adorable and doing back walkovers and she probably would've done a lot more, but we were at a conference on the first day. Karen Litzy:                   55:21                She was very sweet and that's who we're talking about. All right. And I’m going to edit all of this out before I put it out on a podcast. Thank you everyone so much for listening and sorry for rambling at the end. If no one else has any questions, I just want to thank you all for listening and make sure you go and click on the link on this Facebook page. Should take you to the website for the Third World Conference in sports physical therapy. Again, it's October 4th and fifth, and Vancouver. Greg is speaking with Alex Hutchinson and I think that's going to be a highlight of the conference. You don't want to miss it. So Greg, thanks so much for hopping on the call and sorry for the technical difficulties. Thank you so much and we'll try and put all the information that we spoke about in the comments section here. So thanks everybody. And Greg, thanks again.     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 iTunes!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Kelly Duggan on the show to discuss her hybrid physical therapy business model.  Kelly is the creator and owner of Physical Therapy U, a successful insurance based PT clinic in Bridgewater Massachusetts. PTU is focused on changing the healthcare experience for their community with a focus on youth athletes.  In this episode, we discuss: -How Kelly’s hybrid practice has married quality patient care with financial freedom -Marketing strategies that have exponentially grown Kelly’s practice -Top key performance indicators Kelly tracks to ensure her clinic meets its mission -Why your life vision should align with your daily life -And so much more!   Resources: PTU Clinic Instagram PTU Clinic Website PTU Clinic Facebook Strive Labs Email: PTUclinic@gmail.com   For more information on Kelly: Kelly J. Duggan is a physical therapist with over a decade of experience in both inpatient and outpatient settings.  Kelly is the creator and owner of Physical Therapy U, a successful insurance based PT clinic in Bridgewater Massachusetts.  PTU is focused on changing the healthcare experience for their community with a focus on youth athletes.  Physical Therapy U is a hybrid clinic offering PT, massage and sports/fitness trainings.  Kelly uses this hybrid approach to combat the typical decline in revenue that most insurance based outpatient clinics (that aren’t tied to a hospital) experience over time.    Kelly is also a proud wife and mom of her three young children.  Kelly has worked hard to show that although the timing doesn’t feel “perfect”, you can open a clinic at any time of life.  Physical Therapy U was created during the 3 months after her third child’s birth, while she also had her 1.5 year old and 3 year old home with her.  Kelly encourages others to go after their dreams and although being in the spotlight causes significant anxiety, she continues to push herself forward so that others can see what is possible.   In just three short years Kelly has successfully tripled her small business from a 1200SF space to a 4500SF space without the need of tripling her patient visits.  Kelly enjoys sharing her highs and lows with others so that they can learn the best techniques even faster than she did.  Physical Therapy U continues to grow and evolve and Kelly welcomes any and all advice for the future success of her business.     Read the full transcript below: Karen Litzy:                   00:01                Hey Kelly, welcome to the podcast. I'm happy to have you on. Welcome. Kelly Duggan:                00:06                Thank you so much for having me. Excited to be here. Karen Litzy:                   00:09                And today we're going to talk about your business, the growth of your business. I would say the very fast growth of your business over the past three years. So PTU opened its doors three years ago. It was you and your sister working 10 hours a week. And now let's fast forward to three years. You have 17 employees, four PTs, one PTA. I mean that's a huge growth in three years. So I'm really excited for you to come on and let the listeners know how you did it. So let's first talk about how you started. So take it away. Kelly Duggan:                00:49                Yeah. So how we started, I was actually nine months pregnant and trying to decide which direction I was going to go with things. I had always been an employee that worked like around 30 hours a week and I would have one day off with my other kids. And when we got pregnant with our third, we realized that financially that was not going to be an option anymore. I needed to work full time. So I started looking at different options to do that, who I would work for, what I would want to do.  I've always really enjoyed, the program development and the marketing aspect of physical therapy. For me, you know, I've always needed a creative outlet and that was kind of my outlet in physical therapy. But where I was and kind of what I was looking into, that wasn't going to be an option. Kelly Duggan:                01:43                So it kept getting thrown around. Like what about your own place? What about your own place? And so finally, as the pregnancy progressed, I sort of started looking into it. So what do you, what do you do when you first start looking into stuff? You start googling it. So that's where this all came from, is kind of a few Google searches of like, how's this going to work? And, what I did at the time, was reached out to a few other people that were in my situation, parents of multiple kids that own their own practice to see because for me, that was the big hangup of, you know, this is going to take a lot of time away from my family. Am I going to be okay with that? And how, you know, how is that gonna work with my family and work with myself or my kids in the future. Kelly Duggan:                02:31                So I reached out to a few other moms of multiple kids who had opened their own practices. And, you know, I got some feedback that I liked. I got some feedback that I didn't like and, you know, I kind of just hung on to the words of advice from the people that said, go for it. And Yeah, I think my son was like one month old when we finally committed and I said, you know what, I'm just going to do this. And I think, and I always laugh about this, but I think that I was so massively pregnant and then postpartum that my husband was just like, yeah, whatever you want to do, whatever that sounds great. Whatever we have to do, we'll find the money and just kind of like on board. So yeah, we started out really small. Kelly Duggan:                03:20                I found a clinic that allowed me to do a one year lease because for me, I was just preparing for, well, if it doesn't go well, what are my options? I'll always have my license. So, you know, where could I work if this doesn't go well and it doesn't build and it doesn't grow, like I want it to grow. So I found a clinic that did a one year lease. I looked at all the bare minimums of what do I need to make at the bare minimum. And I just laid it all out. You know, I always say I'm not a huge numbers person, but I think owning your own practice turns you into one. So now I'm like all about the numbers and that's, you know, my mom took this photo of me sitting at my laptop. Kelly Duggan:                04:05                Like, I dunno what I was doing either making the website or trying to crunch the numbers and I've got a coffee in one hand, one hands on the mouse and somehow I'm like balancing my newborn like on me. And it was just like very kind of how my life was at that moment. And for me it was if I want to do what I'm really passionate about in PT, which is marketing program development in sports, then I have to create it myself because it's not there. The option is not there for me. So it's just figuring out what I had to do to do it myself. Karen Litzy:                   04:58                And I mean to do this massively pregnant and then with a newborn, I mean that is ballsy.  Like that is no joke. I mean, I don't have children, so I don't know what those first months are like, but I mean, and this was your third. It's not like it was your first, you had two other children. I mean what a leap. Kelly Duggan:                                        It was. And again, it was just kind of like, all right, it's go big or go home. Like if we're going to do this and I'm very much a determined person. If something is not there that I want, I'm going to create it or make it or somehow make it happen. And this was an opportunity for more time with my family in the long run. So in order for me to have more autonomy in the long run, it had to be done and it had to be created and it was, you know, it was for me and it was for my family and it was kind of like that, you know, you see like the parent lift a car off their kid, you hear those stories of was that sort of situation, it was like, okay, here’s this person with no business background, who hates numbers. Kelly Duggan:                06:01                Who is going to like create this massive thing because I have to, that was the option, so it had to be done, you know? Karen Litzy:                                           Yeah. And so that's when you started three years ago. So let's fast forward now to today where like I said earlier, 17 employees four PTs, one PTA. So can you break down for the listeners how you did that because that is massive growth and Kudos to you. Kelly Duggan:                                        Thank you, so it's funny because I didn't plan it that way. It's not like I was like, you know what, my three year plan is this and my five year plan, 10 year plan says this again, I was very naive going into it. So I thought this is my plan and this is where I'll be, you know, three years from now if it's successful, I'll just stay in that same location. Kelly Duggan:                07:00                So we opened our doors in May and in September I looked at my sister, I'm like, well, this isn't going to work. You know, we were in a 1200 square foot space, you know, it took about a month and a half, but we went from no patients to I had a full schedule and I was prepared on the opposite end of that. Like I was prepared for all right, maybe I'll have three days or whatever it is. But we scaled really quickly. So starting in September, I started looking for additional staff and it took me until January to actually hire someone. So I would say anybody that's kind of in this position is just make sure you're preparing ahead of time for if it does go well. Cause I did not. And so I hired someone in January and then I hired my second person in February and that's when I said, okay, I'm not even gonna make it to a year in this location. Kelly Duggan:                07:56                Like we need to expand. So it was probably March so not even one year in where I started looking into what is this location need to look like in order for it to be a success because the demand was there and I didn't want to not provide the same service for more people. Like, you know, you see clinics that ended up getting stacked in their booking. People on top of the next person is just crazy and busy. And I didn't want to do that. I wanted to still be able to provide the same level of service just for more people. So that meant expanding. So I started looking at additional locations and how that was going to work and started hiring and scaling is the big word that we used, but we scaled up from March when I started looking to the following March when we moved into our new location. Kelly Duggan:                08:57                It was just kind of a slow scale and I was lucky enough to find a team of people that understood the importance of where we were going. And they were willing to adjust their hours as needed, but also work anywhere between like 28 and 40 hours as needed as we scaled. So for me, you know, I don't like to use the term, I was lucky because I busted my ass for everything that I've done. But in the sense of hiring people, in a kind of a team and a family that understood the importance of that, I was lucky. I mean these, these people kind of worked as hard as I did to get us to where we need to be. So that was good because you don't always find that in employees, you know? Karen Litzy:                   09:44                Yeah. For sure. And now let's back up for a second. How did you go from zero patients to a full schedule? Cause that's what everybody wants to know. How do I get more patients on my schedule? How do we let people know we’re here and we’re ready to help? Kelly Duggan:                10:03                So. MMM. Yeah, you know, I hustled basically. So in whatever that term means to you, you know, like the older generation are horrified by the use of that term. But, I worked really, really hard. And I just networked and got my face everywhere. And you know, it, I think we've talked about this before, but I feel really uncomfortable when I'm talking in group settings or in front of people Karen Litzy:                   10:34                I know, but I don't get it. Kelly Duggan:                10:38                Thank you. The Facebook lives, but again, it was there was a need to do, I knew that if I wanted to grow my practice, people had to know who I was. And I had to be seen as kind of an authority in the PT World, in my community. So in order to do that, you have to put yourself in front of people. So I was putting myself in networking groups, putting myself in business associations, talking, volunteering to talk, I'm doing all these live videos and posting it to different groups and doing all these things that are way outside of my comfort zone because I knew that people had to recognize me and my brand as, you know, as healers. So, on top of that we did like a lot of online marketing or I always say we, but I did a ton of online marketing. Kelly Duggan:                11:29                As well as, I did some print ads, not a lot because they're so expensive. But what I did do, which I tell everyone to do, cause it's such a good idea, is I think it's everyday direct mailers is what it's called for the post office where you can either create a postcard or a letter and you can map out on the US Postal Service website, who you want to get your letter. And so within like a three mile radius of my clinic, I sent out a postcard, which one side had who we were and what we did and the services we offered. And then on the other side I did a baseball schedule. Right. Or you do a football schedule or basketball or whatever. Because for me, like when I get mail, if it's junk, I throw it out unless it has a sports schedule on it. Kelly Duggan:                12:24                And then it's on my fridge. And then I don't even know who these people are and they're on my fridge, the entire sports schedule because it's the sports schedule. So I put it up there. So to put the sports schedule or whatever that is, you know, in your community, it goes right on people's fridges. And then every day they were opening the fridge and they see your logo and they see whatever it is you put on there. And that helped. And I did have a lot of patients that came to me because they got the flyers and they're like, oh yeah, you're on my fridge. Karen Litzy:                                           Yeah, because don't they say it takes like x amount of touch points before some of them will decide to pull the trigger and make a purchase. Kelly Duggan:                                        So I did a ton of marketing, you know, and even, you know, the patients that we did have asking them, but I don't want to use this as like a copout as to why we scaled so quickly. Kelly Duggan:                13:16                But you know, I also take insurance, so that obviously is a lot easier than convincing people, you know, over your cash rate. But in the beginning I wasn't contracted with every insurance, so I was actually seeing, you know, a handful of patients that were paying my out of pocket rates because I wasn't contracted with their insurance yet. So that was kind of cool. Karen Litzy:                                           Yeah. So you had a little bit of a hybrid in the beginning and then, and now, do you take all insurances in your area or just a couple? Kelly Duggan:                                        I take most insurances there. Again, from the business side of things, there are a couple of insurances that financially, we wouldn't just lose money, but I'd lose like a lot of money. So we can't take every insurance, but we do take most and then we do offer our cash rate or a prompt pay rate if people don't want to use their insurance or some people don't even want to use their insurance benefit. Kelly Duggan:                14:21                So, even though they have an insurance that we would contract with, they choose to still pay us a cash rate and then you know, we have additional services since moving into our larger location that cause again, PT insurance, it doesn't, unless your really savvy is the word I'll use, it doesn't make good money. We basically we paid the bills and that's how we get by. But if we want to make additional incomes of that, you know, my employees can get raises and we can buy new fun equipment. We had to take on all these additional ancillary services in the new location. Karen Litzy:                   15:02                Okay. So what are these ancillary services? Because this is something that I think we really want to touch upon because listen, not everyone has a cash based service. I would say the majority of people by and large do not. Yeah. And that most physical therapy offices around this country take insurance. And like you said, sometimes the insurance does not reimburse a lot. I know New York state, it's very, very low. So what ancillary services have you added? So again, kind of make that hybrid practice. Kelly Duggan:                15:40                Yeah. So in our previous location, which was really small, what we did, and it was a much smaller scale, but we would hold classes every now and then, so we'd have, you know, a yoga class or a strength and conditioning class or something so every now and then we could get a little bump of money, in our new location, which is 4,500 square feet. We're able to add in a lot more. Kelly Duggan:                16:10                So we're looking to make it a little more consistent, but we've had yoga. I hired, so I didn't like rent out, but I hired two massage therapists, and they work on kind of like a per diem rate. So they're not there all the time, but you know, when they have clients. So we've built up and that's really been a huge compliment to our physical therapy services, not only for our patients, but for our therapists in kind of taking the load off of not having to do as much manual because if people are getting massages with it, it just helps that much more and then people are carrying over better. And, so that's been a benefit all around financially and for our patients. And for our therapists. We hired massage therapists. Kelly Duggan:                17:11                I had massage therapists and I have a program that we call the elevation programs so that, we all know that insurance doesn't cover everything, right for physical therapy. They don't really cover the sport based stuff or transitioning someone back to crossfit or whatever it is. It's not always covered within their plan. And then, you know, there also insurances that cut you off after 60 visits or at 90 days. So what we did was kind of bridged the gap between physical therapy and a patient's return to sport or return to their full activity. So we created something called like an elevation plan where people can purchase it on a monthly basis, you know, similar to how you would purchase a gym membership. And the elevation plans include, you know, PT visits, massages and an exercise prescription by a personal trainer, which one of our rehab aids is a personal trainer. Kelly Duggan:                18:21                So we utilize her and kind of kick people off with this really great program. And it's really meant to be a transitional program. So people will do it for a month or two, and then they have the confidence in order to get back to sport or gym or whatever it is they wanted to do. And maybe they're like getting back to, but maybe they're starting it for the first time. So we have yoga, we have the elevation plan, we have massage, and we do like sport performance clinics. So, you know, sometimes we do two hour ones. We just had a dance one for our dancers. Sometimes we do, you know, like a six week program for our youth athletes. We really focused on, at the new location, kind of like, my big thing was, okay, you know, I love to work with athletes. Kelly Duggan:                19:15                I think it's an underserved population. The youth athlete, I think we get lost in the shuffle. So that was for us kind of a big part of what we're trying to do with PTU. So we have all these programs for our youth, for flexibility, coordination, the things that the coaches can't necessarily allocate time for in their practices. We again, are just trying to bridge the gap and support where there is a need. So we created all these programs. So all of that is additional money that helps to run our insurance based practice. Karen Litzy:                   19:54                Right. Fabulous. And I love the sports performance for our kids because you're right, that is not something that is widely used. You know, kids they go to their practice, they do their sport, and then that's it. And I mean, I see a lot of kids in my practice having very adult injuries, ACL injuries, you know, knee pain, a torn labrum. So things like that. So I think what a great idea. And then that's also great for your marketing. Right? Karen Litzy:                   20:37                It’s also great for your marketing because then you have the kids coming in, the parents know you’re there. So if something happens to anyone in the family, they're going to come to you because they already know you, like you and trust you. Kelly Duggan:                20:53                Yeah, absolutely. I think, you know, with having like kind of the youth athlete as your main population, you know, they can't drive themselves. So someone has to bring them, whether it's a parent or an aunt or you know, and then they're exposed to your facility and exposed to what you do. And, I think once they see that you're providing something different, that's of quality and the services, the customer service there, it just spreads like wildfire. Karen Litzy:                   21:28                Yeah. Fabulous. And now so we spoke about what you did to get patients in the beginning, how you've expanded and how you've expanded so quickly, which is all awesome. Now can you tell us, were there any mistakes, any pitfalls along the way that you can share? Kelly Duggan:                21:50                I mean, there's always, pitfalls. I'm trying to think of something. Karen Litzy:                   22:00                Yeah. Like if there's something that you're like, oh man, if only I knew I would not have done it this way. Kelly Duggan:                22:10                Yeah. Well, you know, a lot of pitfalls that were kind of, if I had known I probably would have done differently. The billing aspect of things in the beginning we outsourced, which was fine because again, it wasn't like I was learning so much at the time anyways. It's not like I could learn another skill of the billing side of things. So I outsourced. But we lost a lot of money in outsourcing. And I think not only did we lose a lot of money, but I think there was a lot of opportunity for me to have learned more about why we bill and what we bill and that aspect of things that I just wasn't paying attention to for the first year and a half. I was just kind of filling out and assuming that everything was fine and coming back on in it and it was fine. Kelly Duggan:                23:10                It was just once we decided to take on billing and hire someone, the learning curve there of what we're billing, how much we're billing, why we're billing it, what we get paid. I learned a lot in those first like six months of bringing on billing that in hindsight probably should have just figured out like how I could have done that earlier on. Because once we took it on and we started learning more about what you know, actually pays and what doesn't pay, we were able to make some adjustments in what we do to make more money through insurance. So that was definitely kind of a big eyeopener for me switching from outsourcing billing to taking it on. Karen Litzy:                   24:01                Great. Yeah. Know your billing know where your money's coming from, where it's going and why some things are being paid and others are not. And I mean the list can go on and on. Right, Karen Litzy:                   24:14                That's great advice for people who are wanting to start their own practice, especially in an insurance based practice. Kelly Duggan:                24:24                Yeah. And a lot of those outsourcing companies, they will train you, you know, that's an option. I just kept saying, Eh, I'm like, like this one more thing I don't need to know. And it was like once I learned it, I'm like, wait, what was I doing? Why did I not want to know any of this is so important. Making more money. Karen Litzy:                   24:42                Right. And now what are the things that you look at now? So in business, you know, we talk about key performance indicators. So what are let's say for you and your business, what are the three most important KPIs that you look at? Kelly Duggan:                25:08                Yeah, we look at cost per visit. So obviously you're looking at what you make per visit cause that's important for me. I'm looking at cost per visit and obviously I want that to be lower than what we make per visit because my overhead is so high, our cost per visit is a bit higher. Which is why in going to the new location and tripling in size. It's funny cause a lot of like insurance based PT clinic owners were like, no, like that doesn't like, you can't do that, it's not gonna work. Insurance doesn't pay enough money for that model to work. That's why people don't do it. And I just kept going back to like, yeah, but it's a service to our patients. It's exactly what they need and somehow we're gonna figure out how to make it work because it's what people want and it's going to just provide so much for them. Kelly Duggan:                26:12                So a huge one for me is cost per visit cause it's high. But we want it to be below what we make per visit. So I'm looking at cost per visit and then I'm looking at how can I make that lower? I pay attention a lot to like how many elevation plans were selling in a month, how many massages we're selling in a month. Because again, that is going to bring down that cost per visit for me so I focus a lot on there. I used to focus on, you know, the average amount of visits we were getting out of people. But over time it's been similar over time, so it's not like I'm like, you know, worried about it. But there are certain key performance indicators that I don't know how I want to say this without sounding like, I don't want my therapist to be aware that all right we need every patient to have 12 visits because that's what we need financially. Kelly Duggan:                27:26                You know, you don't want someone's treatment to be affected by the bottom line. So I track it, but that's not something I share with my employees or even try and like, oh, we got to get that to, you know, 13 visits or 14 visits because I mean, it's a wonderful thing if you can get somebody better within four visits or six visits, cause then they're gonna, you know, talk about, Oh my God, I felt better in six visits. So you don't want to focus on those numbers. So I think, you know, you do see that number of listed a lot when people are talking about key performance indicators and how many visits you're getting out of your plan of care. But I think going into it and focusing on that number is not a good thing for us as PTs. Karen Litzy:                   28:15                Right. Yeah. And, also it then puts these perhaps unrealistic what's the word? When they have to meet a quota, is that a thing? Like PTs have to meet a quota or something like that? Yeah, some clinics. It incentivizes the wrong thing, right? I think what you're doing is you're incentivizing patient care. Versus incentivizing patient visits. Those are two very different things. More visits doesn't equate better care. It just equates more visits. Kelly Duggan:                28:59                Yup. Exactly. Exactly. And we've talked a lot about in talking to my coworkers and stuff of, all right, well, what do we have to do? How many visits do we need to do? And how many massage appointments do we need? How many elevation plans do we need so that we continue to deliver the level of care that we're delivering. I don't want to change my business model to seeing a patient every half hour, or, you know, forcing that sort of way to hit our bottom line. I'd rather have it, well, you know, can we get more people in? Can we do performance clinic? Can we, you know, add in yoga again, like how can we add additional services? Because you hate to really like turn into a mill to hit your numbers, you know? So for us, we need to encourage more people to, you know, sign up for massage or maybe we need another deal because we're getting close to that number of we're not gonna, you know, make our minimum requirements and we don't want to change our model. We don't want to change the level of care we're able to provide to people. So I think that therapists knowing that they are getting so much better with like, mmm, you know, wanting to do these additional programs and wanting our patients to do these additional programs. So it's been good in that sense. You know, and I've heard from other business owners and other PTs that they’ll get a bonus if they hit their productivity. Karen Litzy:                   30:42                That's terrible. Kelly Duggan:                30:46                That’s not what we want to do at all. You know, it's like, it's just, again, it's the quality of care and it's then the PTs just thinking about their numbers and not, am I getting people better? Karen Litzy:                   30:58                Exactly. And then, you have PTs saying, oh, I can work through lunch or I'll stay later, or I'll come in earlier because they're just so focused. I mean, let's be honest, a lot of PTs are type A, right, so focused on hitting this arbitrary number to get a bonus. Right? So let's say they get $1,000 bonus. Well, right, that thousand dollar bonus down to all the times coming in early and lunches that you worked through, guess what, that thousand dollar, $2,000 bonus that it doesn't equate to what you're making per hour. Right. And then it just, I think it's a great way to burn out your therapists. And I'm not sure, is the care better? Is it not better? I don't know that I can't say, but I think it's, like we said, just incentivizing the wrong thing. So glad you brought that up. Is there any other big KPI that you look at regularly and that forces you to maybe change the way your business is being run? Kelly Duggan:                32:17                Not really. I mean, I look at a lot of stuff just to monitor for myself. You know, I look at average codes for treatment, you know, and are we in line with the national average. You know, how can we make that in line with the national average while still providing the quality care that we're providing. I mean there's nothing that I, again, it's a lot of stuff that I look at kind of the behind the scenes stuff, but nothing that I would want my therapist too be concerned with I guess. Karen Litzy:                   32:59                Yeah. And what about cancellations? No shows? Yeah. It's always one that everybody always touted as being one, but I dunno. Kelly Duggan:                33:10                We track that and if it starts to get higher than like, you know, a certain number, we were like, okay, what's happening? But we have things in place that, kind of limit the amount of cancels and no shows. You know, we do our reminder calls. We, you know, people that are dropping off, patients that drop off. We use like an automated email system we use. We're integrated with strive, so we use strive, but I know some people use infusion soft. Karen Litzy:                   33:45                Infusion soft is very expensive. Kelly Duggan:                33:48                Yeah. I love strive. It's really user friendly. And the customer service has been awesome and you don't have to like build your own sort of stuff. It's, you know, you create your own content and all of that, but you don't have to like be a computer genius to use it. Karen Litzy:                   34:12                And is that strive labs through web PT? Kelly Duggan:                34:16                We were using them before they were integrated with web PT and they do work with, you know, if you don't use webPT, I believe, you know, but I do use webPT. Karen Litzy:                   34:28                Cool. Very cool. And so we talked about where you came from, where you're at, what you're looking at, how you're growing. So now where do you see yourself going in the next three years? Kelly Duggan:                34:43                Yeah, so, you know, I’m always thinking about that. But you know, one of my biggest struggles I would say right now is because we're so busy as just like, how do I get through the day? How do I get through the day? And I would say a couple of weeks ago, I'm like, what am I doing? Like all of my energy is focused on how am I getting through today and this week? And I'm not thinking of kind of the long term. And every time we have either a student or someone interviewed, they're like, what's the longterm plan for PTU? I'm like, well, you know, I don't really know.You know, people ask, because for me it was, I opened PTU because I wanted that creative outlet. You know, I wanted to support our athletes, but I wanted autonomy and I wanted time with my family. And I'm starting to get that so I don't want to, you know, it's not in the cards for the next three years to expand to another location. Kelly Duggan:                35:42                It's just to get this PTU central location successful in the insurance world. And, you know, I'd like to be able to give everybody raises. And all of that. So I want the next three years is figuring out how do we make this insurance hybrid model, successful so that we can, you know, give people raises and continue to treat at the level that we're treating. And you know, so that I can get the time that I wanted with my family. And then if we're able to do all of that in three to five years, maybe, you know, I've talked about adding on a second location, but I don't even want to think about it because I'm, again, like you mentioned, a lot of PTs are type A, I'm so type a that if I decide that I want to have a second location, I can't say, well, I'm going to do it in five years. Kelly Duggan:                36:39                Like it'll be here in six months. Like that's just how like I work. So I just, I want to keep putting that off. And for right now it's just PTU. It's our central location. I want it to be, you know, successful. And when I say successful, you know, I don't want to sugar coat it. I want it to be lucrative. I want it to be a business that makes money. Karen Litzy:                                           Of course you got, why wouldn't you and what other business world outside of like PT, the healing world do people say I really hope it's successful. Like of course yeah I still want to make money though. Yeah! That's why you started your own business for some freedom, for stability to be with your family, to help the people in your community and to make money. You didn't start a business to not make money. Karen Litzy:                   37:32                He didn't start a non for profit, which is a totally different world. So like if you opened up a clothing store, you wouldn't be like, man I just, I just hope I can make money one day. Kelly Duggan:                                        Yeah. It's funny cause it's the PT struggle, you know, it's like I want to support my patients. But you know, you have to put on that business owner hat and be like, well we need to make money to support our patients. Karen Litzy:                                           So that's right. It's your responsibility to make money so that you can be present in your neighborhood and that you can be present in your community and help people. Because if you didn't make any money, you'd have to close your doors and all those people who depend on you, what do they do then? Kelly Duggan:                                        Yeah, exactly. So in three years, you know, I want, you know, hopefully two more PTs is like the goal, you know, and I'd like to have that within the next year. And I want one of those PTs to take over the performance side of things because I feel like that's one area that we can continue to grow and we could have, you know, we could constantly be hosting some sort of sport related supportive group or clinic or camp or whatever. But I don't have time to plan all that. So I want to hire, I want one of my PTs to kind of take over the performance side of things. Karen Litzy:                   38:49                Very smart. Well, it sounds like you have a good plan in place and I love the fact that you said, you know, I just want to make this into a well oiled machine. This is what I want. And that's amazing because not everything, like you said, not everything has to be scaled to infinity. I mean, knowing where you are in life and knowing what you want and knowing how you want to live your life and if you can achieve that Karen Litzy:                   39:20                Achieve those goals within the parameters that you have. It just has to be, like you said, little tweaks here and there. I think that's amazing. So congratulations on such a huge, huge change in three years. Kelly Duggan:                39:34                Thank you. Thank you. And I want to actually bring that up. I want to say something to that because, I think again, PTs as kind of type A, and especially PTs coming out of school, we are so on this really, really like fast train of trying to be successful and achieve our goals. And, for PTs a lot of people are so focused on their career and their career ladder in their career growth. And I just want to say a reminder to people to kind of pull yourself away from that for a second and just think like, what do I want out of my life? What are my life goals, right? Is it that I want to travel more? Is it that I want to have a lot of money? Kelly Duggan:                40:25                Is it that I want more time with my family? Whatever it is for you. Think about that for, you know, a few minutes and then think about, okay, so how does PT fit into that? And not the opposite way of like, let me like reach the top of this career ladder and then like, well, is PT my life? Or like where am I now? So just pull yourself away from that and think of, you know, like for me it was and it might take a life event for you to figure out that. Like for me it was having my third kid and like, wait a minute, what the hell am I doing here? And it was okay, I want more time with my family. How do I do that? How does PT fit into that? And I just want to encourage more people to do that. Cause I think as type a people, we get so obsessed with climbing this kind of career ladder that, you know, we can get lost in it. Karen Litzy:                   41:19                And great advice. And I am in this, speaker's group, which is really a bit of an entrepreneurial group as well. And the woman who runs it Trisha Brook, at one of our first sessions, she had us write out kind of what do you want your legacy to be? And that's if you think about that you're doing exactly what you just said. You know, you're putting forth what do you want your legacy in this world to be? Right? And it sounds like for you it was too, you know, be with your family to have an influence over your children and to have that be such a great legacy. Have your children, your family, be your legacy, have the community that you're in, be your legacy. But what I didn’t hear from you, and correct me if I'm wrong, but what I didn't hear from you is for PTU to be your legacy. Karen Litzy:                   42:21                Right. It was, I want to make a change in my community and my family and that's the legacy. PTU is part of the way I do that. But it's not everything. Excellent advice. And now I feel like I'm going to ask you this last question, but you might have just answered it. But the question is, given where you are now life, career, what advice would you give yourself as a new grad out of PT School? Kelly Duggan:                42:57                That's it. Don't fall for the trap. Kelly Duggan:                43:12                Don’t fall for the kind of trap of just trying to, you know what, nevermind, I wouldn't say that. Because I feel like all of that got me to where I am right now. You know, the struggle of how do I get high around the career ladder and how do I do all of this. And, so I guess what would I say to myself straight out of PT School is take jobs that you have fun at. If it's not fun at the end of the day, if you didn't laugh, if you didn't enjoy yourself, get out of that situation sooner than later. I think I held on to certain things knowing that they were good for my career and I should have let go of them sooner. Karen Litzy:                   44:08                Excellent advice. Couldn't agree more. And now where can people find you and the clinic if they want more info or they want to talk shop with you. Kelly Duggan:                44:17                So I'm on my website is PTUclinic.com. The email is PTUclinic@gmail.com. I'm on Facebook, I'm on Linkedin. I'm not on there too often, but I'm on Facebook pretty regularly and my clinic is on Instagram. So any of those realms reach out if it's something that you're thinking of doing. I love talking with people that are thinking about opening their own clinic. I love to just encourage it, I think, you know, if it's something that you want to do then to go out and do it and yeah, reach out to me. I'd love to be of any help if that's what you're looking for. Karen Litzy:                   44:57                Awesome. Well thank you so much, Kelly, for coming on and sharing your entrepreneurial journey. I think you gave a lot of people a lot of help today, so thank you so much. Kelly Duggan:                45:07                Thank you so much for having me. Really appreciate the opportunity to talk about it and I hope we encourage some people today. Karen Litzy:                   45:15                Yeah, I hope so too. Thanks so much. And everyone out there 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 iTunes!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Megan Rigby on the show to discuss how she found success with her online nutrition and fitness consulting. Dr. Megan Rigby is a doctorate prepared pediatric GI Nurse Practitioner, IFBB Figure Pro, blogger, macro lover and online coach. She is on a mission to help others become fit, healthy and happy. In this episode, we discuss: -How Megan started her side hustle and when she decided it was time to leave her corporate job -The pro’s and con’s of being an online entrepreneur -The importance of vulnerability and integrity on social media -And so much more!   Resources: Macro Mini Website Macro Mini Instagram Megan Rigby Twitter Macro Mini Facebook Macro Mini You Tube   For more information on Megan: Megan Rigby is a Doctorate-prepared GI Nurse Practitioner, Certified Nutrition Consultant, IFBB Figure Pro, and Owner of MacroMINI. She is passionate about educating others through her coaching, as well as publicly speaking on topics surrounding food, fitness & healthy mindset. Megan has helped hundreds of people experience great physical and overall lifestyle changes. She is on a mission to empower others to become healthier, happier versions of themselves while still enjoying food as one of life’s simple pleasures.  In 2018, Megan left a corporate position as a Digestive Nurse Practitioner to open her own coaching business & has made over 400k+ within her first year. Megan has been featured in Oxygen & Strong magazines as a content creator, along with appearances on News Channel 12. She has been recognized as a top industry leader within her community.   Read the full transcript below: Karen Litzy:                   00:01                Hi Doctor Megan Rigby, welcome to the podcast. I am happy to have you on. Megan Rigby:                00:06                Thank you so much for having me. I'm excited to do this with you today. Karen Litzy:                   00:10                Yeah. And so what we're gonna do is we're going to talk about your sort of entrepreneurial journey, your business story, because, as I said in the intro for you, you are a doctorate prepared GI nurse practitioner and a nutritional consultant and a whole bunch of other stuff. But, something that I think the listeners of this podcast can relate to is there's a lot of healthcare workers, things like that who are listening to this podcast who maybe have started their careers in a hospital and clinic, but maybe you want something a little bit more. So I would love for you to kind of share your story of how you made that transition from, I love that you say you were like a corporate girl in a hospital or clinic, but when you're in healthcare, that's kind of the equivalent. So go ahead and tell us your story. How'd you do it? Megan Rigby:                01:03                I never planned on being an entrepreneur having my own business. That's just not something I ever saw in my future. My Grad program, I had focused on family and childhood obesity. It was my dissertation. I love health and nutrition. I think it's the preventative to a lot of health care. So I always tried to teach all my clients that, but I started to get frustrated a few years in just because working for corporate, you're kind of inside a box. And I think there's a time and place for complimentary medicine and modern medicine and sometimes that can be hard when you're working for a hospital. And so I started having more and more people talking to me on the side about health and nutrition and fitness and people would just start asking, Hey, can you give me an advice? Give me tips and I'll pay you. And so slowly I started doing nutrition plans and education on the side. Megan Rigby:                02:05                And over time I was able to build it into an online business. I realized that my limitations that I have within the clinic are able to actually be kind of removed online. I get to spend more time with my clients, educate them, and truly provide a service that's unique to them. So with time it took probably, I mean two years I was doing a lot of my own online stuff, while working full time in clinic. And then I gradually dropped down to more of a part time position once I started picking up online. And then within the two years I was actually able to make more than what I was making clinic with the online business and I transitioned over and I left September 2018 and now I run my own company doing health, fitness and nutrition. Karen Litzy:                   02:57                And I would imagine that there are pros and cons to this. So I'm just going to name one pro and one con. Right. So the pro, obviously you can probably help more people with online programs. Con would be, do you miss having that person sitting in front of you? Megan Rigby:                03:16                I do. I missed that. But the beautiful thing about online is you can still do zoom calls face to face. So there is still that where you can talk to them. So almost like a telehealth. I would say one of my biggest cons is when I used to leave the clinic, it was kind of like my work was done. Like my charts were done, I was done seeing patients. Now, I feel like I'm on a lot more so my day doesn't end nine to five. I work a lot more around the clock. I feel like, and that's something I'm still trying to work on as a new entrepreneur. Karen Litzy:                   03:50                Yes. And that is absolutely true. I think a lot of people when they think I'll just start my own practice, they think you can leave it at the door when you leave, but you cannot. You're always doing something. I mean, there are times like last night it was midnight and I'm working. Megan Rigby:                04:09                Yes. It never goes away because it's now your business, you're responsible for everyone you're taking care of and you're responsible for bringing more clients in. And so definitely you work, I think a lot more being an entrepreneur, but at the same time you have more freedom, which is nice. Karen Litzy:                   04:26                Yes. You have a little more flexibility, you have a little more freedom. So there's pros and cons to all of this. But let's start, how, if you can get even a little more granular into your kind of transition from hospital to on your own. So my first question is how did you have this conversation with your employer? That's a question I get asked all the time. Megan Rigby:                04:51                Yeah. So I think you have to just be honest about it. And that was something that they knew that I loved the nutrition aspect of things. I love being able to teach and spend more time. So when I went down to part time, you know, I let them know that I was, you know, on my side I was, you know, just educating and teaching people about nutrition and health. And that was not going to interfere with my job. And I think that's the biggest thing. If you can, you know, let them know, reassure them that you're not letting it interfere with your work and how you come in every day and interact with your patients there that you know, helps them as well, as well as not ever taking any of the businesses patients. Karen Litzy:                   05:37                Of course I think we say that of course, but maybe people do. I don't know. Megan Rigby:                05:46                Yeah. And that was something where it's kind of drawing, you know, a line in the sand and making sure that both of the jobs stayed away from each other and they never came together. And I think that's something that a lot of people have to remember. Like I would love to have been able to work at work, but you can't do that. I mean, I came home at night and I saw my clients from online at night and there was no crossing that during the day at all when I was clocked in and I was being a nurse practitioner in the clinic. Karen Litzy:                   06:13                Yeah. And I think that's great advice. And it's just dry and clear boundaries for yourself and also being respectful of your employers. Megan Rigby:                06:21                Yeah. Because in the end, if you decide to go back to clinic, you need recommendations and burning bridges is not something you want to do because who knows? I mean the venture that we have or I have, it may, may die down one day and I do need to go back to the clinic. So I never want to slam that door shut because it provided me so many opportunities. Karen Litzy:                   06:42                Absolutely. And I remember when I left the physical therapy clinic I was working at, it was really hard to do because I really loved working there. But they now refer patients to me and I refer patients to them. Right. So it's like you don't want to burn those bridges because guess what, they can help you and you can help them. And I think you want to really make this a win, win for everyone. So you have this conversation with your employer, they're understanding, you go down to part time for you, what was, if you can describe kind of the hours worked in clinics or are you down to like 20 hours a week or less and obviously we know you're working then on the online part, but what was the breakdown for us? Megan Rigby:                07:33                They let me go to three and a half days a week, which was nice. And so that was considered more of a part time position there. So I worked Monday, Tuesday, Wednesday, and then half day Thursday and I was off Fridays. So I would make sure that all my check ins and my main communication with my clients would be on the weekends. That works best for me. So Thursdays I would do all of my prep when I got off work. And then Friday, Saturday, Sunday, those were my days that I was really able to devote to the actual online business and evenings whenever I, you know, was able to after work I would come in home and I would do what I needed to do. But otherwise it was an 8:30 to 4:30 Monday through Thursday, half day. Karen Litzy:                   08:21                And since going completely on your own, do you give yourself a schedule? Because it must be difficult, right? Megan Rigby:                08:28                I'm still close the computer when there's still work to be done and I always want to make sure that everyone is getting the, you know, service and communication that they deserve. And I think that just comes from being a healthcare professional that you know, you want as much time devoted to each and every client. And so it can be hard to kind of turn that off and feel like you still have unanswered questions or things going on. Karen Litzy:                   08:59                Yeah, there's no question. And again, that's where kind of setting boundaries for yourself comes in handy or making sure that you know, you have scheduled times that you're working even with the online clients and that they know that. Not that they're taking advantage because I don't think they are, but if you allow yourself to be available 24 seven then guess what, people will take you up on that offer. Megan Rigby:                09:27                Yeah. So it is, it's creating boundaries too. And that's what I have learned. It's been hard, but yeah, working, you know, maybe nine to like four and allowing lunch in there, is something that I'm striving to be more consistent with. But it is nice because if you have appointments, you know, you can schedule those in and that's where the flexibility has been really good. But also drawing the line of when you kind of cut it off at night. Karen Litzy:                   09:52                Yeah, absolutely. And now how do you advertise? How do you market yourself? Megan Rigby:                09:56                So social media is kind of where it's all at, as exhausting as it can be. I have, you know, my page and that's where a lot of people find me word of mouth has been the biggest thing and I value that the most. I think if people can refer other people to me because they've had great experiences and outcomes, that's where I've actually gotten a lot of my clients. I don't really do a lot of paid advertisement or anything right now. Like I said, it's just word of mouth and then making sure people who do follow me or start following me understand, you know, where I'm coming from and really being open and vulnerable on social media so everyone kind of knows who I am and there's no hiding. Karen Litzy:                   10:44                And what advice do you have for the listeners on how to be vulnerable? Because that's hard. Megan Rigby:                10:50                It is really hard.  I think it's just to be true to you and stand by what you believe in and how you practice. And provide honest, you know, education, advice and share yourself I think with people has been the hardest thing because a lot of people will look up to healthcare professionals, you know, and think that there may be on a pedestal or something. And I think making yourself relatable is the most important thing because we're all humans and so we all have struggles as well. And I think putting those out there so people can relate to you is going to bring more clients in and more, you know, followers as well. Karen Litzy:                   11:30                Okay. So how do you make yourself more relatable? Because isn't social media is supposed to be like, it's your highlight reel. We don’t want to show people that we have any problems. Right. Megan Rigby:                11:40                With me, it's a pretty easy with the nutrition and the fitness and health because I think, you know, as a female we struggle with appearance. We struggle with, you know, day to day eating healthy, making the right choices, preparing food for our family. So I can relate to a lot of that. You know, I've had my own insecurities and I'm not perfect every day with how I eat. There are days that I want to go to dairy queen and have a blizzard. So I'm able to really relate to people in that spectrum and then talking about, you know, different health issues that so many of us women struggle with and it can affect how we lose weight and really making sure that we stay on top of those. So whenever I talk about something, I try to draw in my past experiences with it and I think that usually helps a lot. Karen Litzy:                   12:28                Yeah. I think that's really good advice. And what would you tell people who maybe have these great stories and we know this is what you should do to kind of get people to get to know you, like you and then eventually right purchase from you. Right. What if you're scared to put yourself out there? Like how do you overcome that fear? Megan Rigby:                12:53                I think you have to jump in with both feet. Like if you are truly passionate about starting a business, that's vulnerable in itself and then putting yourself out there on social media. Like you just have to realize that people are gonna love you or hate you. And as awful as that sounds, it's the truth. I mean, people are going to be drawn to you. So just jumping in and sharing it, whether it's just the writing at first. I know a lot of people are camera shy, so sometimes they say like blogging at first is really good. Or just sharing it on your Instagram through words, before going into any of the videos or anything like that. Even you know what sharing with your family sometimes too because you can be vulnerable with them and getting feedback sometimes can be a little bit comforting if you're not ready to just jump. Karen Litzy:                   13:40                Yeah, I think that's great advice kind of sharing with friends and family are sharing within a trusted circle. Megan Rigby:                13:47                Before it's scary. You're going to get judged. That's human nature I feel like so people will judge, but people also will be able to relate to what they hear from you. And those are the people you want following you and interacting with you. Karen Litzy:                   14:05                Yeah. And do you have any sort of memorable comments or notes or things that people have sent to you that have stood out because you've been a little bit more open? Megan Rigby:                14:17                Yeah. So when I do stories I try to talk about topics that have affected me recently. I usually always try to keep things kind of close to my heart. And so when people message me and say, oh my gosh, I needed this today. It's been such a struggle, like it, it's so nice to know someone else's out there going through it with me or I appreciate the advice. So those things always help to kind of reaffirm like there are people listening and what I am saying is holding others. So, you know, it makes me want to keep doing that more and more. Karen Litzy:                   14:52                Yeah. I love getting those notes. I think it's so cool. And I always think to myself, Gosh, you never know who's watching, sitting, listening. You just don't know. Megan Rigby:                15:01                Cause you're always impacting someone. There's always someone out there watching and listening. Like she said, you never know. So if it's something you're passionate about, something you love and you want to be heard, then it's worth sharing. Karen Litzy:                   15:15                Absolutely. I agree. 100%. We’ve been talking that you're in that nutrition, fitness realm, very crowded field. Every time you turn, everywhere you look, someone is talking about nutrition, whether that be good or bad evidence based or not. It's out there. So what advice do you have to stand out amongst all this competition? Because I'm sure it can be applied to almost any industry. Megan Rigby:                15:49                It can. I always say be true to you. So whatever you believe, stay with that. It's so easy to get into the comparison game of you know, what they're doing or you know, this is the new trend, but you have to do your own research. You have to believe in what you believe in and talk about that. I think that's the most important. So many people in the fitness industry just jump from one trend to another. And so it's whatever the hottest topic is. And I think when it comes to, you know, this industry, you have to really stay true to the basics and what is science saying and what you believe in. Because if people hear it consistently and they can expect the same thing from you, which is the honest truth in what you believe in, they will trust you. It's the people who kind of jump all around that, you know, you kind of start to say, Hey, wait, last week you were talking about this. And that was the best thing there was. So that's what I found is people, they expect the consistency from me and they know that I believe in what I'm talking about. Karen Litzy:                   16:52                Yeah. So not jumping on the bandwagon every time something comes out, but rather look at it critically. Megan Rigby:                17:00                And not comparing yourself. I think that derails a lot of us is when we start to look at what other people are doing in the same field and we feel like we need to mimic that or we need to jump on that. And that can be very distracting too. Karen Litzy:                   17:20                But it's so hard. Megan Rigby:                17:24                It is so hard. I do my best actually not to follow a lot of people in my industry. I'll follow the people who I think provide me motivation, but if there's anyone who evokes jealousy, or you know, kind of gets under my skin, I figure that's negative, you know, vibes and I don't need that. So I really tried to just stay with the people who motivate me the most. I think social media should be a positive outlet. And it's so easy to make it negative. And I really tried to avoid that. Karen Litzy:                   17:58                Yes. As a matter of fact, I'm part of a Oxford debate in a couple of weeks at a physical therapy conference. And so the debate topic is social media and it is, we believe that social media can be hazardous to the profession of physical therapy. And you know, people will argue in favor of that and against that and that can easily go either way. But in the end it's a tool. It is a tool and it's not the tool, but it's the user. Megan Rigby:                18:36                It is. It's how we allow ourselves to use social media. No, I agree. I'm curious to hear how that goes. So I hope you will talk about that. Karen Litzy:                   18:48                I will talk about that. I'm curious to see how it goes to, I hope it goes well. I'm a little nervous about it, but I think it's supposed to be this like fun debate, like lively, fun and funny. But you still want to win the debate of course. So we'll see what happens. So is there anything else about kind of your entrepreneurial journey that you really want people to learn from? Megan Rigby:                19:13                I think starting small, and a lot of people when they tried to start a business feel like they have to dump a ton of money into it. And I've learned that you don't, with starting small and using the skills that you have, you're actually able to start a business that may, you know, not be as profitable as you want in the beginning with time you can reinvest that money you make back into it without taking up such a huge loan in the beginning, especially when it comes to the online type of business. I think there's so much that we can do on our own before we have to really start spending money. And I think that's something that, you know, a lot of new entrepreneurs who are wanting to go the online business, just have to remember that it doesn't take a ton of money to get up and going and get clients. It just takes, you know, the passion and the time and the knowledge. Karen Litzy:                   20:09                Yeah, absolutely. And I have one more question for you. The question that I ask everyone and that is knowing where you are now in your life and in your business, what advice would you give yourself, not to someone else, but what advice would you give to yourself at like the day you graduated and we'll say with your doctorate, why not? Because you’ve got like advanced degrees here. So let's go with the doctorate. What advice would you give to that gal? Megan Rigby:                20:40                Okay. My advice would be to not change anything, to enjoy the ride and kind of allow it to take you where it's going to take you. Because there are times that I wondered, you know, why was I where I was and what I was doing and it all led me here. So I think the biggest thing is enjoy the ride. So often we keep wishing the years away and if only I was here, if only I was there. But every step and every moment you have is leading you to where you really need to be. Karen Litzy:                   21:09                Very nice. It's like that sounded like from Game of Thrones and that's not a spoiler or anything for anyone listening. If you haven't seen the finale, it's not a spoiler, but that was very Bran like of you, it was great. Now where can people find you if they want to get in touch with you, if they want to work with you, they want to follow you. Where can they go? Megan Rigby:                21:36                Yeah. So on Instagram, I'm macro_mini. And then why a website is www.themacromini.com. Karen Litzy:                   21:47                Awesome. And just so in case you know, you don't have a pen and paper and you're not taking notes right now, like I am, you can go to podcast.healthywealthysmart.com. We'll have all the links, one click will take you right to all of Megan's info so that you can get to know her, like her, trust her, and work with her. So Megan, thank you so much for coming on and sharing your journey. I think it will give a lot of people in health care a bit of a boost, maybe a little kick in the butt too, and the confidence to go out and kind of do what you're doing. Megan Rigby:                22:23                Thank you. I appreciate that. And thank you so much for having me on. Karen Litzy:                   22:26                Yeah, my pleasure. This is a great conversation and everyone who's out there 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 iTunes!

LIVE from the WCPT Conference in Geneva, Switzerland, I welcome Christina Le on the show to discuss youth kinesiophobia following knee injury in sport. Christina Le is a PhD candidate in Rehabilitation Sciences in the Faculty of Rehabilitation Medicine at the University of Alberta in Edmonton, Canada. In this episode, we discuss: -What is kinesiophobia? -Preliminary results from the University of Alberta research team focused on prevention of early onset osteoarthritis -Why clinicians should address kinesiophobia early and often in rehabilitation to minimize poor long-term health outcomes -And so much more!   Resources: Christina Le Twitter World Congress of Sports Physical Therapy 2019 Tampa Scale for Kinesiophobia   For more information on Christina: Christina Le is a PhD candidate in Rehabilitation Sciences in the Faculty of Rehabilitation Medicine at the University of Alberta in Edmonton, Canada. As a clinician, she frequently treated athletes with anterior cruciate ligament (ACL) injuries. This experience has motivated her to pursue research to better understand health-related quality of life (HRQOL) following a sport-related knee injury in active youth. Her research include identifying what factors impact youth HRQOL during rehabilitation and developing strategies to improve long-term HRQOL. Christina continues to work part-time as a physiotherapist at the Glen Sather Sports Medicine Clinic. She treats patients on weekends, participates in multidisciplinary clinics with sport medicine physicians and orthopedic surgeons, and teaches an ACL rehabilitation group class called the Functional Agility and Strength Training (FAST) Program. Find her on Twitter as @yegphysio or online at www.yegphysiotherapy.com.   Read the full transcript below: Karen Litzy:                   00:00                Hey everybody. Welcome back to the podcast. I am coming to you live from Geneva, Switzerland at the WCPT meeting and right now I have the distinct pleasure of sitting across a table from Christina Lee. She is a PhD candidate at the University of Alberta and she's also a physio therapist. So Christina, welcome to the podcast. And today Christina did a wonderful platform presentation on Kinesiophobia after knee injury and we're going to definitely get to her study on that. But before we do, Christina, can you tell the listeners what is kinesiophobia? Christina Le:                                          So kinesiophobia is taken from the chronic low back pain literature and has been applied in our knee injury population as well. And it's an excessive and irrational fear of movement due to feeling vulnerable to pain or reinjury. Karen Litzy:                                           And so now let's get to your study. So what I'll have you do first is maybe tell us why you thought this was an important thing to look at. Christina Le:                  01:02                Yeah. So I think after knee injuries in sport, knee injuries in particular, and we're looking more at our youth, we know that there are a ton of different consequences that happen after knee injuries and they spend the physical, psychological and social domains of health. And this is just one that hasn't been studied to great length in our youth athletes in particular. And it's something that I think can contribute to poor long term health outcomes because it's the most common reason for kids quitting sport after they get injured. It's related to physical activity. So it's something that maybe we can manage a little bit better as clinicians and moving forward to help out with better long term outcomes. Karen Litzy:                                           Right. And that sort of lack of return to activity, lack of return to sport can, like you said, have long term outcomes. So we know that inactivity can lead to obesity and childhood diabetes and a lot of downstream consequences. Christina Le:                  01:58                Yeah, exactly. Posttraumatic osteoarthritis is probably one that’s stuck in my head right now. Just coming from the International World Congress as well. And we know that that can affect almost up to half of our youth injuries that have a knee injury as well. Karen Litzy:                                           All right. So let's break down the study for us. So I will just have you kind of take it away and talk about the study now that we know the why behind it. Go ahead. Christina Le:                                          Yeah, so we are currently running an ongoing prospective cohort study at the University of Alberta. It's a part of the prevention of early onset of osteoarthritis research group, I guess that was initiated out of the University of Calgary. And we're looking at youth athletes aged 11 to 19 who have sustained a sport related knee injury. So tibial femoral Patella femoral injury within the last three months. They had to have seen a physio therapist, a doctor or some sort of medical professional and had to have missed at least one session or one game from their sport to be considered injured. Christina Le:                  03:02                And then we're comparing them to age, sex and sport match controls. I'd say kind of 75% maybe through our study right now. And so this study that I presented on today is just a preliminary analysis of what our baseline data was. And what we were looking at was self reported kinesiophobia. So using the Tampa scale for Kinesiophobia and its influence on bilateral knee strength, using isokinetic dynamometer and triple single leg hop and Y balance test. Karen Litzy:                                           Okay. So those were all of the things that you are looking at, that's the data you are collecting? All right. Before we go on, I think most people know what a single leg three hop test is and the Tampa kinesio phobia scale you can look up, but can you talk about what the Y balance test is really quick just so people have a frame of reference as to what you're doing? Christina Le:                  03:53                Yeah, sure. So the Y balance test is we ask our participants to stand on one leg, hands on hips, so they can't use their upper extremity to help out with their balance. They're reaching as far anteriorly as they can while standing on one leg. And then they also do a posterior lateral and a posterior medial reach as well. We do three trials and we take the average of the three direction reaches. So one point they're planted on the injured or the index side and then the other time they're on the other side. Karen Litzy:                                           Perfect. All right. So continue. Now we know what you're measuring. We know who you're measuring. So now let's talk about how? Christina Le:                  04:41                So we are looking at our mean within paired differences.  So we take our injured scores, we subtract them from our uninjured scores in terms of study groups, and then we're just looking at the differences between the two groups on all those variables listed. And then we're also running a logistic regression model that's accounting for our match design. So it means that we are looking at the odds of scoring higher than 37 on the TSK. And we're looking at if there's a difference between our injured in uninjured groups in scoring higher or lower than that 37 and the 37 is based off of chronic low back pain literature where a study dichotomize their participants based on high fear responders are low fear responders based on that TSK score. Karen Litzy:                                           Right. And just so people know, the lower your score on the TSK, the less kinesiophobia you have and the higher score, the more kinesiophobia you are experiencing. Christina Le:                  05:39                Yeah, exactly. So I always say TSK is like a golf score. So higher scores worse lower scores better. And then we're also running separate multivariable linear regressions as well. So effectively looking at the Association of TSK on strength or triple single leg hop or Y balance. Karen Litzy:                                           Okay. And what did you find with that analysis? Christina Le:                                          So what we found was with our mean within pair differences, so when we're looking at our injured versus uninjured groups, just based on these variables alone, that the injury group scored on average about eight points higher on the TSK than the uninjured, which means that they are reporting greater kinesiophobia or higher kinesiophobia as you said. And they're also scoring lower on strength, which isn't maybe the most surprising finding considering they've just been injured. So we're testing them on a median of six weeks after injury. Christina Le:                  06:39                With our odds ratio where we found that the odds of scoring higher than 37 on the TSK was about 10 times greater for the injured group than the uninjured groups, which again, just means that they're more likely to be kind of in that high fear responders group. And then with our multivariable regression, we found that there is an association between our TSK scores and our knee extension strength bilaterally and actually flexion strength bilaterally as well. The differences or the relationship strength itself isn't the strongest. So if we have a one unit increase in our knee extension strength on our injured side for example, it just corresponded to a 0.1 decrease in the Tampa scale for Kinesiophobia, which is a minor change. Christina Le:                  07:40                It's probably not something that we can detect in all honesty or that's clinically relevant, but just tells us that there is some sort of association between Kinesiophobia and strength. Karen Litzy:                                           Got It. And so we know the results of your findings. What are your recommendations? What conclusions did you come to as a result of this study? Christina Le:                                          Yeah, so I think the two big take home messages is that kinesiophobia is present as early as the three months leading up to or after an injury. I think as clinicians we generally tend to look at this closer to the return to sport end of the spectrum of Rehab. But it's something that might be early, as our present, as early as three months. So we should be dealing with it as early as three months. And that it's potentially something that might affect both sides of the body as well. Christina Le:                  08:28                So if you've had a right knee injury, doesn't mean that you don't necessarily have kinesiophobia on that left knee as well. So it's just trying to get clinicians to think maybe a little bit more bigger picture here and that I think ultimately if we can address kinesiophobia early after an injury, then potentially we can set people up for more physically active lifestyles, that sort of thing. And then hopefully help out with that reduction of those poor long term negative health consequences. Karen Litzy:                                           And so as a practicing clinician, so let's say I am seeing a, just making this up off the top of my head this is not a patient I have I swear, I am seeing a 16 year old boy who plays Lacrosse and let's say he will use a term sprained his knee, maybe let's just say it's an ACL strain or sprain. Karen Litzy:                   09:22                So not a tear doesn't need surgery. So they're coming to me, should I be using the Tampa scale on the first visit that I see this person? Or do you wait for a little bit further down the line? Christina Le:                                          I don't think it hurts to be using that right away. I think that what these individuals with knee injuries or any MSK injury, realistically they might be fearful of different things at different times in their rehab. And I think picking that up early on might be able to detect that, oh, maybe he's scared of going downstairs or something like that. Whereas later stage Rehab, maybe it means that he's a little bit more fearful of changing directions with contact around. I don't think it hurts to necessarily use that Tsk early by any means.          Karen Litzy:                   10:13                Okay, great. So that's a nice take home for the clinicians listening that hey, this is easy. It's simple, it's free. You can get it online and just have your patient fill it out and it’s easy to score. We just heard if you're over 37, maybe that's something to worry about. The lower the number, the less kinesiophobia. So it's something that we can easily incorporate as clinicians with youth knee injuries. Can this be extrapolated to other injuries outside the knee and let's say the back? Christina Le:                                          So the tricky part with the TSK is that it actually hasn't been validated for knee injuries yet. So it's hard to say is this something that we can use in other areas? I'd really think that there is a need to validate this tool or if it's not, then to generate a tool specifically for knee injuries. Christina Le:                  10:59                Cause I think it's something that we discuss a lot as researchers, as clinicians with our patients. So for now I guess it's the best tool that we have but it doesn't mean that it's necessarily the right tool yet. Karen Litzy:                                           Yeah. Well something to add to your list. Get Jackie Whittaker and get your team together. And that's another study you can do because you have the time. Right? Christina Le:                                          Totally. Really hoping to bring on Doctor Johanna Krista at some points on this topic as well. So I think she's a good one to look at if you're curious about the kinesiophobia stuff in our knee injured population as well. Karen Litzy:                                           Awesome. And then because you said you're about 75% through the study of preliminary data. Where do you see this going? Christina Le:                                          So in the grand scheme of things for my own PhD, I'm going to be using this data to look at more health related quality of life in our young adults and our young athletes with sport related knee injury. Christina Le:                  11:55                I'm a big proponents of kind of that bigger picture. So again, I think as clinicians, we're really honed in on the whole return to sport thing as are our indicator of successful recovery. And looking at the literature, we know that only 66% of people return to their pre injury sport at the pre-injury level. And we don't really have great numbers for anything past probably two or three years either in terms of sport participation. So are we may be selling our patients short if we're only focused on that one thing as recovery versus again, kind of thinking bigger picture. Can we set them up in terms of physical health, psychological health, in terms of Kinesiophobia specifically, social health as well, so that they are able to maintain these healthy, active lifestyles, avoid osteoarthritis, avoid obesity, all that kind of stuff. Karen Litzy:                   12:47                Awesome. Well it sounds like you have big plans and I think it's only going to help clinicians and help the young athletes and young adults and teenagers and tweens that we treat on a regular basis. So thank you for your work. And now I have one more question. I probably should have told you this ahead of time, but I didn't cause I forgot. But the question is knowing where you are now in your career and in your life, what advice would you give to yourself as a new Grad out of physio school? Christina Le:                                          I would've said seek mentorship early and often. I think it took me a long and windy road to kind of get where I am and in all honesty, that's probably made me who I am now as well. Christina Le:                  13:32                But I think it would've been great to have maybe a little bit early on into my career as a new Grad, a little bit more mentorships with somebody or some people to kind of cling on to more or less to have a little bit of guidance in terms of what I should be doing, where I should be focusing my efforts on and spending my energy on. Karen Litzy:                                           Awesome, great advice. Now, where can people find you? Christina Le:                                          I am a on Twitter, I'm @YegPhysio, Yeg is the airport code for Edmonton, Canada. So that's why I'm that. And that's pretty much the only thing I'm active on in tems of social media for professional stuff. So, yeah. Karen Litzy:                                           Perfect. Well, thank you so much for taking some time out of your schedule here at WCPT to come on the podcast. Christina Le:                  14:17                Thank you so much. I'm going to throw a quick plug in for the world sports physiotherapy Congress in October in 2019 I'm hoping that all of you guys are going to be there cause we are going to be there. So you should have a lot of fun of you'll come. Karen Litzy:                                           Yes. And it's in Vancouver in and around that first weekend of October. Yes, the lineup looks fantastic and even if you don't work with a sports specific population, you can take all of this information and you can pair it down or you can pair it up to the population that you're seeing because it's all about concepts. It's not necessarily sports specific. Christina Le:                                          Yeah, exactly. I think it's something that's going to be useful for every MSK general practitioner out there. Whether again, yeah, you're in sport or not so highly, highly recommended. Yeah, you guys should all come out and hang out. Karen Litzy:                                           Yes, absolutely. We will both be there and I'm definitely looking forward to it. So, Christina, thank you again and everyone, 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 iTunes!

LIVE from the WCPT Conference in Geneva, Switzerland, I welcome Daniel Board on the show to discuss torture-survivors’ experiences of healthcare services for pain.  Daniel Board is a Specialist Pain Physiotherapist working in a pain management clinic at Chelsea and Westminster Hospital in London, UK. Clinically, he helps people with a variety of persistent pain conditions and has a special interest in refugee healthcare. In this episode, we discuss: -Torture-survivors' experiences of healthcare services for pain -The importance of the patient-clinician relationship and communication skills -How to avoid burnout when servicing this patient population -And so much more!   Resources: Daniel Board Twitter Chelsea and Westminster Hospital     For more information on Daniel: Daniel Board is a Specialist Pain Physiotherapist working in a pain management clinic at Chelsea and Westminster Hospital in London, UK. Clinically, he helps people with a variety of persistent pain conditions and has a special interest in refugee healthcare. Daniel is also an early career researcher and recently conducted a qualitative study investigating torture-survivors’ experiences of healthcare services for pain.   Read the full transcript below: Karen Litzy:                   00:01                Hey everybody, I am coming to you live from WCPT in Geneva, Switzerland. And I have the pleasure today of interviewing Daniel Board. Daniel's a physio therapist in the United Kingdom and he specializes in persistent pain. So Daniel, welcome to the podcast. And today you had a really interesting platform. So I want you to kind of give the listeners a little insight into what your platform was, because like I said, you are specializing in persistent pain, but you really have a very unique perspective. Daniel Board:                00:35                Yeah. So my background is in working with people with persistent pain problems. And part of that is that I'm lucky enough to work in a specialist clinic for torture survivors at Chelsea and Westminster Hospital in the UK. The platform presentation I did today was presenting the findings of a research study that we did last year, looking at the experience of persistent pain in survivors of torture survivors are kind of an underrecognized group. They have a variety of psychological, physical, and social, kind of consequences and burden as a result of torture. For example, persistent pain rates succeed. 80% inspires of torture. Rates of PTSD and depression exceed 30%. Issues aren't just standalone. Many certainly the torture survivors that we encounter are living in a country of excile and there are also lots of problems associated with that, such as seeking asylum, lack of social support, and also obviously the language barriers, and kind of what they're not necessarily knowing what their rights are with regard to accessing services within the UK. So that's the population. Karen Litzy:                   01:49                And what did your study specifically look at that you presented today? Daniel Board:                01:54                So what we looked at from the evidence base is very limited. There was a Cochrane review last year that looked at interventions for managing pain in torture survivors and they find that there was no evidence to refute or support any intervention currently for managing persistent pain. Clinically, we see, as I said, quite a complex population and typically outcomes from treatment aren't great. We also find it quite difficult to engage them within our services. We have high sort of failed attendance rates and that really affects their ability to access and benefit from healthcare. So the study that we looked at or the study that we did was a study looking at what's torture survivors experiences of pain services in the UK is like so often, torture survivors that generally the first place they'd go to is that GP with a pain problem. Daniel Board:                02:48                But they would also, the participants in our study, had seen GPs, they'd seen physiotherapist, pharmacist, they'd been referred to trauma orthopedics, cardiology, rheumatology, and that in itself posed a number of issues. So one of the first things we find was actually there was a big confusion over or a lot of confusion from the survivors of torture perspective over what their diagnosis was. So because they'd seen lots of different health care professionals, they're often confused. So for example, one of the quotes in our study was, ‘One says you have fibromyalgia, one said you had PTSD and another one said a slipped disc.’ So all of these things, they don't necessarily mean a lot to the patient and it can often leave them confused. So it was the first thing that we found. Karen Litzy:                   03:34                And with the finding like that and like the confusion of the patient, is that a reason that may be why they're not seeking out physical therapy or maybe why they drop off? Daniel Board:                03:46                I think to be honest, I think there's a number of reasons why they might not engage very well. I think there's a couple of issues with diagnosis and let's maybe start with that. One of the things we noticed in the study was a really overly biomedical approach to diagnosing and treating pain, which isn't isolated to torture survivors. It's widespread, but certainly with this group that was relevant. So participants receiving diagnoses like degenerative disc disease or disc derangement. These were things that were noted in our study. And even if they didn't fit necessarily with the participants picture of pain, so they might have had widespread pain or pain that didn't fit that specific diagnoses. That does a couple of things. First of all, providing a diagnosis, which doesn't necessarily fit the clinical picture. Daniel Board:                04:38                It takes away, I think, ownership of being able to do anything about it. So by saying you've got disk to arrangement that's going to instill fear, that's going to take away any kind of ability that they might perceive they have to change that situation. So that was one of the things with diagnosis. The other important thing we find was that there was a distinct lack of recognition of torture experience when diagnosing pain. So if torture was recognized often it was done. So the word that came up quite a lot in the study was that participants had a biopsychosocial overlay, which in itself is a pretty ambiguous term. And there was a real lack of recognition of the affective and cognitive components of a pain experience and how torture experience might influence that within a pain experience. So I think that would affect how do they engage with services because I think it takes away some of the ownership by providing that kind of diagnosis. Daniel Board:                05:31                I think the other thing is that it's not as simple as there's not one thing that is the problem with us engaging this population. Rates of PTSD and depression are very high our participants said that they struggled to engage with services often because they either lacked motivation to get to the hospital or they were in too much pain to complete that physiotherapy exercises, for example. So those were a couple of things. And I think there's also one of the things that we find one of the problems that we think then as a finding from the study was that there seems to be not necessarily a dualistic on the part of the clinicians. I think that's probably a little bit outdated given what we know about current pain understandings. Daniel Board:                06:18                But I think there still is that perhaps a dualistic tendency in the organization of services, particularly in the UK. And I'm sure it applies to other countries as well, that if you have a physical problem, you go and see the physical services. If you have a mental health problem, you go and see the mental health part services. And I think that leaves populations like torture survivors who present with a really complex mix of all of these factors in quite a precarious position. So for example, they might come to a pain service, I'll see a physio, and they might say, Oh, you look like you're really struggling with PTSD. Let's get you some help with that and then come back and see me. So then they'll get referred to a psychological service, but they might struggle to engage with the psychological service because of the pain that they're in. So it just seems to be, I think the service provision we have at the moment isn't well suited to this population. Karen Litzy:                   07:07                And so is this population, they're not being treated collectively. So if they're going to see, let's say you for pain, they'll see you and then if they're referred to psychologists or psychiatrists, they stopped seeing you and go see a psychiatrist or psychologist. It's not happening at the same time. Daniel Board:                07:28                So at the moment, no, not in the general health services. I think the key thing with any care and specifically with this population is it is very individualized, each of their particular problems or the things that are affecting the very individualized. So, for example, we might have someone who gets referred to the pain clinic I work at and they might really be struggling with their mental health. They might be really struggling with PTSD, having regular flashbacks. And what we try and do is assess the weight of the various physical, psychological and social components and help them kind of almost line it up. As in what do you think is the most important thing to get sorted first? Do you think you'll be able to engage with the pain service? Daniel Board:                08:13                You've actually got all this other really difficult stuff going on. So for those people we might say go and engage with a community mental health team, get some help with the PTSD and then come back. But that being said, I think that doesn't mean that people who are undergoing sort of significant psychological distress can't engage with pain services. So what we've started to do, we've just set up, a specific exercise class for this group of people, which is psychologically supported. So myself and one of my psychology colleagues, we've kind of paired the approach right down to keep it simple and actually you say kind of we understand you're really struggling with your pain problem. We can try and help you or try and help it impact you less. So actually setting some goals with you. We use the patient specific functional scales are really nice outcome measure if keep going, what do you want to do? I'm really struggling to bend over. I can't play with my kids. I can't climb stairs. Okay, great. Let's see if we can start doing that. And I think well slightly off on a tangent. Pain education is a really important part of that. But I think sometimes it gets lost in translation particularly. Karen Litzy:                   09:23                Yeah. I was just going to ask if it is a language barrier talking about pain education, we know that we can simplify it. Not Dumb it down but we can simplify it. But if there is this language barrier that Gosh, that must make it so much harder. Daniel Board:                09:35                It is really, really difficult and there is some really nice work being done. The evidence base is limited, but there is some really nice work being done. April Gamble, who is a researcher who I've met here with the conference has done some really nice work looking at pain education in groups within their cultural setting and has come up with a variety of different tools that can be a cultural accessible tools that can be used. So she's definitely a person, a good person to speak to you. I think what we try and do in the clinic is find one very simple metaphor that we can use with patients. So I'll talk a lot about the volume on your nervous system being really high or I don't know, when you're assessing you find something that works for them and then when we're doing stuff in Vivo, kind of let's do some exercises, what's showing up for you? Daniel Board:                10:23                Kind of what thoughts are coming in your head, how that might be a barrier and that's where the psychologist is really helpful. But then looking at reassurance, lots of reassurance and actually, okay, you're not damaging yourself. It's just a volume knob on high and I will mimic turning up a volume knob about a million times a day, I think with my patients. And yeah, it seems to work well for a group. But again, we can't be prescriptive and actually it doesn't work with everyone and we still need to look at other ways of engaging that group that it's not necessarily working for. Karen Litzy:                   10:55                Yeah, great thoughts. Thank you. And anything else? Did we miss anything else from the study? Daniel Board:                11:04                So they key things, I'll summarize them cause I can remember them cause we just talked about them. I guess the key things were that there was a distinct lack of recognition of torture experience when diagnosing and treating pain. There was something which we haven't overly covered, which was that the patient clinician relationship. Karen Litzy:                   11:23                We're going to touch on that in a second. That was my next question, but go ahead. Daniel Board:                11:27                We'll hold that one. And then the last thing was the current organization of health care services and how that's not necessarily conducive to such a complex population. Karen Litzy:                   11:36                My next question, if you didn't bring it up, was going to be how do you as the therapist, how are you able to connect number one and number two, is there a burnout rate for the therapist, working with people in this population? Because if you're an empath, let's say someone who's very, very empathetic, I would think this would be a really tough group to work with until you kind of get your bearings with them. So can you kind of touch upon that? Daniel Board:                12:08                Absolutely. Starting with your question about the patient kind of clinician relationship and how you foster a kind of a good therapeutic relationship. I think you can probably over complicate it a little bit. I think from a therapist perspective, I think one of the key things that we have as physiotherapists is we're very good at talking to people and we're very good at helping people kind of be open. And I think actually what physios in the clinic, when we spend time with people, we're often the first sort of people that they might have told about that specific problem. I think we're really lucky. I'm really lucky that I'm able to work with psychologists, so if there's anything that is really significant that they're on hand and they can help me. Daniel Board:                12:53                But I think as Physios, certainly when I was not working in pain, I think we look at mental health as a bit of a Pandora's box. And I think there is a fear amongst some therapists of going, well, I don't know. I don't want to ask the question about your mental health or how your depression is, or whether you've been taught, for example, because I don't know what I'm going to do with that information afterwards. So if I get an impression of you being a low mood and then you tell me that you've got some suicidal thoughts, I've got to act on that. And that's scary. So I think personally myself, I used to be perhaps that way inclined. But actually I think as I said, we're very good at talking. Daniel Board:                13:31                A lot of what we do is talking as a profession. And I think actually just having a really good listening ear to someone, being able to say the things that come naturally to you with patients. So I'm not acting in shock at someone's telling you what's happened to them or avoiding questions about things that might be difficult and then dealing with whatever it is that comes up and that probably will have an element of you knowing what your support processes are within your service. So we have a really good pathway for suicidal ideation, for example. I think that patient clinician relationship is really, really important. And I think we as therapists, we've got really good chance to just be open and talk to patients. In the same sentence though, not with all survivors specifically. One of the things in the study was that actually some people really wanted to tell you about their experience and some people didn't. Some people were really avoidant of it. And I think it's just being careful that you're not overstepping. Just being kind of a really sensitive approach is important. Karen Litzy:                   14:31                So the other question was, as the therapist, how do you protect yourself from burnout, from feeling just so empathetic towards these people that you're taking it home with you at the end of the day? Daniel Board:                14:46                I guess there's a couple of things. I'm very lucky as I said that I work with a really good team of Physio, psychologist, doctors, nurses, and I would feel very comfortable being able to say or talk about anything that I was worried at with them. I think, sadly you do get a bit used to those conversations at times. I think they do affect you less. But inevitably you're going to hear stuff, which is, which is horrendous. And I think the key thing in the same way that you would do with any other kind of mental health is not keeping it bottled up and actually if you need support, being able to talk about it, with your colleagues to get some support if you felt that that was needed. Karen Litzy:                   15:23                Yeah. No, that's fair. That's fair. Well, I mean, I have to say I think it's a wonderful service that you're providing for this group. It's not easy. I have never worked with that population so I can't put myself in your shoes. But I admire it greatly because these are truly marginalized group of people who really need the care. So congratulations to you and your clinic on doing this. Daniel Board:                15:50                Thank you.  I think this population encounters physios every day, I think we're just lucky that we've got a service, which is nicely set up to help the people. Karen Litzy:                   16:00                Yeah. All right. So I have one last question before we finish. Well two actually, but we'll start with one and it's a question that I ask everyone. So knowing where you are now in your career and in your life, what advice would you give to yourself as a new Grad straight out of physio school? Daniel Board:                16:19                Very, very good question. As a new Grad, I'm going to say is probably the key thing is say yes to everything. Opportunities. A good physio colleague of mine, Dave Reese when I was applying to do the masters of research we did last year, I was unsure. I kind of had that imposter syndrome and I think we often feel that, and he said a really good, a good thing, just lean in. So any of those kinds of experiences, which might seem scary, like presenting at a conference or being interviewed for a podcast or whatever it might be in your professional life, whether that be clinical research, I think, yeah, just take any opportunity to develop and learn from people that perhaps know more than you. Karen Litzy:                   16:59                Great Advice. And then lastly, where can people find you if they have questions they want to follow you on social media, where can they find you? Daniel Board:                17:05                I'm relatively active on Twitter and my Twitter name is @BoardDan that's probably the easiest way to get me as well. Karen Litzy:                   17:14                Perfect. And just so all the listeners know, we'll have links to your clinic and links to everything at podcasts.healthywealthysmart.com. So you can go over there one click and it'll take you to anything if you want more information. So, Dan, thank you so much for taking time out of your day at WCPT. And everyone, thanks 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 iTunes!

LIVE from the WCPT Conference in Geneva, Switzerland, I welcome Efosa Guobadia on the show to discuss entrepreneurship in physical therapy.  Efosa L. Guobadia, PT, DPT, is the founder of the integrated wellness company FFITT Health; President and CEO of Move Together, a 501(c)3 for purpose organization dedicated to improving access to quality rehab medicine around the corner and around the world; Co-Founder of the initiative Global PT Day of Service, which has spanned 60 countries since its inception; Founder of the informational website PT Haven; and also developed and led the international volunteer program ATI MissionWorks for ATI Physical Therapy. In this episode, we discuss: -Efosa’s entrepreneurship in underserved communities -How to approach roadblocks and tackle them head on -Three qualities of inspiring leaders in the entrepreneurial space -Exciting ways you can get involved with service through PT Day of Service -And so much more!   Resources: Move Together Website @efosaguobadia @ptdayofservice @ffitthealth Move Together Instagram PT Day of Service Website  PT Haven Website efosa@movetogether.org   For more information on Efosa: Efosa L. Guobadia, PT, DPT, is the founder of the integrated wellness company FFITT Health; President and CEO of Move Together, a 501(c)3 for purpose organization dedicated to improving access to quality rehab medicine around the corner and around the world; Co-Founder of the initiative Global PT Day of Service, which has spanned 60 countries since its inception; Founder of the informational website PT Haven; and also developed and led the international volunteer program ATI MissionWorks for ATI Physical Therapy. In 2017, he contributed a chapter on sustainability as well as the closing afterword for the book ‘Why Global Health Matters”, edited by Dr. Chris E. Stout, and with a foreword by Nobel Laureate Jody Williams. He received his BS in Kinesiology from the University of Massachusetts in 2007 and his Doctorate of Physical Therapy from the University of Scranton in 2010. He is recipient of the 2017 Distinguished Young Alumni Award given by the University of Massachusetts/Amherst School of Public Health and Health Sciences and is a 2018 American Physical Therapy Association Social Impact Award Recipient.  He is currently based out of Guatemala City, Guatemala.   Read the full transcript below: Karen Litzy:                   00:00                Hey everybody, I'm coming to you live from the WCPT conference in Geneva, Switzerland. And I have the distinct pleasure of sitting next to Dr Efosa Guobadia who is a physical therapist from the United States now based in Guatemala. And he has also the cofounder of PT Day of service and move together, which we will talk about during this interview. But first, what I'd really love to talk about Efosa is you were on a panel today about entrepreneurship and physio therapy. So can you give us the highlights? Efosa Guobadia:            00:34                Yes. Well, Karen Litzy is such a high pleasure to share time with you. The only time I get a chance to hang out with you, you put a smile on my face. I love the energy and all that. So yes, the panel is about entrepreneurship. So one of the things that I certainly talk about, I said entrepreneurship is a mindset, you know, it's about bringing the vision and the vision of your heart and the idea in your mind into actuation, you know? And with that being said what I also said, I think everybody has, it has the potentiality and the capacity to be entrepreneurial or you sometimes talk about product market fit or passion market fit and where does your passion, your idea slash your product meet the market. You know, and I think that's also very important. A friend of mine recently we're having a concept about what's an entrepreneur? He says an entrepreneur is the intersection of your idea, fundamental value and the wants, desires, desires and the understanding of the client and consumer. And that sweet spot is so important. If it's just about your ideas, you may be a starving artist, you know, but if it's a too much about the client, you know, you may be selling out a little bit. So find that great amalgam and that sweet spot and I think that's very important. Karen Litzy:                   01:37                Yeah. Thank you for bringing that up. I think that's great. I usually tell people when they're like, not sure if this idea can actually turn into a business. And I'll always tell people like, make a list. Like, what are you good at? What are you really passionate about? And what would someone be willing to pay you for? And if you can find that sweet spot, and again, it's like you just said, it's your passion where it intersects with what the consumer needs or what the consumer doesn't know they need yet. And that's where entrepreneurism really comes into, I think, a great place for the person. So let's talk about what you're doing as an entrepreneur. Efosa Guobadia:            02:16                I love that so much. And I agree. To piggyback on what you just said, Karen, it's about fundamental value. And I think this is true in any industry. So whatever this thing, this fundamental value, your product service, after a person comes into contact with it, are they better off? And then well, we can talk about marketing or this or that, but that should be the first thing that you curate. So that's very foundational. I'm living a pretty interesting existence right now Karen Litzy so this past November in 2018, I actually decided to move to Guatemala and now I'm doing two different things. So I feel a part of my bandwidth is for the global health sector. You know co founding, you know I lead the organization move together and our mission there is to increase access to quality rehab medicine around the corner and around the world. Efosa Guobadia:            02:56                I've been going to Guatemala now for the last seven years I've been doing this global health work for the last seven years. I moved together under that umbrella. We've been doing some pretty interesting work there for the last three years of amazing partners on the ground and amazing participants and volunteers that have joined us from the US and other places around the world. We help to build the development of rehab clinics in underserved communities. And the keyword there, this is the keystone where there's the operization, the local PTs and students on the ground. They run these clinics that we co set up throughout the year and on the ideas that it thrives uder them and we are glad to say it has been so. And then we have other programs under them, the nonprofit move together, PT day of service, which you mentioned, we have a program called that pro bono incubator and that's US based in which we dispense funds to pro bono projects in clinics in the US over the last two years we just spent $20,000 to a 11 different projects and a mentorship and resource to many more than that as well. Efosa Guobadia:            03:53                So that's been pretty fun. So that's one part of my existence. The other part of my existence is entrepreneurial. This past I officially opened this March, but I did some ramp up work to it this past march. I opened up a clinic in Guatemala City and it looks at three verticals. It looks at mobility, which is Rehab. And I do some movement analysis with the movement three d camera. We do look at nutrition. I'm hiring some nutritionists to look at because nutrition is important for a few reasons, right? For pain. It's relationship with inflammation and with energy and a certainly with weight management, weight management is predicated on nutrition. I think above all cardio and then lean muscle mass. So it's looking at it through that portal has been important. And the third vertical has been mindset that, you know, a routine and breathing and sleeping and all that good stuff. So creating a team that helps me do those things in an ecosystem systematic way has been fun. You know, the early part of it has been mobility and people have been responding so very well to it in Guatemala. They're telling me now I can't leave, but you know, some of my clients and it's been fun. Karen Litzy:                   04:56                Awesome. And now, you know, your version of entrepreneurship is let's say different than maybe some traditional entrepreneurship where you're setting up shop in a very developed country and it's certainly different than what I do as an entrepreneur. I think from a practical standpoint, different, but I think from a fundamental standpoint and where our mindsets are and what we're trying to do for our clientele, it's pretty similar. Would you agree? Efosa Guobadia:            05:23                A hundred percent fundamental value around the world. Its fundamental value in each industry needs to know their fundamental value. Let's say for us, our fundamental values as healers is help people move better so they can live better. That exists and is needed anywhere in the world. So again, know fundamental value, build the architecture and fit it to the market into the behavior and the knowledge and the awareness of your customers or customers to be and that's how you make it make sense wherever you go. Karen Litzy:                   05:47                And for maybe listeners out there who would like to replicate what you're doing in an underserved area or in an underserved country, what were some of the biggest roadblocks you experienced in the beginning that you would like to advise people on? Maybe how to avoid or at least how to minimize? Efosa Guobadia:            06:07                Oh, interesting. I think it's so important to identify roadblocks and barriers. I sometimes say this with my clients now you need to know the dragon and sort of delineate the dragon so you could slay it. You know, so it's the transcend another general thought. Anytime Challenging things happen. I cheer this in the panel as well. It's information, you know, it's that when a situation happens, good or maybe not good to the way you want it to happen, it's situation. What's good about situations, it leads to solutions. So once you figure out how to handle something, now you have this tool of this extra solution. Now you can play defense and prevent that from happening again. Or if it does happen, you can handle a quicker, and actually turn it into a good, et Cetera, et cetera. So that mindset, that paradigm shift, the mindset. Efosa Guobadia:            06:50                If you're an entrepreneur of how do you engage with things that don't necessarily happen the way that you want to have it on the, for me and some of my experiences, every country has its own things. And one thing is you go through the legal process is setting up your business. What I just had to learn is a little bit different from the US so tagging in this is a truth for all entrepreneurs and all projects, you know, identify and tag and the right people who could best help you with what you need to do. And then that saves time and that maximize your efficiency as well as your effectiveness. Karen Litzy:                   07:18                Yeah. So when you kind of hit those roadblocks, I love the way of reframing it as not a, Oh my gosh, I'm so stupid. Or how did I not see this coming? Oh great, now I'm sunk and I'm going to go sulk into a corner. But instead you're saying to reframe it as, well, here's this roadblock, but guess what? Now we have a system in place to avoid this from happening again. So being very intentional about how you're thinking of roadblocks or I don't want to say failures or things like that in your business, but being intentional so it doesn't happen again, and then you can go out and help others do the same. Efosa Guobadia:            07:54                You said that perfectly. Nothing to add to that. Karen Litzy:                   07:55                Okay. All right. So let's talk a little bit more about entrepreneurship, specifically leadership. So if you're an entrepreneur, you're a leader, right? You're either leading yourself, you're leading others. So what do you feel like are qualities of, let's say leadership within the entrepreneurial space? Efosa Guobadia:            08:15                Yeah, I can say a few of both. They overlap and they're interrelated like you're saying. But on the leadership front, I think, there's three things that are important. You know, maybe I'll break it down to three C’s. So one C is courage, the second c is compassion, and the third C is credibility. So I'm gonna explain what I mean by those. But first of all, with those three things, you start with yourself. You need to serve yourself. You need to lead yourself first, before you can think about leading people. So on the coverage piece that then set on your heart or the things that you believe in, do you pursue them or do you stand up for them? And the micro moments and the macro moments. And it's like a muscle you have to cultivate and you’ve got to work it out. You know? Efosa Guobadia:            08:51                So expressing when things are more macro and big and where things are really intense. You've had this muscle, I'm going to be strong, I'm going to be courageous. I'm going to be dictated and guided by what I see is right and righteous. So courage is important. The other part is credibility. Again, starting with yourself. Do you do the things that you set that you intend to do we get the to do list. Have you written out 20 things consistently for the last month. I've only got three things done. You're telling your conscious and your subconscious, you can't trust what you write down. So start there. Create credibility and trust with yourself and then it’s metaphysical it transmits to your team, you know, you can't really have credibility with others without having credibility with yourself. And then caring and compassion. You know, one of the most important words in my life, caring, you know, caring about yourself, being compassionate about yourself. Efosa Guobadia:            09:33                To be able to do that with your team. You need to be able to do it yourself. There's one politician and I heard say it as a couple of years ago, the best thing a leader could do for his team, his or her team is to care about them. You know how you do that by actually caring about them, you know, so actually care about yourself to take care by yourself, actually care about your team, to care about your team, on the entrepreneurial realm. A lot overlaps with say consider our focus decision making capabilities. And I will also say reasoning, you know, able to multidimensional think a lot of entrepreneurism is problem solving and thinking ahead and thinking what's coming down the pike. So that's the critical reason. A lot of the decision making, whether you've got to make quick decisions or deep decisions. Efosa Guobadia:            10:14                What's your prototype, what’s your paradigm, how do you handle that? How do you stay calm under pressure? Maybe that goes to a curse a little bit. And then in focus, you read all the greats, you know, whether it was old school philosophy or current CEO's, one of the most important things that they talk about is the ability to focus on your task at hand and to chop wood on your task at hand as their old quote. I forget who said it now, the way you do anything is the way you do everything. So for me to close on this, I enjoy doing dishes. I don't do it that much, but when I do dishes, I'm locked in. I've tried to clean it as best as I can and I know that it's going to transmit to my clinical treating and my leadership or building your footing. So those would be some thoughts there. Karen Litzy:                   10:56                Yeah. And I loved the compassion I had a woman on a couple of weeks ago who talked about having compassion for yourself and forgiveness for yourself and how can you even make a decision if you can't even give yourself compassion? So, those qualities of leadership, courage, caring and compassion, and credibility. Yeah. So if you can't give that to yourself, then how can you give it to your business and be a successful entrepreneur? And courage by the way, this year was my word of the year on my vision board. So when you said that, I perked up and said, oh, courage. Yes. So that's something that I'm working with and I've been in business for a while. So I think another thing for everyone out there who's an entrepreneur or wants to be an entrepreneur is it's not like, oh, I have courage one day and then that's it. It is for ever, you are forever working on it. At least that's my view. Efosa Guobadia:            11:56                I agree. Excuse me. I agree. It's a muscle and it's not this goal to achieve and that you're good at. It's an attention and intention really has to do a behavior and courage and you’ve got to be smiling in this world. It's so much about courage is a call to adventure. What is it in your heart, what do you feel pulled to and are you willing to answer that call and say, heed that call. Even if it's a small step, even if it's a big step, even as a small step that leads a big step. If you do, if you heed the call, if you go for it, if you stand up for the things that you believe in, you will live a life in full. You know? And it’ss be a certainly an interesting one. Karen Litzy:                   12:32                Wonderful. I have nothing to add to that. Now before we went live you were talking about how it's such an exciting time in physical therapy and we're here at WCPT with 4,500 people from around the world. And I have to say it is exciting. So what is your version of now is an exciting time for physical therapy? Efosa Guobadia:            12:51                It's a combination of things. You know, there's so many exciting and interesting people doing exciting and interesting things you with your cash based practice you with this podcast. So many other people. The prehab guys, you know, I don't even know those guys, but I admire them from Afar, how they're growing, how they're fitting something in the market, how they're influencing and inspiring clinicians and clients have like so many others. So many exciting people doing exciting things. So that's one variable too with technology. You know, technology is allowing us to do a multiplication of things that we couldn't do six months ago, 12 months ago, and then certainly two, three, four, five years ago. So understanding where the tech is now or where the tech might go, it's a variable that leads to a multiplication. And then the consumer that, you know, they're more intentional with where they spend their time or where they spend their dollars, how they engage with health and health care and all that good stuff. Efosa Guobadia:            13:39                So they're becoming more of a partner. That's how I treat my clients and my consumer, my patients as a collaborator in the journey. So you play with those different variables of technology ideas of different people, a consumer that's wanting to be healthier and then wanting to be fit. And intentional in that healthiness in that fitness, we're at this place really where anything is possible and everything can change. And I think in the next 10 years Karen the next 10 years, we're going to see an evolution slash revolution of efforts and actuations within our profession. And certainly the other step is how we collaborate with other verticals and other industries and other professions as well because not just about what we could do alone by what we could do is by what we could do together. Karen Litzy:                   14:21                And on that, that is just the perfect segway because the next thing I want to talk about is move together and PT day of service. So let's give a plug to both of these, well move together, the parent organization of PT day of service. So let's talk about that a little bit so that the listeners know what the heck you're doing. Efosa Guobadia:            14:42                Yeah, sounds good. So move together is a 501©3 that I cofounded in 2016. And the way we define mission is that we measure everything that we do and say by. So the mission for the organization is to increase access to quality rehab medicine around the corner around the world and access being the keystone word and the keystone structure cause with access that we've seen in some of the places that we've been to, the place doesn't exist for people to go to or the place does exist. They don't have the means to go there of it does exist. They have the means that placement, I have the things that that community member that community needs. So it was a multidimensional challenge, so it needs a multidimensional approach. So that's been pretty exciting. Efosa Guobadia:            15:18                I smell inside and out every time I think about our vision first. But the way we defined vision, vision is Simon Sinek talks about this a lot. Do you need to be able to see it? You know, that's why we call it a vision. And then when I think about it, I think about it as a guiding light or the northern star that's shining the way forward. I also think about it as the horizon. There's always going to be necessary distance between your horizon. That's the definition of horizon and so it becomes this pursuit and then you're pursuing the doing of good and doing and what your vision is, which I'll share in a moment, but also how you enjoy the journey. You're able to turn around and look at the shore, see how far along you've gone and also set up beacons and objectives along the way to measure your progress. Efosa Guobadia:            15:58                Our vision for the organization is a clinic in every community and a sense of community in every clinic, a clinic in every community speaks to the horizontality of where we want to go, the geographical breadth of where I want to go. Community in every clinic speaks of punctuating depth and the verticality of what we do and the places that we do go. So a clinic in every community and community in every clinic. And that really drives what we do. We have three pillars in our organization, one that looks at increasing the quality and quantity of clinics. We do that. We have a program, PBI in the US and other clinic development program around the world or work with municipalities and mayors. And, and our community leaders to build development operationalized clinics. We have a second pillar called empower local clinicians. You know, not just a going and leaving going and leaving something behind and power and local capacity. Efosa Guobadia:            16:42                Mike Landry talks about that term about local capacity. So most of our projects abroad we usually teach, you know, and learn and do labs things of that nature and we partner with other kinds of organizations to start doing it more in an architectural way for sustainable change. And then the third pillar, which ties into PT day of service is catalyzing servant leadership. What we've seen about our profession, certainly beyond our profession, PTs and PTAs and students, they like to serve we are a  profession of heart and compassion. You know, so many people have been doing so many good things already, but for many people they don't know where to start, you know, so how can we create this junction of Bi directionality where people can be fulfilled while fulfilling other's? We see path for academic leadership and association leadership and corporate leadership and those are great. Efosa Guobadia:            17:25                It was very important for us as an organisation. Josh and I, we talk about this a good amount is creating a path for servant leadership. You know, so we have two programs right now in that pillar program. We're very excited about anybody listening that is interested in our mission and vision. This would be a good portal to join, call the catalyst club and it’s all family for the organization. It's a critical mass to volunteer team that's going to help us fulfill the vision and pursue the vision. And then of course we have PT Day of service. Just an amazing program, really driven by amazing, amazing team which Karen, we love you so much for being on our team since really the beginning and then amazing people around the world participate in a PT day of service when we challenged students, clinicians to do an act of service on the same day and around the world. Efosa Guobadia:            18:07                Year one we had 28 countries participate. Year two we had 42 countries participate. Year three we had 55 in year four we have 56 give or take, we're in year five which the big year for us and we're very excited and we’re looking to grow not just for the sake of numbers but to grow in the sake of service and showing that service can grow at the end of the day. What that program is about PT Day of service. It's about local service for a global effect and a global impact in your backyard in multiple places. Karen Litzy:                   18:35                Yeah. So this year it's October 13th and if you want more information you can go to PTDayofservice.com or move together.org Karen Litzy:                   19:01                And we'll have all of the links to everything, under this podcast at podcast.Healthywealthysmart.com. So one link can take you everywhere. So Efosa before we finish, I have one last question. I cannot wait to hear your answer. I'm like super psyched about this as a question I ask everyone and it's knowing where you are now in your life and your career, what advice would you give to yourself as a new Grad fresh out of the University of Scranton, right? Efosa Guobadia:            19:27                So were you saying I'm having a conversation with a 24 year old, Efosa that guy was interesting. I wish I could have a conversation with that guy. So what I will say, I'm actually gonna say, he's gonna be interesting. So are you asking me to look back and what advice I would give that person will be to actually look ahead. So there's an exercise that I do sometimes called futuristic retrospection. I came with this term several years ago. And what the exercise you actually do is visualize yourself as an older person and this is similar to other activities but futuristic retrospection, it goes to visualize yourself as an older person. So 24 year old me is talking to 90 year old me, maybe I'm hanging out in pajamas, you know, and a cat is just doing whatever I'm doing. Efosa Guobadia:            20:10                And in that conversation I would tell my 24 year old self do this. In that conversation, ask your older version of yourself, what do you wish you did? What do you wish you did at 24, 25, as soon as you graduated, what do you wish you did? Where do you wish you were at? Who do you wish you where? et Cetera, et cetera. And then, certainly you have to extrapolate what you think that answer might be. And then whatever that answer is, you've got to let it guide you. You know, there's an article I read at slate a couple of years ago that said, when we think about an older version of ourselves, the same part of our brain lights up as if we're thinking about a stranger, at least in the Western world, right? When we think about an older version of ourself, the same part of our brain lights up as we're thinking about a stranger. Efosa Guobadia:            20:47                So this exercise allows you to get feedback and thoughts from your subconscious. The person who really knows you the best, and it's pretty powerful. Jeff Bezos, he utilizes something similar called the regret minimization framework. You know, think about an older version of yourself and what then do you think you regret not doing, you know, and then to make sure you do that. And then the other thing at least the character Togo has this quote, we're presented with insurmountable opportunities. So there's a never ended amount of opportunities in the world, you know. So with that being said, it becomes about being essential with your time. You know, people going to ask you to do things, you know, which is good, which is fun. And the better you are at things hopefully the more that you’re going to get asked. The honor is the ask, you don't have to say yes sir. So be essential about what you're doing so there’s this balance of knowing your measures, knowing your markers. Know you're vision and let that guy that didn't create or the things you accept and you multiply that by being adventurous as well. You know, trying things, finding that sweet spot will allow you to maximize yourself. Your time. 24 year old, they feel similar. Karen Litzy:                   21:54                Wonderful Advice. Thank you so much. Where can people find you if they want to ask you questions or find out more about you? Where are you on social media and all that kind of fun stuff? Efosa Guobadia:            22:03                All my handles on social media or my first name followed by my last name, @EfosaGuobadia.  I do a lot of mentorship talks with folks that are certainly a lot of folks, new professional folks, students and all that good stuff. I take much joy in that and is very conversational. A lot of the answers are within you and I guide you to some thoughts. So somebody is interested in that, shoot me an email and we'll find a time in the schedules, they can shoot me an email address. That's my first name, efosa@movetogether.org and you know, so whether it's email or whether we do a 30 or 45 minute talk, that's one of the ways I enjoy serving. So, be intentional reaching out cause I mean that. Karen Litzy:                   22:46                Well, and for all those of you listening, take advantage of that because to have Efosa mentor you or just talk to you about anything, you will walk away knowing more and feeling I don't know better about yourself somehow. I don't know how that's even possible, but that's the sense that you get after speaking with him, you're going to walk away with value. So take advantage of that. So folks, so thanks so much for coming on and taking time out of WCPT. Efosa Guobadia:            23:15                Karen, thanks so much. I think this may be the third time between Josh and I are hanging out with you, we have so much love for you, I thank you so awesome. Thank you for this, another way for you to serve this information. Karen Litzy:                   23:26                Thank you. And everyone, 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 iTunes!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Ryan J. Lingor, MD and Michelle Cummings, PA on the show to discuss HSS Ortho Injury Care.  Dr. Lingor serves as an Assistant Attending Physician at Hospital of Special Surgery, faculty at Weill Cornell Medical College, Medical Director for HSS Ortho Injury Care, and Team Physician for the New York Rangers.  Michelle is a physician’s assistant who enjoys helping patients get back to their active lifestyles while also providing them with a thorough understanding of their orthopedic diagnosis. In this episode, we discuss: -The unique offerings of HSS Ortho Injury Care -Expanding patient’s access to quick and affordable medical care with the HSS Ortho Injury Care business model -How to market your services and gain trust with your community -And so much more!   Resources: HSS Ortho Injury Care   For more information on Dr. Lingor: Dr. Lingor serves as an Assistant Attending Physician at Hospital of Special Surgery, faculty at Weill Cornell Medical College, Medical Director for HSS Ortho Injury Care, and Team Physician for the New York Rangers.   Upon graduating from St. John's University in Minnesota, Dr. Lingor obtained certifications as a Registered Dietitian, Certified Athletic Trainer, and Strength and Conditioning Specialist. He went on to complete athletic training internships with the New England Patriots and Miami Dolphins and was named Head Athletic Trainer of NFL-Europe's Hamburg Sea Devils.   Dr. Lingor graduated from medical school at Loyola University Stritch School of Medicine and completed his residency in family medicine at Illinois Masonic in Chicago and his sports medicine fellowship at the University of Notre Dame. He is board certified in family medicine and obesity medicine with a subspecialty in sports medicine. His previous experience includes working as an Assistant Team Physician for the New York Jets as well several local high schools and colleges.   Having professional passions in weight management and comprehensive sports medicine, Dr. Lingor utilizes his background in nutrition, athletic training, and strength and exercise training to provide a comprehensive, personalized approach to help his patients achieve their health and performance goals.   At HSS, Dr. Lingor utilizes musculoskeletal ultrasound for diagnostic and therapeutic purposes, performs and conducts research on biological treatments for chronic tendon problems, provides comprehensive concussion management, and employs dry needling for muscle and tendon problems. He is active as a researcher and regularly presents at national conferences in primary care sports medicine.   Outside of medicine, he enjoys traveling, cooking, and being active outdoors, having competed in several marathons and three Ironman Triathlons, including the Hawaii Ironman World Championships.     For more information on Michelle: Michelle Cummings graduated magna cum laude from the University of South Carolina with an undergraduate degree in Exercise Kinesiology. During her studies, she spent three years as an undergraduate research assistant working on a study which focused on implementing health and nutrition programs into churches. Michelle then earned her Masters Degree in Physician Assistant Studies at the Massachusetts College of Pharmacy and Health Sciences. Prior to going to HSS, she worked as a PA for a private orthopedic and sports medicine practice focusing on upper extremity injuries. Michelle enjoys helping patients get back to their active lifestyles while also providing them with a thorough understanding of their orthopedic diagnosis. In her spare time, Michelle enjoys running, cycling, hiking, traveling, and crossword puzzles.   Read the full transcript below: Karen Litzy:                   00:01                Hi, Doctor Lingor and Michelle welcome to the podcast. I'm really happy to have you guys on today to talk about the HSS Ortho Injury Care. So thanks for coming on. Alright, so let’s sort of start from the beginning. All right, so what is the goal of this new clinic? What is the why behind it? Dr. Lingor:                    00:27                It just has always been a good place for orthopedic and sports medicine conditions. One of the problems that we've had at the hospital is getting appropriate access early on when patients need to be seen. So our providers tend to be pretty busy. So what we wanted to do is create a resource for patients to be able to go for their acute sports medicine and orthopedic needs. Karen Litzy:                   00:55                So that takes me to the next question is why sports medicine over other specialties? Obviously there was a hole to fill, right? So why this over others? Dr. Lingor:                    01:08                For myself, I really enjoyed helping keep people active and I think somebody’s activity correlates with their quality of life. And so if we can help, you know, people when they get injured or something to hold them back from, from being active on a daily basis, that's kind of where I wanted to help out. Michelle Cummings:      01:33                For me, It's two fold. One because I'm so passionate about sports in general and secondly, the specialty itself, you can actually make people better a lot quicker than in other specialties. So that's what drew me to sports. Karen Litzy:                                           I agree. I think with those sports injuries, I know coming from the physical therapist’s perspective, you kind of see this progression, right? So regardless of the age of the patient you kind of see from injury and you can really follow them through to recovery, which is really exciting from my standpoint and now, what are the commonly treated injuries seen in the clinic? Dr. Lingor:                    02:14                So we see all sorts of musculoskeletal injuries, the common stuff if somebody has a shoulder injury or just shoulder pain, we see a lot of knee injuries after athletic event, hip pain, all sorts. So any of the extremity injuries we do specialize in. And for patients that have back pain, fortunately we are a suited at HSS to have a back pain clinic. So we direct those patients to the right, the right place. Karen Litzy:                   02:47                And so why should a patient come to this Ortho care clinic versus going to the ER? What is the difference? Michelle Cummings:                              So the difference? Well, the ER you'll always have long wait times and they're not always apt to treat just orthopedic and sports injuries. So here we have an x ray onsite. Quick access to films as well as splinting and casting availability here. And what's Nice is you can actually schedule appointments online or call directly and we schedule same day and next day appointments. So if a patient sprains their ankle, you know, a night at basketball, they can go on and schedule an appointment early the next morning. So to try to shorten the wait time to the ER. Karen Litzy:                                           So you alluded a little bit to the splinting and casting, but you know, as non-operative clinicians, what types of conservative treatment are you providing for these patients as they come in? Dr. Lingor:                    03:49                So a lot of this stuff, you know, fortunately for us and most patients just don't want it to be checked out to see if they have something that they need to be more concerned about and kind of be directed in the right area. And fortunately we're kind of at a good position to give them access to all the resources that we have at the hospital for special surgery for those patients that need it. For stuff that we can take care of in the office here, we do have, as Michelle said, the x rays, we can do injections into different areas as necessary and we have the use of ultrasound to make sure that we are accurate with the injections and the care that we're providing. Karen Litzy:                   04:36                So this is how new? It's pretty new, right? When did you guys first open? Michelle Cummings:                              Yeah, we first opened in November of 2018 so it's been a couple of months now. Karen Litzy:                                           And as with everything new, every new venture, right, it has its ups and downs. So what are some of the challenges that have come up since this clinic opened? Dr. Lingor:                    05:02                Well, the biggest challenge is just getting our name out there and letting people know that we exist. We've been very fortunate to have a lot of interest both in our hospital and in the community to get people in the door when they need to be seen and get them moving in the right direction. So there's been a lot of positive energy that we've been able to benefit from in our first few months and we're still working out some kinks and not everything is smooth as you mentioned when you first get going. But, we've been very blessed to have a great staff around here that, that are all interested in, in doing what's best for the patient and providing exceptional patient care. Karen Litzy:                   05:46                And so you have some challenges, I'm sure there's also been some pros, right. So what have you found since opening the clinic have been a real positive or maybe even things you didn't even expect? Dr. Lingor:                    06:03                I think one of the nicest things is that our patients generally are in a pretty good mood when they come here because they're oftentimes patients, they're looking to go to the ER and they anticipate, you know, waiting for a couple hours and may have been told to follow up with her orthopedist at that time. And so patients are, excited when they come to a very reputable hospital and then being able to get an appointment the same day or the next day. And so they're pretty excited about that, about that opportunity. And so that's just kind of fun to work in that kind of environment where everyone is in a good mood off the bat. Karen Litzy:                   06:44                Yeah, that sounds amazing. And I would also have to think that, you know, when you go, if you have an orthopedic injury or like you said, it's soft tissue ortho injury and you go to the ER, you're not guaranteed to get an orthopedic specialist to treat you in the ER. Would you say that's correct. So is that how this kind of differs? Dr. Lingor:                    07:04                That's exactly right. If you go to the emergency room, they have the resources for, you know, taking care of the life threatening or really serious things. And that's perfectly appropriate for the ER because we don't treat those sorts of things. And with patients that go to the ER and have a lot more of the, you know, 90% of the orthopedic injuries where it's appropriate for us. And so this is a way for us to cut down on patient’s wait times and their costs as you know, an emergency room bill. Get them moving in the right direction right from the beginning. Karen Litzy:                   07:50                Do you guys take insurance? Michelle Cummings:                              It's actually listed on our website. So if a patient had questions about the insurances we take, it's all listed on the website, but we take all major insurances. Dr. Lingor:                    08:04                And that's pretty easy to find if you just Google HSS ortho injury care, you'll see it pops right up and you can see the insurances that we take and you can book yourself online and really booking an appointment is about a three minute process. Karen Litzy:                   08:19                Nice. And is this something that you patterned after? Like is there another clinic like this somewhere else in the country or is this one of a king clinics? Dr. Lingor:                    08:33                To our knowledge, this is one of the first ones in the region. I think a lot of other orthopedic places that have walk in clinics and stuff like that. I think this is the first stand alone clinic that operates, kind of how we do and you know, something we saw as a need and it's been a wildly successful in our first few months. Karen Litzy:                   09:01                Which is amazing. Dr. Lingor, I have a question for you. So aside from being an orthopedic physician, you also have a nutrition background, which I find really interesting. So are you able to infuse any of that within this clinic or do you see that as maybe something that you might want to infuse into in the future? Dr. Lingor:                    09:23                Well, with the sports medicine and medicine in general, being a field of nutrition in its other fields, it is something that I really enjoy learning about and trying to keep up with. In the clinic right now, it just helps me to better counsel patients and answer questions that they have, about nutrition and things that they can do to optimally heal and prevents some of the chronic conditions. And so I utilize it that way. And fortunately at HSS we do have a nutrition and dietetics team that we call upon as well as physicians who specialize in nutrition. We need more help. So it's not, I don't solely practice in the field of nutrition now, but kind of more as a complement to what we offer at the clinic. Karen Litzy:                   10:16                Yeah, I think that's great. Where do you see this going? Where do you see this, you know, that old question, where do you see this going in five years? Dr. Lingor:                    10:29                Yeah, so we're kind of looking at the hospital for special surgery as branching out to a couple of different other sites around the city, as well as a couple of places throughout the country in Las Vegas and in Florida. And so we're looking at kind of making this, you know, this being the flagship and then kind of model after the places just because it has seemed to do so well for our patients and for our physicians as well to get patients in. So by that I mean that when patients call other doctor's offices and they can't be seeing those to us, and then if necessary, then we get that patient back at an appointment that's a little bit more expedited then what the other physician would have been able to originally see them. Karen Litzy:                   11:26                Yeah. So you're sort of like, that patient could come in to you guys and if you feel like a referral is necessary, then you can kind of help streamline the process for the patient, which is amazing for patients because that's what they want. Because they come to you, they don't know what's going on. Dr. Lingor:                    11:41                Yeah, that's exactly right. And often times when they call one of our surgeons office, it may be a day at the surgeon just happens to be in the operating room and you know, regardless of how bad they want to see that patient, if they just don't have the ability to get them in. So, that's why I always say that we are here when the patient needs us and kind of get them moving in that right direction. Karen Litzy:                   12:01                And you know, and looking on the website, you have Michelle, a physician assistant and then a couple of other orthopedic physicians. How do you guys all kind of work together to make this clinic run? Michelle Cummings:                              Now that’s a good question. So Dr. Lingor is here more than anyone else as the medical director. So He's here usually five to six days of the week. We are closed on Sundays and I come in later in the morning and cover the night shifts and then we have the other providers that will cover sometimes on the Thursdays and also on Saturdays they cover in the need to fill in the gaps. Karen Litzy:                                           Got It. And this will be kind of like you said, your flagship operation and then hopefully kind of move this model throughout the country. I guess my question is from where you are now then from where you started, I mean, you obviously see this as something that's sustainable, right? Because I think a lot of people, when new things kind of move into their communities, there are always a little hesitant. What do you do for the community? And New York City's a big community, right? Like you said, getting the word out is part of it. But do you have any plans on kind of being part of like really being part of maybe even smaller communities, New York is gigantic, but really kind of getting into the community to get people to trust? Dr. Lingor:                    13:39                Yeah, I think that's really great point. And that's one of the things that just in our area, we're located on 65th street and second avenue. And so we see a lot of patients just in our area with, you know, a few block radius of patients walking by who have seen the signs a little bit and then come in and check it out to see what it is and say, Oh yeah, I have this knee issue. I wonder if you guys can take a look at it. We do welcome Walk-in's we prefer patients to make an appointment just to decrease their own waiting time. But we do see a lot of that and just providing that access to patients when they need it. I think has really helps build our name in our own little community that we serve right now. Karen Litzy:                   14:22                Yeah. I have my own practice and that's always the hardest thing, like you said, is getting the word out, letting people know you're there. What other marketing things, have you guys done that you've found successful so that if people are listening, they're like, wow, I really wish we had something like that in our community. Maybe they want to start it. What would your best advice be? Dr. Lingor:                    14:49                Well, one of the things that fortunately New York City has a plethora of is sporting events around being open during those times. So, like for instance, when the New York City Marathon is going on, you know, on that Sunday will be open that day to provide, access and for again, people in the area just to kind of get our name out a little bit more that people are walking by and having, you know, welcoming people in if they need to be seen by one of our providers that day and not, you know, that for the runners. Cause they're a little busy that day. Right? Yeah, exactly. Hopefully not too many of them. But we are just one block off the race course over the edge of some of those special events and volunteering with those groups. It's something we look forward to. Karen Litzy:                   15:48                Yeah. So kind of making partnerships within the community so they know you're there and they can refer to you and all that fun stuff. Dr. Lingor:                    15:56                Yeah. So we have several of our positions that do volunteer in past years with those events. And so we see when patients come in for the marathon Monday that they host after the New York City Marathon. Those patients, you know, they're seen by a medical professional that then if they need to get further testing done now we can provide that access to people. Karen Litzy:                   16:24                Fantastic. I mean, it sounds like you've got a great, a great niche over there and that you've definitely found a way to kind of plug that hole, right. You've found a way, you saw this sort of lack of accessibility and have made something a lot more accessible. So is there anything that we missed or anything that, you know, you want to the listeners to kind of remember about the clinic? Dr. Lingor:                    16:53                Yes. Things come up and unfortunately musculoskeletal injuries come up unexpectedly at the worst possible times. And there's a lot that can be done if when patients have that time of need, whether they're going on vacation or have a major life events. That's our primary goal is to provide access for the patients when they need it and help them sort through some of the frustrations. And difficulties that come along with musculoskeletal and sports injuries and you know, get them back to their level of health and quality of life that they're used to enjoying. Karen Litzy:                   17:38                Awesome. And Michelle, how about you? Anything that we didn't touch upon or any closing thoughts that you want to share? Michelle Cummings:                              No, I think just thank you for having us on the show and helping us get the word out. It's very helpful from different aspects to get out the word out in New York. So thank you for having us. Karen Litzy:                                           Yeah, you're welcome. And you know, I think it's also important, like now as a physical therapist, this is great for me to know because you know, we see patients directly now, so someone comes to me and I'm not sure, then for me it's great to say, Hey, there's a clinic that specializes in this. And then what it does for me is it kind of builds up my credibility with the patient because I'm sending them to a place where they're going to get the help that they need. Dr. Lingor:                    18:25                I’m very excited that physical therapists have the direct access, so through the physical therapy and find that, you know, the physical therapists that we commonly work with. It's been a great relationship with that. We look forward to expanding on that. And again, thank you very much. Karen Litzy:                   18:46                My pleasure. My pleasure. Thank you so much for coming on. So again, if you want to find out more information, you can go to hss.edu/ortho-injury-care. Is that right? Dr. Lingor:                    19:06                The easiest thing is just go to Google and type in Ortho injury care. Karen Litzy:                   19:14                Or you can go to podcast.healthywealthysmart.com and we'll have the link right there for you so you can just click on the link and go right to it. And hopefully we see more and more of these types of clinics popping up around the country because it certainly does fill a gap. So thank you guys for all that you do to help people with sports injuries, musculoskeletal injury. So thank you. And everyone, 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 iTunes!