Healthy Wealthy & Smart

LIVE on the Third World Congress of Sports Physical Therapy Facebook page, I welcome Professor Ewa Roos to discuss the GLA:D Program. Professor Roos is an internationally leading researcher and change agent in the field of musculoskeletal health. She has been able to both produce high-impact clinical research and translate that research into clinical tools that are easily and effectively implemented in hospitals, primary care clinics and even community settings in municipalities. In this episode, we discuss: -The three components that make up the GLA:D program -Are GLA:D exercises superior to performing any other form of exercise? -The benefits of participating in group therapy -A sneak preview into Professor Roo’s talk at the World Congress of Sports Physical Therapy -And so much more!   Resources: 3rd World Congress of Sports Physical Therapy GLA:D Program Ewa Roos   For more information on Professor Roos: Professor Roos has a passion for advancing the frontiers of knowledge in muscle and joint health to improve the quality of life of those with musculoskeletal disease and to improve health care delivery for these conditions. Her focus is on patient involvement, non-surgical and surgical treatments and clinical care pathways. A decade ago Professor Roos and colleagues started to investigate the evidence underpinning the outcomes from arthroscopic knee surgery. When they found very little evidence to support the ever-increasing frequency of these surgical procedures, they started investigation of the efficacy of arthroscopic surgery compared with sham surgery or structured exercises through a series of high quality randomised controlled trials performed in collaboration with Danish and Norwegian orthopaedic surgeons and physiotherapists. To the surprise of many and the concern of some, the results of these and other research projects have found that arthroscopic surgery for the degenerative knee is no better than sham surgery or non-surgical treatments for improving pain and loss of function. Professor Roos is an internationally leading researcher and change agent in the field of musculoskeletal health. She has been able to both produce high-impact clinical research and translate that research into clinical tools that are easily and effectively implemented in hospitals, primary care clinics and even community settings in municipalities. She has also served as an expert on clinical guideline committees for osteoarthritis (Sweden and Norway 2003, Sweden 2012, 2017--, Osteoarthritis Research Society International 2014, China 2017), knee osteoarthritis (Denmark 2012) and meniscus pathology (Denmark 2015), thereby impacting the delivery of clinical care in the Nordic countries and worldwide. One of the principal outcomes from her research has been the development of the Good Life with osteoArthritis in Denmark (GLA:D®) project for people with knee and hip pain. The GLA:D® project is an outstanding example of how to successfully implement evidence-based clinical guidelines in primary health care practice and municipalities. Its underlying principles focus on patient education, patient empowerment, exercises and self-management. Since 2013, more than 1000 clinicians nationwide have been trained in delivering GLA:D® care to about 30,000 patients, who report remarkable improvements in health in terms of less pain, less disability, consumption of less pain medication, increase in physical activity, reduced sick leave and return to work (www.glaid.dk). The GLA:D® project now serves as a template for establishing similar initiatives in other countries including Canada (2015), Australia (2016) and China (2017). Professor Roos’ research unit at University of Southern Denmark now has 20 members, attracting international recognition for its involvement in evidence-based medicine, development of patient-reported outcome measures and pioneering research in the field of joint injury, osteoarthritis and the role of surgery and exercise in treatment. Professor Roos plays an active role in breaking down the barriers between disciplines and forging interdisciplinary teams to collaborate on addressing key research questions of common interest. She is open-minded and inclusive, welcoming the opportunity to work with other disciplines and professional groups - a trait not always found in academia – to ensure the highest standards and the best possible outcomes for people suffering from musculoskeletal disease. To this end, she has been integral to the creation of the new Center for Health in Muscles and Joints at the University of Southern Denmark, which aims to become the leading institution in Denmark for information exchange, interdisciplinary research and innovation in the domain of musculoskeletal health. Professor Roos has published many articles in lay language targeting patients with osteoarthritis, often in collaboration with the Swedish and Danish Rheumatism Associations and she has made hundreds of appearances in printed and electronic media and TV. She takes every opportunity to increase political awareness of the impact of muscle and joint disease for the individual and the society and the proven benefits of physical activity for those with these conditions in Denmark and internationally, to raise its visibility through public debate, and to advocate for its recognition as a public health priority to offer treatment of muscle and joint disease equal to that of other chronic diseases including heart disease and diabetes. In 2014, her contribution to public health was recognised when she won the OARSI (Osteoarthritis Research Society International) Clinical Research Award for her “outstanding work in exercise as prevention and treatment of joint pain, joint injury and osteoarthritis”. This is the first time this highly competitive award was given to someone other than a medical doctor and to a Danish researcher. In addition, in 2014, she was awarded the Queen Ingrid of Denmark’s prize for outstanding arthritis research by Queen Margrethe II of Denmark, and the Danish Rheumatism Association (Gigtforeningen). Professor Roos is the author of 205 peer-reviewed publications. She has published in high impact journals such as the New England Journal of Medicine, the British Medical Journal and The Lancet. Her work has been cited in total 10952 times with 1 paper cited more than 1100 times and 23 additional papers cited more than 100 times. Her h-index is 54 (January 2018). She has supervised 21 PhD theses to completion with her students having professional backgrounds in medicine, physiotherapy, nursing and sports. Four of her PhD students have received awards and/or prestigious post-doctoral funding from the Swedish or Danish Medical Research Councils. Her success in attracting project funding is testament to the value that funders place on her research. In total, she has attained over 27 million SEK, 10 million DKK, 0.6 million AUD, 0.8 million CAD, 0.9 million USD and 4.2 million Euro as applicant or co-applicant since 2005.   Read the full transcript below: Karen Litzy:                   00:00                My name is Karen Litzy. I'm a physio therapist. I'm based in New York City and I am so happy to be on the Third World Congress of Sports Physical Therapy Facebook page interviewing Professor Ewa Roos. And we are going to talk a little bit about her background and the GLA:D program and a sneak peek at what she's going to be speaking about at the Third World Congress, which is October 3rd through the fifth in Vancouver, Canada. So Professor Roos, thank you so much for taking the time out and joining us today on this Facebook live. Ewa Roos:                     00:44                Thank you. It's very exciting to meet you Karen. Karen Litzy:                   00:47                Yes. And for all of you who are on watching, if you have questions, we can see them. So feel free to put questions in as we get a little bit more into the conversation. But before we get to the meat of what our interview is about, can you talk a little bit more about yourself? Ewa Roos:                                             Okay. So what do you want to know? Karen Litzy:                                           Well, let's talk about how long you've been a physio therapist and kind of what led you into the work that you're doing now. Ewa Roos:                     01:16                Okay. So I've been a physiotherapist since I graduated back in 1981. So that's a really long time ago. And the reason why I moved into this area was because I was very much involved in sports. I went to a sports high school and I competed on the national team in my sport, which is something called orienteering when you're running in the forest with the use of a map and a compass. And I got an obvious injury and suddenly I couldn't run as much as I wanted to run. And I visited a number of sports medicine doctors and they actually can’t tell me either and that built up some frustration and eventually actually have surgery for these overuse injuries. That was not very smart either. So that really sparked my interest and then my career. And then getting a degree in physical therapy was the fastest way of getting to work with what I wanted to work with Sports medicine. Karen Litzy:                   02:21                And what took you from that, from getting your degree to where you are now? Professor, researcher. Ewa Roos:                     02:28                When I think back I realized that I had aspirations of becoming a researcher already as a kid. I published my first paper back in the 80s. But it didn't really take off until I found a very good supervisor in the mid nineties and that's good advice, I think. Find yourself a good supervisor. Karen Litzy:                   02:57                And so you’ve been conducting research in that since the 80s. And can you tell everyone where you currently are working? Ewa Roos:                     03:05                So I'm working at University of Southern Denmark. Karen Litzy:                   03:09                And that takes me into the GLA:D program. So before we start talking more about it, can you let the listeners know what does GLA:D stand for? Ewa Roos:                     03:22                So GLA:D stands for good life with osteoarthritis in Denmark. Karen Litzy:                   03:26                And when did this program start? Ewa Roos:                     03:30                So I think I would like to start by saying that while I am a researcher, GLA:D is not really a research because GLA:D came out of the frustration I felt knowing about all the evidence that was out there and sitting on clinical guideline committees in Sweden, Norway, Denmark, China and globally. And we could see that all guideline committees, they're recommended patient education, exercise and weight loss if you were overweight as first line treatment for osteoarthritis. And there were lots of money spent on these clinical guidelines, but nothing changed in clinical practice because of these guidelines. So GLA:D actually came out of pure frustration and we realized that something needs to be done to help clinicians implement these clinical guidelines into their practice. That was the beginning of the GLA:D program and that was in 2013. Karen Litzy:                   04:41                Okay, so it's yourself, Soren Skou. Yes, I pronounced that correctly. Ewa Roos:                     04:48                Soren Skou was my PhD student at that time. And Soren is a very young, smart, energetic young man and the combination of the two of us was really good to make things happen. Karen Litzy:                   05:05                Okay. So before we get into, and we'll talk about some of the discussions on social media regarding the GLA:D program in a little bit, but before we get into that, can you talk a little bit more about what is involved in the program and how it works? Ewa Roos:                     05:23                Okay, so the whole aim is really to improve quality of care for patients with osteoarthritis and to do so we use three components. The first is that we educate clinicians in Denmark, it's mostly physiotherapist. It could basically also be other clinicians who have the sufficient background and knowledge about osteoarthritis and knowledge about exercise as treatment. So we have a two day course to educate about osteoarthritis and about delivery of exercises. That's the first component. The second component is then what these clinicians deliver in the clinical practice. So that is patient education and exercise therapy, which is group based and supervised by a clinician built on evidence. And the third very important component is that we evaluate the outcomes with an electronic registry. But I would again like to point out that this is not per se a research project because this is uncontrolled and this is real life. This is what happens across a nation. Karen Litzy:                   06:46                I think it's important to note that this is not like a randomized controlled trial, you’re collecting the data that you are finding from clinicians, from actual patients sort of in the trenches so to speak. Ewa Roos:                     06:59                Yes. So if you run most controlled trial, everything is very much controlled. That's not the case when you do it in real life clinical practice, but GLA:D it's a minimum, it's a core package of patient education and a 12 exercise sessions. But as a clinician you're always the one who determine what your specific patient need. So you have to deliver the patient education and you have to deliver the exercise, but you are absolutely free to add whatever you think your patient may need. They may need manual therapy to improve the range of motion of the joint or something else. That is absolutely fine. You can also send them to a dietician if you think that would be beneficial for them, et cetera. Karen Litzy:                   07:53                And so sorry for that. We may hear horns and sirens because I'm in New York City, so I apologize everyone. So as far as the program is concerned, so it's not like a clinical practice guideline but rather a full program. So I guess my question is if clinical practice GLA:D guidelines weren't being followed, how do we know that the program is going to be something that's sustainable and followed? Do you know what I mean? Like if therapists were like I'm not following these clinical practice guidelines. Ewa Roos:                     08:31                So, I’m not really sure I understand your question. But, so I think that's probably why to be able to answer that or respond to that question I would say that it's basically that we can see that clinicians want to take the courses and we can see that they actually register patients in the registry and we can evaluate the outcome. And that's a very good way of measuring the quality of what's being delivered. We can see how many sessions they have attended, for example, and things like that. Karen Litzy:                   09:06                Yeah, yeah, exactly. So if I'm a clinician, so if I'm looking at it from the clinician standpoint, for me, it gives me some accountability. Right? So it's like, of course we're always accountable to our patients and should be to ourselves. But it's always good to know that you're being held accountable and being held to a certain standard for your patient in order to kind of be part of the program, if you will. And I think that's important because otherwise, I mean, human beings, right? We get lazy and we're not following things as best as we should. So I think that's an important component of the program. Ewa Roos:                     09:55                I would say that the longer we go on, the greater is the part that has to do with quality assurance. Karen Litzy:                   10:03                Absolutely. Yeah. And so, you know, let's get into some of these discussions on social media now that we have a better idea of what the program is, so some of the discussions are regarding whether the GLA:D program is superior to performing other forms of exercise. But what are your thoughts on this? Ewa Roos:                     10:24                Yeah. Okay. So when you do a research study, the primary outcome can be pain relief. And if you look at randomized control trials and if you look at the effect that you find from different exercise program, there are no studies showing that one type of exercise is superior to another program when it comes to pain relief. So when the neuro muscular exercise program that we used in GLA:D is being compared to other exercise program, we can say it's similarly effective, but it's not more effective than other exercise programs. But what is interesting is that we can see that when we deliver it in clinical practice, one of the thing is that we're able to teach it to physiotherapists with very different backgrounds. You know, we have taught more than thousand physiotherapists in Denmark and some of them are real musculoskeletal experts, but some are not. Ewa Roos:                     11:28                And just being able to teach a program to clinicians with very varying background that is in itself, something that requires a good framework for the program. I think. So that is one aspect and then we can see that we're actually able to have about 25% pain relief directly after program. So we can kind of duplicate the findings that we have in randomized controlled trials. But what I think is even more important is that we can maintain that improvement at one year. And that is something that we don't always see in randomized controlled trials actually. So in some regards it looks like we're doing better than in the randomized controlled trials. And this is not a research project. So I can't tell you why I can just say that the clinical findings are really good and encouraging because it looks like there must be some kind of a better understanding of the disease from the patient's perspective. And there are some indications that there are some lifestyle changes. One third for example, report that they have increased their physical activity level. We can see that one out of three stop taking painkillers and we can see that there is a lot less sick leave, especially among the knee OA patients at one year. Karen Litzy:                   12:58                And do you feel that, at least in Denmark, I'm assuming if a thousand therapists have gotten through this, this is a pretty recognized program in the country. So do you feel like patients have more buy in so to speak because it is a recognized program? Ewa Roos:                     13:17                That's a very interesting question. And my feeling is that there was more buy in from patients, from clinicians and from those referring to the program that is general practitioners and orthopedic surgeons. What the general practitioners tell me is that they really like to refer to program where they know the content of what is being delivered. They don't really like to refer to a physical therapy as a black box treatment that they don't really know what is going to be delivered. And I guess to some extent they may be right because there has been delivered passive treatments for which there is really no evidence in these patients. Karen Litzy:                   14:07                And the other thing that I find interesting about the program is that it's in a group setting. So you have a lot of people together in one group and I also wonder does that also foster, first of all, it's a nice sense of community, you have a support group. Again, accountability on the patients. If it makes them more accountable, they’re doing their exercises, right? And they've got the support. Ewa Roos:                     14:36                Yeah. You can see that when you go and audit the clinics that you can kind of see the interplay between the patients. And there was some kind of positive peer pressure, you know. And for example, we do some exercises on the floor very deliberately and there may be older patients who come in and say, I cannot get down on the floor because I haven't been on the floor for the last 10 years. You know? And the physio can say, well that's fine, you don't have to, you know. But after a few sessions, that person will be on the floor, not with the help of the physio, but inspired by the other patients and as some kind of side effect, you know, they're also learn how to get up with the help of a chair and they get less fear of falling because they know they can get up again. Karen Litzy:                   15:22                Right. And I look at that as such a positive for the program, but also for the patient, the individual patient, because then they're more likely to do the exercises. I’m sure part of it is they're doing exercises on their own. I would assume it's not just twice a week or however many times a week you're coming into the program. Ewa Roos:                     15:44                So what we told them actually is that this is twice a week. And we do not require them to do anything at home if they want to, sure they can do it. But there is no requirement of home exercises. And I think that makes it maybe, but this is pure speculation, a better experience because you feel sure if you're more secure about what you do, you have someone to hold your hand because it's painful to start exercising when you have osteoarthritis and you ask your body to do things you haven't done for a long time. And many people get anxious if they should exercise at home and they also feel bad conscience if they don't do it. So actually I think it seems to be a better experience to tell people do this twice a week. We know it will be better if I did it three times a week. But we also know that for most people it's not possible to squeeze that into their daily life. So it's a very pragmatic decision to say twice a week because that is what most people can do. It's not the best, but it is pragmatic. Karen Litzy:                   16:55                And do you find that your class attendance is always very high? Meaning are there a lot of dropouts? Ewa Roos:                     17:04                Yeah. So if we look at the last annual report that I have access to was from 2017 we are about cleaning of the data for 2018 but that was nearly about 30,000 patients. And we can see that eight out of 10 patients have completed at least 10 supervised sessions. That is very good, I think. Karen Litzy:                   17:27                Very good. Yeah. Because you know, people always say exercises are great, but if you’re not going to do it it’s not going to make any bit of a change. Now is there anything else about the GLA:D program that you'd like to talk about and let everyone know about before we talked more about what you're going to be speaking about at the conference? Ewa Roos:                     17:53                So I think it's important to say that the GLA:D program would not be the success it is if it didn't have the buy in from the clinicians and that the clinicians wouldn't feel that it really supports their clinical practice. And because it's the clinicians who take ownership of the program and it's them who kind of market it in their local areas, it's them who inform the general practitioners. So GLA:D is really more of a grass root movement or bottom up initiative or whatever you would like to call it. We actually had no, or very, very little funding to get this whole thing started. We actually only had funding to set up an electronic registry. That was it. The rest was just pure frustration, hard work and wonderful support by all the clinicians who have embarked on this and they feel that it really eases their daily practice and it has also made it possible for them to attract new patients. So it's actually been a good business for them in that sense. Karen Litzy:                   19:06                Yeah, and I also liked that you mentioned earlier that if you've got a patient taking part in the GLA:D program, that it doesn't mean that you're not perhaps seeing them for one on one therapy as well. Ewa Roos:                     19:19                So GLA:D, it's a framework, you know, and there are some core things that you have to deliver, but if you would like to deliver extra things on that because you are the clinician, you're the only one that knows the patient. I think that's really, really important to stress. And I think this pragmatic approach and this flexible approach is part of the success. And that may come because we have all worked for very long in the clinic and know what it's like to be in the clinic and we know that it needs to work. So for example, if it was a research project, we also do functional tests. Like we look at walking speed and chair stands just for example. And if you did that in a research project, you would do three attempt, you know, but we don't do that. We only do one attempt because that is what you can do in clinical practice. So, we have tried to do everything in a way that we evaluate the outcome. We can check the quality, but we've done it with minimum resources on the therapist. Karen Litzy:                   20:38                And oftentimes that's what it's like when you're in a clinic. Ewa Roos:                     20:41                You need to make your ends meet during the daily work because else you won't do it. Karen Litzy:                   20:51                Exactly. Exactly. And I think it's also worth mentioning that the GLA:D program is not only in Denmark, it's also in let me see if I can remember Australia, China, Canada. Ewa Roos:                     21:07                Yes. This year in April, Switzerland will come on board. In November in New Zealand will come on board. Karen Litzy:                   21:16                Great. And the thing that I found really interesting is in China is that it's physicians who are running the program, their orthopedic surgeons, which is in your head, you think, well, that was interesting. It's competition, so to speak. But I think it's, I think that's great. And hopefully in other countries, hopefully you guys will expand in other countries in the near future as well. All right, so let's get to what you're going to be speaking about at the Third World Congress of sport physical therapy. So can you give us a little preview? Ewa Roos:                     21:55                Okay. So we haven't been talking much about research. We've been talking about implementing clinical guidelines in clinical practice. But I think I have been so fortunate that I actually grew up academic department of Orthopedics and that has put me in a position that I've had many close collaborations with orthopedic surgeons and we have across professions then been interested in surgery and exercise therapy as treatment for different kinds of problems, mostly knee problems. So, over the years I have been involved in randomized controlled trials where we have compared surgery to exercise for an acute ACL tear in the young active populations, for a meniscal tear in the middle aged population and for severe osteoarthritis in people that we have provided with nonsurgical treatment, comprehensive package and then randomized them to have a total knee replacement in addition or not. So I will talk about the outcomes of these trials and I will talk about how you as a clinician can use these results in a shared decision making with your patients. Karen Litzy:                   23:20                And I think that's so important, having that shared decision making, being honest with your patients and giving them all points of view so that they can then make the decision that’s best for them. Ewa Roos:                     23:31                Yes, because there are pros and cons with different treatment strategies and there is not one treatment strategy that fits all patients, but I think it's really good if patients can get informed so they're able to make a treatment decision that is right for them. Karen Litzy:                   23:52                Well I am definitely looking forward to that and you know, as we speak, I am seeing and a 12 year old girl who had an ACL tear with subsequent surgery, and I see a lot of ACL patients. So that is something that I always try and give, you know, all views so that they can make the best decision. And sometimes that involves being the quote unquote bad guy. Ewa Roos:                                             What do you mean by bad guy? Karen Litzy:                                           Well, not bad guy, but sometimes telling them things that they don't want to hear saying to the patient because you're trying to give them all points of view and sometimes patients don't want to see all points of view. I think oftentimes, and this has been my experience with patients is they want to hear the point of view that is going to confirm what they've already decided without hearing all the points of view Ewa Roos:                                             Confirmation bias. Karen Litzy:                                           Right. And so sometimes you have to if you want to be open and honest with your patient and give them all of the information that they can take with them to make that decision. Sometimes you have to tell them things that maybe they're not wanting to accept. Ewa Roos:                     25:15                It would be very beneficial if we could develop educational packages or educational tools for young patients as well. Just as we have for osteoarthritis patients. That will be really beneficial. But it's a hard nut to crack because when you're young, you think you're invincible and your perspective is not very long. You want things to happen here now or yesterday would have been even better. Karen Litzy:                   25:43                Well, I'm definitely looking forward to that because I'm always looking for better ways to communicate with my patients and really to be able to give them all of the information they need. So I am definitely looking forward to your talk.  And we've got a couple of comments that I'll just read. All right. I am going to not say this person's name right, but Meredith Gosh, I hope I said that correctly. She said, your work is incredible. Your work is incredible. You truly make the world a better place. So proud to know you. Hope to see you soon. Karen Litzy:                   26:47                And then another one from Jay F Esqulare who is part of the world Congress, said you're a pioneer in the world of physio therapy, knee injuries, osteoarthritis and rehab programs such as GLA:D, so amazing to have you at SPC 2019. So, hopefully, everyone who is listening will now be a little bit more curious. Will want to come to Vancouver to listen to your great talk. So again, it's Vancouver October 3rd through the fifth of this year, 2019 in Vancouver. All the information is right here on the Facebook page. So you can go and click on the link on the Facebook page and we'll even put it underneath this video. And if it's okay with Professor Roos, we can also maybe put some links to the GLA:D program as well. Ewa Roos:                     27:50                You can link to GLA:D Canada and GLA:D Australia and you will find information in English. That might also be a good thing. Karen Litzy:                   27:57                Awesome. Yeah, that would probably be great, we're going to be in Canada even better. So in English. Ewa Roos:                     28:03                If you link to GLA:D Switzerland, you will also get information in French, German, and Italian. Karen Litzy:                   28:10                Awesome. So we've got a lot of languages covered there which is wonderful. So Professor Roos thank you so much for taking the time out of your day today and coming on, and I look forward to seeing you in Vancouver in a couple of months. Ewa Roos:                     28:24                Nice talking to you Karen. Karen Litzy:                   28:27                Thanks so much. Bye everybody. Thanks so much for coming on and we'll see you in a couple of weeks with another interview.   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 Robin Meyers on the show to discuss fear.  Robin Joy Meyers is an international speaker, fear strategist, molecular geneticist and radio show host.  She educates and empowers women who are thought leaders, executives and entrepreneurs. Robin specializes in implementing strategies to harness the positive power of fear to their advantage through executive coaching, workshops, and speaking engagements. In this episode, we discuss: -The science behind the fear response -Why self-awareness is key to harnessing the power of fear -Recognizing the positive and negative side of fear -How Robin transitioned her career throughout different periods in her life -And so much more!   Resources: Robin Meyers Website Robin Meyers Instagram Robin Meyers Twitter Robin Meyers Facebook Robin Meyers LinkedIn   For more information on Robin: Robin Joy Meyers is an international speaker, fear strategist and molecular geneticist. She founded Navigate2Empower to educate and empower women who are thought leaders, executives and entrepreneurs, on how to harness the positive power of fear to their advantage.  Robin specializes in implementing strategies for self-awareness, mindset and leadership through executive coaching, workshops, and speaking engagements. As a molecular geneticist, Robin discovered the TUB36 gene, a gene that affects the wing formation of fruit flies. She is also the host of the popular radio show, Activate Bold Choices, and is best-selling author of “Alone but Not Lonely” and “The Art of Unlearning.”    Read the full transcript below: Karen Litzy:                   00:01                Hey Robin, welcome to the podcast. I am happy to have you on. All right, so we've got a lot to talk about here. Just given your bio, we've got a lot to dive into. So the first thing I am so curious about is what is a molecular geneticist and how did you get into that field? Robin Meyers:                                      Yeah, I have an eclectic background. I know I got into molecular genetics actually really because I didn't get into med school. I thought I was going to go to med school and I didn't get accepted in the states. And of course my parents were like, you're not going out of the country. I was like, okay. Although now looking back could have been fun. So I went to, I got accepted into Case Western reserve in Cleveland, Ohio and sounded like a great program. So I went and became a molecular geneticist down the road. Karen Litzy:                                           And what does a molecular geneticists do exactly? Robin Meyers:                                      You spend quite a lot of time in the lab. I actually was in a lab working with fruit flies. So in a lab with a lot of fruit flies, killed many of them a lot on research. So I was on research specifically looking for genes that had to do with flight. Robin Meyers:              01:34                So lots of DNA work and I'm not talking about, I'm talking old school, so now I'm going to date myself. Old school, 1986 to 89 where you know, the DNA plates were big glass plates that had to be poured. That was the hardest part I think. Karen Litzy:                                           I mean it's pretty amazing because now you know, we hear a lot in the news about women in stem, science, technology, education, medicine. So we hear a lot about women in stem and how the push is to get more women involved in these professions. So you were involved in this profession in a time where I have to think there weren't a lot of women there. Robin Meyers:                                      Well interestingly enough, I never really put that together until recently in my life that maybe I was a pioneer. I don't know. Robin Meyers:              02:34                I was too shy and quiet then to even think about that. But, it's true. There really weren't, and it was really on the forefront because when I graduated it was just the beginning of the human genome project and all of the human genetics. You know, my first job was with the French Anderson Group who was part of that genome project. And one of my companies that I started working for was the first DNA purification columns, like the disposable kind. And it really was on the forefront. So kinda cool. Karen Litzy:                                           No, I think it's amazing. I think that this is the coolest thing. And, and when I was reading through your bio, I feel like, so just for context, Robin and I have known each other for well over a year now, right? Maybe year and a half, two years, I'm not quite sure. But I remember reading her bio thinking, well, I didn't know any of this. Karen Litzy:                   03:28                I didn’t know you discovered a gene. I did not know any of this. And I just think it's like so cool that here you were and I will say a pioneer in the fields of stem. And I just wanted to highlight that for people so that, you know, they know that you’re coming from this sort of, I would think analytical data driven background. Robin Meyers:                                      I really am actually, you know, and it's funny how for me as I developed, I always thought of my science and my master's degree was kind of just a stepping stone into whatever that next step was of my life. But dots do connect, you know, and when you start to own it, you do see these patterns. I did, I discovered a gene. And it's funny, it wasn't until recently, even in the salon when it was like you did what? Robin Meyers:              04:25                And the ironic part is the gene, it's still called TUB36 because it's on the chromosome region of 36 in fruit flies has to deal with the wing formation, for fight or flight for flying like dystrophy and working with fear and that whole concept, it's like, it's just kind of weird and ironic and exciting and just interesting. Karen Litzy:                                           Yeah, it's really interesting. And so let's get into now this other part of your life and your career, which is a fear strategist. So the same question as what is the molecular geneticist I have for what the heck is a fear of strategist. Robin Meyers:                                      So I've taken over owning fear strategy because, you know, I became a coach, you know, after I left my graduate degree and became a wife and a mother and went through that phase of my life, and other jobs, I really started to figure out who I was and finding my own voice and dealing with my own fears and things like that. Robin Meyers:              05:38                And so I worked with women giving themselves permission to look outside the box and working in transitions really. And so I've been every kind of transitional kind of coach to life strategists. And when it comes down to it, as I've owned the molecular genetic side and the science of fear, I was like, I'm a fear strategist. Like really what it is, is being able to understand that fear is real. And I think that's really where my message is right now. Like, if I can get the world to understand the science of fear, that it's not just this thing that should stop us in our tracks. Yes, it's limiting beliefs, but we can work through that. And I think when people hear the science of it and realize that it does work to our advantage, it creates a whole different conversation in this world. Robin Meyers:              06:35                So it makes people stop and say, what is that? Instead of like, you're just another coach. But there is the science. So it kind of for me kind of stirs up the science and to be able to say, let me tell you, let me explain my science background to you. Karen Litzy:                                           Yeah. So let's talk about the science of fear. So what is it about fear? What happens with them? I'm assuming that's what happens within our bodies, when we have that feeling of fear. So could you tell the listeners a little bit more, give us a background on what is the science. Robin Meyers:                                      Okay. So it's totally fascinating. So the science is, you know, our brains so anyone in science will understand this, that you know, our brain is the most complicated organ in our body. Our emotions basically are lit up from different regions of our brains working together in combination and lighting up and igniting. The fear response is in combination of five areas that light up. Robin Meyers:              07:41                And that's the amygdala, the sensory cortex, the Thalamus, the hypothalamus and hippocampus, all those areas. When a fear response comes they have to work together to produce that next step for the fear. Now the interesting thing is as all of that coordinates together, the Amygdala, which is like the size of a cashew, not only decodes your emotions, but it stores the imprint of every fear of every response from pre verbal stages throughout your entire life. Like every single thing, if you think of it like a tattoo, like you keep getting a tattoo with every single thing every fall, every emotion, every emotion associated with fear is another tattoo. And I don't think people actually realize, it's almost like if you could kind of tell me all about your life and actions that have happened. And I could sit there with a stamp, an ink pad, and just stamp a piece of paper and like you could physically see how many imprints you have. Robin Meyers:              08:53                It's fascinating because not only do imprints start storing prior to you even realizing it, and that's more so because our parents impose their imprints of fear on us, but every little thing for the good and the bed. So there's a whole pattern of evolution that happens. Karen Litzy:                                           First of all, I love the metaphor of the tattoo imprinting in the Amygdala. I love that. I'm going to start using that with patients who have chronic and persisting pain. I love it. Thank you. And it takes me back to, you know, as you know, Robin, I have a long history with chronic pain and a lot of that was centered. What kind of made the pain worse or prolonged would be fear avoidance behaviors. So I can't do that. It's going to hurt my neck. I don't want to do that it's going to hurt my neck. Karen Litzy:                   09:55                I can't sleep. It's going to hurt my neck. So now I look back and think of that day when that pain first happened, I woke up and couldn't get out of bed. So much pain. And the thing that I guess I didn't connect until right now was how fearful I was. How fearful I was laying in bed not being able to move. So can you imagine the size of that Tattoo in my amygdala? Robin Meyers:                                      Yeah, exactly. Exactly. So the idea is to take it one step further is to realize what those imprints are and remove the ones that aren't serving you. And you know, that's easier said than done. It's not easy. No, no, no. I'm not saying any of this is easy, but there's some that have been imposed that you really can't put your finger on it. Robin Meyers:              10:52                Right? And then there's some that you've had an accident or something that you can put your finger on it, but it's not serving you. And then there's some deeper wounds that you really have to work through. But if you can start removing the ones that totally aren't serving you and actually work through it so it makes you the more you've worked through it. What I find with my clients, with myself, just people I deal with, it makes you live much more presently and actively and it takes courage. I always say it’s actively moving through the action with the conscious courageous presence because you have to be present and it is, it takes a lot of courage, no doubt. Karen Litzy:                                           And how do you start working through some of these things? Like can you give the listeners, I don't know, one or two tips or exercises that they might be able to start doing today if they realize they have a fear that might be holding them back. Robin Meyers:              11:54                So the biggest thing really is self awareness. It's really taking the time for you to understand who are you and just you forget kind of the noise of what your responsibilities are. If you've got, you know, spouse, dog, kids, whatever stage of life you're in and everyone has a different stage. So, and just to tell your listeners I had three kids and now 22, 24, 27. So I've been through a lot. Trust me. So I get it all. But whatever stage you're at, I only say build in five minutes every morning just to be in your own thoughts. And ask yourself, what do you need? You know, it really does come down to self awareness and saying, these are my non negotiables for me only for me. And you're going to find that you become very aware of people that work in your life, things that work in your life, conversations and what's acceptable. Robin Meyers:              12:57                Once you start doing that, you're able to kind of start peeling away and going after things that have held you back. You know, the other side of this conversation is that our brain, as brilliant as it is and everyone's brain is, is great at keeping us in the patterns that it's been given. So a lot of that is reprogramming and there's ways to actually get into your subconscious and reprogram. But it is reprogramming. So it's baby steps and sometimes it's two steps forward and three steps back. And it's being very gentle with yourself and not beating yourself up and saying, okay, tomorrow's another day, but it's just breaking into a new pattern. Karen Litzy:                                           And those patterns I agree in the brain can be so deeply set, deeply set from childhood into adolescence, into adulthood. Like you said, whenever a stage in life that you're in. Karen Litzy:                   14:01                And you know, again, I go back to this population of people with pain, which is a huge population across the world. It's a $1 billion industry and that's just back pain, forget about every other kind of pain. So I think being able to work with someone to maybe tap into some of these patterns that we have developed, I think can really help people perhaps make sense of some of their pain, help overcome some aspects of that pain. I can say anecdotally from myself, so an n of one that being able to do that for myself was really helpful, I felt was for me the next step that needed to happen. Robin Meyers:                                      I totally agree with you. It's sometimes like those patterns of talking yourself like, but if I get out of bed I might hurt. But if you don't get out of bed and you don't try, will you hurt? What is that risk? Karen Litzy:                   15:13                Looking at the risk reward there. Right, right. Robin Meyers:                                      I'll go back to a story if you don't mind. When I was 11, I think I was 11 I used to ride horses. I don't even know if I was good at it, but I used to ride horses. I had a really bad accident and I broke my back in three places. I ended up being fine. Actually it ended up being a blessing in disguise because I had a horrible scoliosis that they discovered. But I was in a back brace and possible surgeries and you know, initially it was like, is she going to walk? And things like that. It was a nine month recovery, but, and I was 11, so I think it, as much as it affected me, my parents really obviously dealt with it. Robin Meyers:              16:01                Fast forward to my daughter being 10 years old and we lived in the countryside of outside of DC in Virginia where horses are Galore. She wanted to ride horses. I actually didn't think twice about it. It was a local farm. It was around the corner. I would take her, I would watch got her all the safety equipment. My father happened to call me, my mom had already died and my father had called me and didn't call me often. And instead of like, hi, how are you today? He just ripped into me. He just, you know, his, the first thing out of his mouth was, I'm so disappointed. Are you stupid? And I was like, oh well those are triggers to my childhood. Hello father. But when I sat, now when I process it, I understand in a way where he was coming from and I said, she's fine. Robin Meyers:              16:53                I had an accident and I understand your thoughts. So for me, I honestly had to make a conscious decision to say, I could have easily said, you're not going to ride because I had this accident and I'm afraid for you versus processing. Listen, it was an accident. Logically it was an accident. I'm going to be there. We have all the possible safety stuff. Is there a possibility of an accident? Yes. Is there the probability? I don't know, but why am I going to not let you try something because of what happened to me. So that's an easy imprint to get rid of. Right. But it's just an example of making a real conscious choice to say, I'm going to cut that cord right there and not let that pass on. Because if I let it pass on, then she at some stage in her life would either say, I've always wanted to do this and I'm going to try it, or I'm never going to try it, but I wanted to do this. Karen Litzy:                   17:57                Yeah. And you are able to kind of change that imprint. You cut that fear, but your father couldn't. Robin Meyers:                                      No, he couldn't. He was furious. Oh, he was so mad. And that's coming probably for him of a place of fear. Karen Litzy:                                           Right. I'm sure when that accident happened to you, your parents must have been beyond scared. Robin Meyers:                                      I'm sure. I'm sure. And for them, you know, they obviously had to drive to every doctor's appointment and all of that and every ounce of pain I felt probably was as bad, if not worse for them. Right. As a parent. So. Sure. So I get it. Karen Litzy:                                           Yeah. Yeah, I get that as well. And I think that's a really great example for the listeners of how you can start to change these imprints or tattoos that have taken hold in your brain to allow you to move forward in the PT World. Karen Litzy:                   18:55                And this is probably in more worlds than PT, but we call that graded exposure to activity. So for instance, for me, I'll give an example. I felt I couldn't carry anything because it would hurt my neck. So I carried nothing around New York City, a place where you have to walk everywhere and groceries and things. I was like, I can't carry anything. So I always get everything delivered until, until the one day. I spoke with a physical therapist from Australia, David Butler, and he said, well, why don't you just go to the grocery store and put like, I don't know, a loaf of bread and a bag of snacks in it would be so light and just carry it home and see what happens. Right. And so that's what I did and I got home. I was like, okay, that felt pretty good. Karen Litzy:                   19:49                And then each time I went I would add one or two more things to the bag. So gradually exposing myself to the activity that I was fearful of doing. Until now I can carry, I'm like a pack mule, you know, running around New York City. But if he had not encouraged me and helped me to see that I was doing a disservice to myself through fear, I don't know where I would be today. And I'm assuming that's what the kind of work that you do with your clients is helping them to see the fears that are holding them back. Robin Meyers:                                      Right, absolutely. So I try and work with everyone to see, to acknowledge what it is. And you have to acknowledge it, right? I mean it's something, but once you peel back that layer of it, is it logical or illogical? Robin Meyers:              20:46                Did something happen or did something not happen? And then what is the origin of it? And, with the groceries, how do you start working through it? Because when you become more present and you start learning about you and like using you as an example, right? You learned that you are stronger than you thought, it didn't hurt and now instead of holding yourself back. So you did move through it and you actively were aware of your surroundings and how you felt. There's actually a genetic disorder called Urbach-Wiethe disease, and it's a mutation where people cannot feel fear. It's very rare. It's like 400 people in the world or something and its parts. It's not just in the Amygdala, it's parts of certain regions of that combination of the brain. I don't know the other regions, but like that harden and kind of waste away. Robin Meyers:              21:50                But now that wouldn't work to your advantage. Right. I mean you want to have that element of awareness and I think that's what fear needs to be looked at like a positive awareness of listening to yourself. Karen Litzy:                                           Yeah. And I think oftentimes when you're coming from a place of fear, you're in it so to speak, it's really hard to acknowledge that because do people feel like acknowledging that is acknowledging a weakness that they might have? Robin Meyers:                                      Exactly. And that's where the conversation needs to shift. Because I think when people realize that the science of fear exists, like the diagnosis is, it's not if you have it or not. Everybody has fear. Right. So if we want to talk like, you know, as practitioners, the diagnosis is you have it.  The prescription is you have a choice on how you react to it. Karen Litzy:                                           Yeah, for sure. You definitely have it. We all have fear and how that fear manifests itself. Now in the beginning you said it could be good or bad. So how could fear be good? Cause I think we always associate with fear being bad. Robin Meyers:                                      Right? And that's what has to change. That's the conversation that needs to shift because I think there's an element of fear that's good. I really do. I think it needs to work to your advantage. You know, I honestly think that it makes you stop and think. Robin Meyers:              23:29                Now again, there's different levels of people's fears, right? So I don't think in an half hour or an hour we're going to be able to like solve the world's problems. It's good because it makes you actively move through the action of fear. So if you can take that imprint in that tattoo and look at it and say, answer the question, what is it? Identify what is it? Why am I afraid of this? Why? Why is this going to hold me back logically? Why is this going to hold me back. Karen Litzy:                                           Logically? See but that's the hard part. When you have fear, it's hard to get that logic, right? Robin Meyers:                                      And that's the whole part though of almost, you have to reverse the brain, your brain function and trick your own brain because your brain is going to keep you set in that fear based negative side. But we need to do is switch that whole paradigm to the positive side. Robin Meyers:              24:36                So I was at a course for a workshop that I did and I was one of the facilitators and the last part was this trapeze for some reason I don't like heights, I've never fallen, but just not my thing. Like I'm not going to jump out of an airplane anytime that like it's not enjoyable for me. I don't ever see doing that. But this trapeze, and this was like a pretty rustic course by the way, climb up this 40 foot tree that had the little pegs in it. Yeah, turn around on a very small perch and jump, you know, like four feet out to catch the trapeze bar. I sat there for a while looking at it as most of the people were going and I'm like, I think I'm good for the day. And then I'm like, you really got to go do it. Like why not now? You're totally harnessed in right. So logically I'm harnessed. There's no reason why I shouldn't, my body on the other hand is like, I'm shaking like a leaf. I know I can't get hurt. Robin Meyers:              25:42                Just do it. Like you have to trust yourself to just go do it. I ended up climbing up this tree. Of course when you get up to the top of the perch, I was turned around and hugging the tree. Yeah, I could see that. Yeah. Yeah. And like the guy below is like, okay, turn around. And I was like, yeah, give me a second. I'll be there in a moment and you know, go to the edge. Then they're like, just jump. And I was like, Eh, okay. You know, and you'd have to pause. But again, it's that logic and your brain playing games with you. But again, I'm standing in a harness where I know I'm not going to do a face plant onto the ground. So I took a deep breath, right. And eventually walk to the edge and put my arms in front. Robin Meyers:              26:31                I actually caught the trapeze. Thank God that would have been embarrassing. But I trusted myself, you know, again, will I ever jump out of a plane. No. Cause that's not enjoyable to me. Karen Litzy:                                           Like there are limits to where you can push yourself. And if it's not like Marie Kondo says, if it's not going to bring you joy, then you don’t have to do it right. Robin Meyers:                                      But, I did it and it was a point, it was more proving to my own self that I could take that leap of trust. So that's where I think it's really getting in tune and in touch with yourself that you can understand fear working for you and not against you and really using it to move you forward in life. You know, I remember when I first started coaching, one of my first instructors said, when you're excited about something and you're fearful of something, like that's a great combination. And I've always really, it's always proven true to me and I've always believed it. Because it's kind of like not proceed with caution. It's just be aware. It's just that self awareness, you know, listen to yourself, trust yourself. But go for it. Karen Litzy:                                           And I think that's great advice. Listen, trust and go for it. Yeah. I mean, why not? Because what's the worst that can happen? You fail. Karen Litzy:                   28:07                And that's okay too. Right? Okay. I failed plenty of times. Oh my goodness. If you never failed in life, what have you been doing with yourself? Right. So I totally get that. And now, so you went from, like I said, molecular geneticist to fear strategist, coach. How did you make that transition? I think this is a great question because there are a lot of people who work in healthcare, very science based who are like, hmm, maybe I'm ready to make that leap, but I just have no idea what to do. Robin Meyers:                                      It's a great question. So my transition took many years and let me cut it short for everybody else in the world. So obviously I was younger and did my molecular genetics training and jobs, and then I took a stint of time to raise a family and then I went back into the workforce smaller jobs. Robin Meyers:              29:18                I always taught. I ended up finding, I taught biology and stuff like that. So I kept my science going. I'm not into research in my later years, but I kept it going and then realized that I never really gave myself permission to be me and to use my voice and my strengths. And so that's when I started to kind of look towards the coaching program. And especially working with professionals and women professionals. I think overall, but all professionals allowing themselves to think outside the box. And in saying that, you know, and this comes down to the whole fear thing, we're always told that you know, you're either left sided, your brains left side or right side, right, were dominant in one side or the other. So I really don't believe that. I feel like when you give yourself permission to really learn who you are, there's a great synergy that can happen and you can combine both sides of your brain and that's when you really start listening to yourself. Robin Meyers:              30:29                So, even if you're in a science based world or something, you know, for me, my greatest strength right now is really connecting the dots back into the molecular genetics of fear and being able to bring a whole different angle and discussion and awareness, that I would not be able to. And I don't think many people can have the discussion that I'm having with it cause they just don't have that. So I think it's great to be able to combine your sciences and whatever creative side that you want to. Karen Litzy:                                           Yeah. So don't throw away the science part, use it, use it to your advantage, use everything you've learned to help others. Robin Meyers:                                      Absolutely. There are ways to connect the dots. And I mean, like you and I, you were saying, you know what, we've known each other a couple years and it wasn't until recently that I either admitted it or if you guys found out that I was a gene finder. Karen Litzy:                                           Now knowing that it makes so much more sense for what you do now. Karen Litzy:                   31:47                Now I'm like, oh, now I, yes, this makes perfect sense. It just comes back full circle as to that. I think the natural progression for you in your career and you know what was next for you. To me it all makes sense. Robin Meyers:                                      Yeah, it makes sense to me now too. It really is coming full circle. And I was actually just having a conversation. Someone's like, you know, you're kind of been in this business for several years now. And I'm like, actually I feel like I'm new. I almost feel like I've started over again just because I finally allowed myself to Mesh the worlds together. And that's what I would say is, you know, you don't have to stay science in the left brain and whatever the creative is the other side, you can mesh it and at whatever stage of life you're at, you know, if there's something that really excites you in that other world, find the time. Robin Meyers:              32:44                And even if it's once a month or once a week, you know, find something in that other element that you want to explore it. Karen Litzy:                                           Yeah, absolutely. Great Advice. And, now that takes me to the last question that I ask everyone, but I feel like you might've just answered it, but I'm going to ask it anyway. Knowing where you are now in your life and in your career, what advice would you give yourself as a new Grad, as the molecular geneticist fresh out of college and Grad School? Robin Meyers:                                      Well I was very much an introvert, so maybe be a little more outspoken. But to allow things to happen and not think that it had to be one way only. I walked that line, like if it wasn't going to be something, just molecular genetics, then I had to leave the field. Robin Meyers:              33:43                You know what I mean? And I think if I knew what I know now, although again, it all works full circle, I would have realized like you can think outside the box and I think that's what makes us all unique and you know, whatever your background is, you're bringing a very special element to the conversation. So think outside the box. And that's where I would have said to myself, you know, don't stop being creative just because you're taking one path. Karen Litzy:                                           And, I think that's great advice for anyone, but especially for women in the stem profession. I think that's really great advice. And now where can people find more about you? And if they have any questions where are you? Robin Meyers:                                      The best way to find me is just to go to my website, which is www.robinjoymeyers.com. And from there you can get on my calendar. Robin Meyers:              34:43                I'm always happy to set up a discovery call with anybody if you want to have just a chat for 40 minutes and you have questions, things about what I'm doing and where I'm traveling and busy speaking with the fearless women's summit right now, all over the US.  And I'm taking a group only of 10 women to Italy in October for a retreat of giving yourself permission to be you. So yeah, just go to my website because that's the easiest way to find me. Karen Litzy:                                           Awesome. Well, that sounds pretty amazing and thank you so much for coming on and sharing all of this information on fear with myself and with the listeners, and I can tell you, I said I'm totally using that tattoo thing. I think that's brilliant. So thanks for that. I'll give you credit for sure. I will credit you for that. Thank you so much for coming on. I appreciate it. Robin Meyers:                                      Thanks, Karen. It's been a blast. Thank you. Karen Litzy:                                           And everyone out there. 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. Mark Merolli, Ann Green and Professor Catherine Dean. In this episode we discuss our upcoming focused symposium at the World Confederation for Physical Therapy Congress in Geneva Switzerland on Sunday May 12th at 4:00 PM. The title of our symposium is Education: Technology and Informatics.   In this episode, we discuss: - The why behind our focused symposium. - Current global entry standards for physiotherapy in relation to digital health technology and informatics. - How technology affects the world of physiotherapy and are we preparing new graduates to meet those demands - A sneak peek into the specifics of our talk. - What we hope the symposium and discussions in Geneva will lead to. _ And much more!   Resources:   WCPT Congress 2019 Professor Catherine Dean Twitter Ann Green Twitter Dr. Mark Merolli Twitter     For more information on Mark Meroli:   Dr. Merolli is Physiotherapist (musculoskeletal) and Certified Health Informatician. For many years now, he has been a leading voice on all matters technology in physiotherapy. He has global reputation for his expertise in digital health and informatics, which has led to his involvement and consultation on this area across several WCPT and member organization events and initiatives. He has presented on digital health at several recent APA, and WCPT conferences, run workshops, written articles for member magazines, and been interviewed on podcasts to discuss these areas. His research interests include how technology is engaging patients to be more active participants in their own health management and how we can ensure the digital preparedness of future health professionals.   For more information on Ann Green:   Ann Green MSc, FCSP, FHEA is Head of Life Sciences at Coventry University. Ann is a Fellow of the Chartered Society of Physiotherapy, awarded for her contribution to education, research and policy. Throughout her career Ann has worked in higher education and has developed physiotherapy programmes in the UK and internationally. She has been active within professional accreditation, physiotherapy educational policy and worked for the UK health regulator, the HCPC, in programme approval and international registration. Ann’s research outputs span 20 years with her earliest publication about admission and progression trends in undergraduate programmes and her recent publications relating to postgraduate physiotherapy education and the development of the individual, the profession and careers. She has been invited to speak internationally on advancing physiotherapy practice. Her current research with an international team, is on social media and its role in global physiotherapy professional networks. Ann is one of the co-founders of the Big Physio Survey, an open access resource which enables physiotherapists from across the world, to share case studies online, which forms a global repository to showcase our rich and diverse profession.   For more information on Catherine Dean:   Professor Catherine Dean is a physiotherapist with a full-time academic appointment with teaching research and administrative responsibilities. In 2011 Professor Dean moved to Macquarie University in a key appointment for the University’s expansion in health and medicine. She was appointed the inaugural Head of the Department of Health Professions and has established NSW’s first professional entry Doctor of Physiotherapy (DPT) degree.  The Macquarie DPT includes advanced physiotherapy skills, business management, leadership, policy and advocacy units as well as completion of a research project.  In 2014, she received the Executive Dean’s Service Award for engaging students and the community in establishing the Discipline of Physiotherapy and in 2015 led the DPT teaching team which was awarded the Faculty of Medicine and Health Sciences excellence in teaching award.  In 2017, she was appointed Deputy Dean of The Faculty of Medicine and Health Sciences. Prior to her Macquarie University appointment, Professor Dean worked as an academic with teaching, administrative and research responsibilities at the University of Sydney for 20 years. Her research interests are developing and testing of rehabilitation strategies to increase activity and participation after stroke, translating evidence into practice and clinical education. She has published in leading journals such as Stroke, Archives of Physical Medicine and Rehabilitation and Pain. She has been awarded over $5.8 million in grants for research and education. Professor Catherine Dean’s research has changed physiotherapy practice in stroke rehabilitation. Professor Dean’s research findings have been integrated into national and international clinical practice guidelines, such as the NHMRC-approved Clinical Guidelines on the Management of Stroke and featured on the Canadian Stroke Network StrokeEngine site.     Read the full transcript below:   Karen Litzy:                   00:01                Hello everyone and welcome to the podcast. I want to welcome Mark back onto the podcast and Anne and Catherine, welcome for the first time. I'm so happy to have you all on this episode. And for all the listeners, what we're going to be talking about is our focused symposium that is going to be taking place at WCPT in Geneva May 10th through the 13th for the WCPT meeting. And our symposium is education, technology and informatics, and it is Sunday, May 12th at 4:00. So if you are going to be in Geneva, you're going to want to come to this focused symposium. Now, this all sort of started with Mark, so I'm going to throw it to you first as to so you could tell the listeners why you wanted to even put this focused symposium together. Mark Merolli:                00:58                Thanks for doing this again. And I'm actually really excited that actually got you on some part of this wider team, uh, to, to be part of this focusing posing in Geneva. And it's great to be on your podcast again. Uh, but you're right, when we last spoke on the podcast, we talked I think more broadly about just the impact that technology,  the wider discipline of informatics is having on the physio profession, future trends, disrupters, et cetera. And I think obviously for no uncertain terms that work has continued and that impact continues to grow. But one of the things that, you know, obviously, are very near physio educator for some time now. And I think working in that space of, um, health informatics, um, digital health, uh, so, you know, the intersection of technology and healthcare, I think one of the things that's been really readily apparent to me for some time now is need. Mark Merolli:                02:02                Um, and to ask ourselves the question as to where this all fits into the way we educate our future physical therapists, physiotherapists. So I thought when calls for abstracts came along and sessions for WCPT, that it would be very topical, um, for WCPT and the wider profession to embrace the idea of, you know, let, let's have a look at, at current ways we educate university students, um, in this space? Have a look at perhaps where technology features in what we teach, where it should feature, where it can feature. Um, and I was just really glad to see the WCPT thought this was equally worthy. Um, I'll debate, um, and put it up as a focus symposium for us. Uh, and the speakers on, on the symposium, the panel yourself, uh, your entrepreneurial self. Um, and, and Ann Green will have known for a very long time as a physio educator in the UK. Mark Merolli:                03:04                Um, and Catherine, uh, over here in Australia as well, who's a very innovative forward thinking educator who's one of the few people I know who's pushed to this stuff for many, many years before this was really a debate. Uh, I thought you were all pretty much perfect, um, example of people that could help push this topic and discuss it. So that was the motivation from my end. Um, I think it's one thing for you and I to talk about technology in the profession but a very different but complimentary themes to talk about how this all fits in education. Um, cause I think in no uncertain terms, we either don't do it, um, we don't know how to do it or we do it quite ad hoc for the most part. Um, so it would be really, really nice to discuss at WCPT, we're hoping to get along as many people as possible as to how we might actually go forward with this and see informatics, technology, digital healthcare starts to become a more sort of interwoven thread in the way we're trying to future proof this profession. So I'm really looking forward to doing this with all of you. So thanks for, thanks for spreading the word for us I guess. Karen Litzy:                   04:18                Yeah, and I mean I'm really looking, I've learned so much just from listening to the three of you, so I can guarantee if you're in Geneva you are going to learn a lot with this focused symposium. So, Ann let me throw it to you now and can you give us a little snippet as to what your part of this symposium is going to focus on? Ann Green:                                           Okay. Well Hello Karen. I'm really pleased to be part of this podcast and join this panel. So as Mark said, it had been an educator for a long time. I've involved with a professional body in setting curriculum guidelines. I've involved with statutory bodies. Um, and I suppose that's the obvious point when, when you saw when you forming curriculum. So it was really interesting to have a look what the UK is doing and then have conversations with, with Catherine, Mark about Australia and yourself about at the U.S. and what we all found was that there are, are a few guidelines. Ann Green:                   05:19                And so I'm really interesting to discuss with everybody in the audience. Is that a good thing? Is that a liberating or should there be more guidelines? Um, I've previously been involved with Mark and do this research around social media and it's interesting that a number of guidelines appeared from all corners once physios became very active on social media. So it would be interesting to know, um, what we can learn from that. Uh, and whether it's professions, accrediting bodies, individuals we should be guiding or letting people freely develop and uh, and see what happens. Karen Litzy:                                           And do you feel like looking at those guidelines for social media, which like you said, I think we can all agree that probably most, uh, physical therapy governing bodies of countries around the world have some sort of guidance on social media that came way after people were using. So yes. Karen Litzy:                   06:21                So it's one of those kind of, are we asking for permission or asking for forgiveness and, and I think that's where guidelines around informatics can be kind of interesting because you want to know, are we asking for permission or are we doing things like wild west? It, that's a definitely a US thing. Um, uh, is it going to be like the wild west out there as more informatics and more technology get involved in the profession where then people have to ask for forgiveness for certain breaches of let's say privacy or things like that? Ann Green:                                           Yeah, I suppose, I think what we did learn from social media and the guidelines, the teeth essentially came round to good professional behavior. Um, uh, maybe mmm. Maybe in terms of going forward with how people are using technology, um, in health cat, it will perhaps be framed around, you know, the sort of common standards that we have for professional behavior, respecting patients, privacy, um, and um, and using evidence. Karen Litzy:                                            Yeah, absolutely. And now, Cath, can you talk a little bit more about what you're going to be sharing a in Geneva with this symposium? Catherine Dean:            07:37                Oh yeah. Thanks Karen. I'm, hi, I'm Catherine. I'm, I'm an educator. For a long time in 2011, I changed university and I had the opportunity to develop a physio therapy program from scratch from a green field, which is a, I've never worked so hard in my life, but it's very exciting. Um, when I came to the knee university, I really wanted to ensure that our graduates, it was future proofed and future focus. So I knew I had to embrace technology and, and um, health informatics. I wasn't quite sure how to do it. Um, I was very fortunate to  meet Mark at a conference who helped me out. And I really want to share at the conference a little bit about what I did, what worked and what didn't. Uh, um, the lessons I've learned it you learn a lot from the errors as you make and hopefully I can stop some other people making some of my errors. Um, but I'm really interested in what other people have done because there's still lots to solve. And how do we actually adequately prepared, um, the future professionals for practicing a ever increasing digital world. So be there Sunday, May 12th at 4:00 PM Geneva. Karen Litzy:                   08:45                And what, what do you feel like from your perspective and with the students that you've worked with in the past and are currently working with, what do you feel the biggest, I guess, barrier to, having these students be, whether it be, cause they seem to be proficient in technology, right? What is it that is maybe the biggest barrier about using this within the practice of physical therapy? Catherine Dean:            09:14                I think it probably intersects a little bit with what Anne said. I think, well, they often proficient in using their technology. They perhaps don't understand the ramifications around privacy issues. Uh, and then I think some of the other issues is it's around professional behavior. Again, uh, your, your, your digital profile is, it is, it reflects the profession as well. So you need to think about, um, adequate oh, standards and provisional by, but I also think while they can be really good at technology and make flashy things, sometimes the content still misses the critical analytical skills that are needed. So, um, I, in some ways it's just another format for communicating and it has its own challenges about that. What you do communicate has to be accurate and evidence based. Karen Litzy:                   10:08                Yeah, for sure. And Mark Your, you know, your goal in putting this panel together is to really spark conversation and to get people interested in informatics. But one thing we didn't talk about in this podcast yet is, and it's a question I get every time I say, oh, I'm doing this focus symposium on informatics. It's what's informatics? Mark Merolli:                10:32                We haven't had to refer people back to the other podcast episode. I don't remember look in no uncertain terms. When we talk about informatics, we're, we're really talking about information science, um, and is an essentially where technology plays a role in how we improve use of inflammation in healthcare. So, you know, we were covering everything from the way we collect health information, store it, uh, analyze it and then essentially put it into practice. It's about making healthcare safer, more efficient, more evidence based, you know, improving essentially the quality of health information using technology. If I can put it in a nutshell. Ready for if Karen, if I could probably just echo Cath sentiments. Really it's um, I agree 110% with what she said, but part of the other reason for having this topic and the symposium, I think yes, we are all passionate advocates but this is also an exercise in supporting, uh, our colleagues, uh, and the wider physio profession as well. Mark Merolli:                11:33                Um, and much like implementing technology into practice, whether that be a small practice or a hospital. Um, you know, technology requires a big change management exercise. And one of the, you know, we were just talking about the barriers here. One of the barriers is also the confidence and the skillset and the that are actual educators and workforce clinical supervisors have to support this too. Um, so one of the things I'm very passionate about and part of the reason for getting the word out there here is that, you know, we actually need to consider the existing work force, the audience of this symposium, our colleagues, the other educators who are expected to teach these students these themes but may not also be all at 100% confident themselves. So I think that's probably one of the other barriers and considerations that I'd like to throw into the debate as well. Um, how we can support the existing workforce. Karen Litzy:                   12:30                And I think that's important. And I think part of what I guess I should say what I'm going to talk about during this symposium as well. Um, but, uh, I think what I'm going to be speaking of, I'm coming at this from a practice owner, from a practicing clinician. So I'm served, people are wondering what I'm doing on this panel of academics because I am not an academic. I'm not in, I'm not teaching in a university. Um, but I am coming at it from the point of view of the practice owner, the practicing physical, the practicing physical therapist and the point of view as someone who may be hiring these students as they come out of school and, and supervising the students. And so I think from a practice standpoint, I mean I'm really looking for, uh, graduates who at least bare minimum have an idea of what informatics are. Karen Litzy:                   13:30                Um, kind of what we use. Mark you just said, but I'm also looking at how can we use technology to make my practice run a little bit more smoothly. And that can be an electronic medical proficiency and electronic medical records, understanding how electronic medical records  work and why they're there. Um, and again, the safety and privacy around that. And also using technology with my patients, whether that be an APP or a wearable, how it's like, yeah, anybody can use an app or a wearable, but to marks, uh, I think other passion, you know, big data sets and things like that. Yeah, anybody can do that. But then what do you do with the data you're collecting? It's got to go somewhere. You have to understand how to use that in order to help improve your patients' journey with you and also your practice as a whole. Karen Litzy:                   14:24                So that's kind of where I'm coming from. A little bit more of the, how can this all be applied in the real world with real patients and real businesses, whether that business be a large hospital, which is going to be way different than what I do. Um, and in some respects, large hospital systems maybe have better data collection. I don't know. I'm just throwing that out there cause they have more resources at their fingertips. So I would, I'm looking forward to are the people who are sitting in the audience to kind of get, Hey, this is what I use for my practice. So kind of sharing best practices amongst people from all over the world I think can really go a long way in supporting each other. Like you said, mark, kind of bringing it back full circle. Yup. Mark Merolli:                15:07                They symposia are very collaborative and that's the whole point of these. Um, you know, we're, we're hoping to not talk too much, uh, outside of audience discussion. Uh, I think we're at a very unique opportunities to point with this topic. Uh, and I think that, you know, as a collective and WCPT has always been a great forum for that to really shape this debate. Um, and actually create some state of, of, you know, guidance going forward. I, and again, like Cath has said in, in our discussions a lot, um, guidance is one thing, but you know, creativities in hello. Um, we actually hope that some of the ideas come from the room and come from the session. Karen Litzy:                   15:48                And so let me ask you all the same question before we wrap things up here. And that is your pie in the sky view of this symposium. What would be the best outcome you can hope to achieve at the end of this two hour symposium? Right? Two hours. Yeah. Okay. So what would be your, your best outcome for this two hours symposium? So any one of you can kind of take it first? Ann Green:                                           Um, I'll, I'll go first. Okay, go ahead. Well, I'd like people to think that the time went really fast and they wish their discussion and debates could've gone on longer and that they will continue those debates at the conference and the each person we'll go back Ann Green:                   16:39                and say, I am going to get involved. I am going to effect change in my own region, Ann Green:                   16:45                in my own area with the people that I'm interacting with. Karen LitzyL                                          Awesome. Mark Cath. Either one want to, Catherine Dean:            16:53                for me, I would like to connect with people who had some bright ideas they have tried and had success with and I'm really happy to to just have a network of academics that are really trying to work on this so you can actually have a kind of a community of practice where you can share your ideas and share what's gone worked well and what hasn't. And and um, look, they'll always be local contextual factors, but there's probably lots to share and, and, and some good ideas if we can get together in a, in a virtual environment. Yep. Mark Merolli:                17:30                Yeah, it looks similar to me. I think what I'd love to say is very much the way that the whole social media landscape ramped up, um, on the back of WCPT congress is, I, I've loved after this congress, you know, educators far and wide start to actually talk about this stuff, starts to try and think of ways, um, to bring this into professional development and university curricula and that um, technology, digital healthcare informatics stays, you know, high on the, you know, WCPT annual member organization agenda. Um, and we sort of see it as a regular feature at conferences and et Cetera. So from this day forth, the type of thing. Karen Litzy:                   18:10                Yeah. And I think that's all great news. I would say I would hope to kind of meet other clinicians and practice owners who may be, can again collaborate and be the driver for a lot of the technology that we're seeing in every day use that can then be brought back to maybe local universities and to say to them, hey, listen, this is what we're seeing in practice. This is what needs to be taught to your students. And then see if we can have that collaboration between the academics and the clinicians, which I think is, is sorely lacking in our profession as a whole. That's just my opinion. Um, but I definitely feel like having great collaborations between the academics and the fulltime clinicians can just drive the practice forward in, in a way that will make us more innovative and creative and, and quite frankly, a happier profession. Um, so that would be my sort of pie in the sky view is to really get a lot of cross pollination between all of us Karen Litzy:                   19:21                So. All right, one more time. I'm going to thank Mark and thank Ann thank Cath for coming onto the podcast today and for being great partners, uh, in what will definitely be a really fun and interactive symposium. Again, it's edge, it's called education, technology and informatics and it's Sunday, May 12th at 4:00 PM, and that is at the WCPT conference in Geneva, Switzerland. So if you're there, come by, um, and sit down, share your thoughts, make sure you're coming. We want you to come armed with your thoughts on informatics, what you're doing, what worked, what didn't, so that we can have a really robust conversation within the room. So guys, thank you so much for coming on and I look forward to seeing all of you in, in real life, Karen Litzy :                  20:16                Geneva. Karen Litzy:                   20:21                Yes, bye bye. Thanks 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. Jason Falvey on the show to discuss healthcare fake news.  Dr. Jason Falvey is a physical therapist working as a post-doctoral research fellow at Yale University in New Haven, CT.  Jason’s research interests focus on improving post-acute care quality and outcomes for older adults recovering from major medical events, such as surgery or critical illness. In this episode, we discuss: -The definition of fake news as it relates to healthcare and medical disinformation -What Jason recommends you do when you encounter articles with a high comment to retweet ratio -How you can avoid falling trap to your biases by crowdsourcing to interpretate literature -The importance of seeking information not affirmation -And so much more!   Resources: NY Times Fight Fake News Why Healthcare Professionals Should Speak Out Against False Beliefs Jason Falvey Twitter Jason Falvey Yale Email: jason.falvey@yale.edu  The Outcomes Summit, use the discount code: LITZY For more information on Jason: Dr. Jason Falvey is a physical therapist working as a post-doctoral research fellow at Yale University in New Haven, CT. He holds a bachelors degree in English, and a doctor of physical therapy degree from Husson University in Bangor, Maine and a PhD in Rehabilitation Science from the University of Colorado, Anschutz Medical Campus.  He is also a board-certified geriatric clinical specialist. Jason’s research interests focus on improving post-acute care quality and outcomes for older adults recovering from major medical events, such as surgery or critical illness. To date, Jason has authored or co-authored 18 peer reviewed papers in widely read rehabilitation journals.   Read the full transcript below: Karen Litzy:                   00:01                Hey Jason, welcome back to the podcast. I'm happy to have you back on even though we're not talking about what we usually talk about when you're on these podcasts and we have our specials with Sandy Hilton and Sarah Haag but I think this is still a really great topic and I'm happy to have you on to dive into it. Jason Falvey:                 00:24                It’s great to be back and I have been excited to present this topic for a couple of months. While it’s no sex podcast part five I think we can definitely got come up with some interesting points for the audience. Karen Litzy:                   00:37                Yeah, I think so too. And so everyone today we are talking about fake news as it relates to health care. Because I know a lot of you that are listening are in the healthcare world and if you're not, this is also a great way for you to kind of understand that everything that you read on social media isn't true gasp, right. So, Jason, let's talk about first, what in your opinion, is the definition of fake news as it relates to healthcare and let's say medical disinformation? Jason Falvey:                 01:19                Yeah, I like the term medical disinformation because fakes news is not nearly as common in medicine, you know, as far as the falsified information. But medical disinformation is much more common than people may realize. The context is most of the hundred shared articles of last year, over 50% of them are of poor evidence quality when experts have actually rated that. So when I talk about fake news and medical disinformation, I'm really kind of breaking it down to a handful of categories. So there's fake news that's rare, but it does happen that's false or completely inflammatory, you know, that is completely falsified data, or completely false claims that are created to either scare somebody into making different health care decisions or drive them towards a curative product that may be your marketing. So that’s not common, but that definitely is out there. I think the more common pieces of fake news and medical disinformation are hyperbolic and intentional. Jason Falvey:                 02:34                So the splashy headline that says Bacon Causes Cancer, you know, where people are putting that headline so it’s clicked on and read when the real story behind a lot of that evidence is substantially more nuanced. And then there's also hyperbolic and unintentional where a well meaning university employee publishes a press release on investigators article and misstates or over-interprets the conclusions to be much broader, more sweeping than they are suggesting that a drug cures cancer or Alzheimer when really it was affective in early stage studies for one particular protein in a mouse model. So those are the three definitions I tend to stick with, but really it's medical information that's not fully accurate, that’s shared widely and may influence healthcare decision making. Karen Litzy:                   03:32                When we talk about these flashy headlines and this medical disinformation whether intentional or unintentional, as healthcare professionals, sometimes we're responsible for sharing that. It's not just the lay public. Right. So when you look at these headlines and you read through let's say a press release, is that where it ends? Do you say to yourself, yeah, this sounds good. I'm going to share it. Jason Falvey:                 04:05                I think that should be the focus of what we talk about today and that is how do we as health care providers recognize fake news? How do we kind of avoid unintentionally sharing it and how do we avoid intentionally sharing it? So I think my guiding principle for all of these things, for any healthcare professional, it's Hippocratic oath, it's do no harm. And then health care beyond what we do with patients and beyond the hands on care that we provide sharing misinformation, whether intentionally or unintentionally has the potential to cause harm. Patients for going standard of care treatment and in lieu of an alternative medicine or unproven other therapy that may actually cause their health to decline, you know, or causing them to participate in a treatment that is unlikely to benefit them and causes harm both financially or time and potentially health care harm. So I think Hippocratic oath above all else should really drive our decision making and the impetus for why we should care about this. And the other guideline I use is I really want patients and providers both to be looking at social media and healthcare information that they're sharing and really make sure that they're seeking information, not affirmation. So they're seeking to broaden or challenge their pre held assumptions and not just share things, read things and kind of propagates a worldview that just affirms that are already firmly held biases to harm a patient. Karen Litzy:                   05:58                Okay. Yeah, but so you mean we can't cherry pick things to confirm our own biases to make ourselves look better? Is that what you're trying to say here? Jason Falvey:                 06:16                Yeah, that sounds like a terrible polarizing thing to say, but I'm really going to stand by that I think and just say I really don't think we should be cherry picking evidence and just sharing evidence that is fully supporting our world view. We may have a brand to keep, you know, I don't think I would widely share studies that I think are well done that maybe say physical therapy isn't as helpful as other things, but I certainly would acknowledge that they exist. I don't think I would market them heavily, but I certainly wouldn't ignore them or basically say that they're not accurate either. But I think we have to be really careful, especially when we're talking about vulnerable patient populations, thinking about patients with dementia or patients with cancer who are really hanging on hope that there's something medically that can be done that's outside of what's already been offered to them and kind of have a cure. And I think it's really important that we choose our language and we choose what we share, how we share, and the quality of what we share very carefully. Karen Litzy:                   07:29                Well, and you know, that goes back to do no harm. And I think goes back to being an ethical person because when you look at these vulnerable populations, like you said, the elderly people with possibly terminal diseases, people with chronic pain, these are people who are looking for things that they feel they have not gotten that will fix them. Right? And so that's where snake oil salesmen come in. That's where people sort of touting that they have this great flashy thing that isn't supported with evidence, but it sounds really, really good. And so how do we as healthcare professionals combat that without looking combative and turning off those people that we actually want to help? Jason Falvey:                 08:22                Yeah. How do we combat that information without unintentionally propagating it either. I think when we evaluate information, I think one of the things I really encourage is time, take time to think about the information, take time to research the primary source of that information. Take time to recognize if there is potentially both sides of an issue. So outside of things like, you know, vaccinations causing autism, which is a clearly manufactured result. If you follow back the evidence or if you go ahead and follow back evidence about infant chiropractic work. But I guess generally falsified or highly, highly, highly biased to the point where there really isn't a pro side, but a lot of medical things have a potential pro and con side. So I think it's important to recognize the nuance and carefully layout reasons one why you disagree with something and two the rationale methodologically, not just your opinion of kind of how you came to that conclusion. Jason Falvey:                 09:42                But I think you have to do that without validating what you think is a very poor quality or highly biased or dangerous source to share. If, for example, you saw a tweet about the harms of vaccination and it may be, it was for your older adult population getting the chicken pox vaccine and it caused them Alzheimer's, you know, caused them to get dementia. Let's say you just saw a story like that. Which is not true. How do you, you know, how do you combat that? Some people would just retweet it with a really dismissive comment, like this is garbage. Don't listen to them. Well then doing that, and I'm guilty of this in the past as well, we've actually unintentionally propagated that information. Right now I have not very many followers, so 2000 followers all of a sudden see that and potentially one more retweets it and then another 2000 people. So I unintentionally exposed 4,000 people. Even if I'm dismissing that information, I've lent it credibility by sharing yet. Jason Falvey:                 10:51                I think what I have to do is write something about the study, not actually link or validate in some way and not unintentionally spread fake news. And there's not an easy way to do that. So I think you really have to toe the line between not sharing the primary sources, potentially providing that provider of fake news, financial revenue from clicks, which is a lot of times what they want. Or providing a really misguided researcher, a clinician validation that their technique is not loved by the general medical population because they're jealous of his success, you know, something that they can take it the other way to spin it as a positive for their business. Karen Litzy:                   11:39                Right. And because if you're re tweeting this and clicking on it and retweeting it, you're giving it life, which is what they want. That's what we don't want to do. Jason Falvey:                 11:52                Right. And I think that's one of the ways that propaganda is designed right from the early days of using propaganda as a war tool. It was shared not just for people that believed in it heavily. It was shared in outrage and passed along and whispered about which served the exact same purpose. So really it's hard to discipline ourselves in a really, like we see something, we feel like we immediately have to react on social media and immediately have to comment on it. And I've been guilty of sharing articles that are either satire and actually taking them seriously, which has happened once in a fatigue non-caffeinated state. And also information or studies, which I think in hindsight probably weren't high quality or perhaps overstated its conclusions. My own articles have had overstated conclusions written and press releases that weren't by me or interpretation of written press releases that are perhaps more definitive than I would have wanted, you know, not fake news, but certainly unintentionally declarative about the quality and strength of the evidence versus, you know, the hypothesis generating evidence that it was. Karen Litzy:                   13:16                Yeah, absolutely. You sort of alluded to one way as healthcare providers that we can combat the fake news or the medical disinformation and that's taking time to read the source if it's a press release, to read the article, to maybe look at the methodology and to see how would rate this study? So that's one way we can combat it, which takes time. And like you said, on social media, people often react quickly because it's emotional. So maybe we need to take a deep breath and then take a moment and think about what we want to do. Do we want to share this misinformation or do we want to read it and come up with maybe another way to share more positive information? What else can we do as healthcare providers to get around this fake news? Jason Falvey:                 14:14                When we encounter something that we think is fake news or unintentionally or intentionally hyperbolic to the point where we think it's harmful to patients. And I think that's the line I draw. If I think that potentially sharing or engaging with this information in any way which propagate information that's harmful to patients. I generally take a little extra caution. And one of the things I look at, you know, I see in politically or in health care news, if I see a that goes out that has a really high comments or retweet ratio. So there's this term ratioed and it's not scientific and it's not peer reviewed. But I find that the good starting point when you see a tweet from a government official or a healthcare provider, healthcare related source, and there's more than double the amount of comments, then there is retweets and the likes. Jason Falvey:                 15:18                It makes me go and do a little bit more investigation. You know, sometimes those comments are positive and way to go. And sometimes there's a lot of skepticism or criticism of the findings or people really, you know, offering some real insight into some of the problems in methodologically or otherwise. And often a well done methodological study can be completely blown out of the water on Twitter by a very poorly written headlines. Right. We should care about storylines, not just headlines. And one of the ways we do that, looking at comments, retweets, and the likes, looking at that ratio and look at the source, right? Who's retweeting? And so I pay attention to that because most fake news on the Internet is actually propagated by bots. So there's a very high percentage of fake news that was propagated by automated accounts that are automatically set up to capture certain hashtags or certain language and amplify it. Jason Falvey:                 16:23                You know, if you're a political audience would know that that's how the Russians basically designed the misinformation campaign to influence the 2016 election using bots to amplify certain messages. Well, that happens to a lesser extent in health care. There are certain pockets, you know, of health care professionals, and there may be some in our profession that provide certain treatments. There may be some in other alternative medicine professions, there may be some in mainstream medical professions that are physicians or nurses who use their medical expertise and propagate information about medical techniques like abortion or vaccines in a way that makes them seem more credible. So I look at who's retweeting what the population of people are retweeting is, who the person the primary sources coming from. Right. You said if it's a summary of an article from a press release or somebody's blog, like I want to go and find that primary source and then also look at the bias of the person who may be interpreting that information for me if they're a credible source. Karen Litzy:                   17:40                Yeah. And I think you also want to keep in mind those hot button issues may have more misinformation about them. Like you said, vaccines, abortions, these are hot button issues, right? So you have to I think take a more examining eye to some of these hot button issues then with others. That's not to say that other issues in health care do not have as much misinformation surrounding them. But when you're talking about things that are really emotional for people, I think that's when you have to also take a good editing eye to some of this information being put out there. Jason Falvey:                 18:26                Looking at the source of information is one thing you can see. Cleveland clinic has accidentally posted fake news before where they put in like a really positive result from an innovative experimental therapy for cancer. And they put it in a brain scan and said this person had a miraculous results forgetting to mention that they also were receiving the standard care and this additional therapy would, they didn't know if that was the cause or if it was just a normal reaction to the normal care. But then all of a sudden you created a demand for something that is at best maybe ineffective and at worse, we don't know if it's harmful. By having a high visibility site, your responsibility for news is even higher. So I think that's an important piece. Like know who's tweeting it, but then go back and make sure you have the whole story. If it sounds too good to be true. Jason Falvey:                 19:38                This is the humanities education that a lot of PT students have complained that they've had to take history and literature and policy courses throughout their undergraduate degrees and some have suggested streamlining education to really eliminate those things. My counter argument is those skills you learned from critical thinking and critical reading and analysis and understanding of historical context and how to read hyperbole, how to read marketing and different kinds of language really with a critical eye, you tend to develop a radar for when you're suspicious of information and when you want to go and look a little deeper, even if it's from what you view as a pretty credible source. Karen Litzy:                   20:27                Yeah, absolutely. So we've got taking your time really looking at not only the source of the article but who's re tweeting it and that retweet to comment ratio. Is there anything else that we should be doing as healthcare professionals to make sure that we're not propagating this misinformation? Jason Falvey:                 20:54                Another thing I think would be really helpful is crowd sourcing, right? So most of us are networked on social media with a lot of other really knowledgeable professionals. You know, I know that on my Twitter feed alone, half the people are probably smarter than me. Karen Litzy:                   21:10                Oh, I don’t know about that. Jason Falvey:                 21:14                But that's intentional, right? Like I want to be in a community of really intelligent people who think about issues critically, who may have different opinions than me. And I could say, I just read a study about Xyz and the conclusion seems flawed. Who would want to, you know, and maybe I don't name the article, maybe I don't put a link to it. I just put the tweet and throw out a few names and say, Hey, I would love if some of my community would like to take a look at this and tell me what they think. Right. If I'm on the borderline of whether or not I think this is legitimate or I asked somebody in the profession, you know, lean on them to really make sure that I'm taking that extra step to not share information that is influencing medical decisions in a negative way. Jason Falvey:                 22:03                And I teach my patients these same strategies, right when I'm talking to patients and caregivers who are googling information, WebMDing, looking at blogs, and I've had patients with significant neurological illnesses that are terminal. And one of the places I've practiced, and I won't name that place if it's a relatively rare disease, but this person searched the literature and she was very well educated person, searched the literature high and low for a cure for her neurodegenerative disease and found one that was highly controversial. Probably harmful. And she invested thousands of dollars and hundreds of hours of travel over three months for something that was not beneficial while she was askewing typical medical care. So you know, that kind of taught me how to teach patients, not just how to look for information, right? That's part of the problem. But how to evaluate information, how to triangulate information to make sure that the reference that they found is supported by expert opinion and maybe other articles and making sure that there's a critical mass of support for this particular treatment before they really make a major alteration to their course. Jason Falvey:                 23:21                A single article about a vitamin supplement that might help that has little harm. You know, that may be something that I don't intervene on, but somebody who's thinking about making massive changes to their medical routine, whether it has directly to do with Rehab or not. I encourage people to look at the literature critically and I use the word triangulation and I draw it out. I'm just like, you should be able to verify this information should be similar between these three things. Right? And if they tell me that they've done that and they found those three things, I'm more comfortable, even if I disagree, at least I've done my diligence to make sure they looked at the issue in a robust way and not fallen victim to something that was purely a single tweet or Facebook post of medical disinformation. Karen Litzy:                   24:15                That's a shame. And I think it's important that you brought up that as healthcare professionals, we should be talking to our patients about this and we should be teaching them stuff. Glad that you went through that. Yes, we should be teaching them what to look for. If we can have a more educated patient base and a more educated base of health care professionals that high in the sky view. Of course the amount of misinformation may be less. Jason Falvey:                 24:45                Yeah. And I think there are certain countries that have done a lot of work. Norway for example, has done a lot of work from a country perspective on educating citizenry on medical and you know, general disinformation, both political and medical and teaching, how to recognize it. Giving a lot of the same strategies we've talked about of really time and a little bit of additional resource and that solves so many of the problems. If you don't change some of these decision making process and they still are firm believers in the medical information at that point then you go to some of the other strategies, you know, more targeted intervention. But I think as a general population strategy, those are great places to start and really just, I tell patients all the time, I am going to be telling you seek information, not affirmation. Jason Falvey:                 25:45                If you have a friend who told you about this treatment, you need to remember that everybody responds individually, the medications and treatments and you know, cause I think we've all had patients that say my friend got this therapy and their knee got better, really inappropriate for that patient. But it's really hard to walk that back, you know, from just your professional opinion. So teaching them how to look for information and letting them look for it on their own instead of providing it to them I have found is sometimes a helpful strategy because it feels like I'm not forcing my view on them. At the end of the day you can rest knowing that you put tools in people's hands, you know, health care providers or patients teach them how to do these things. I mean, but it does take some effort on their part too. Jason Falvey:                 26:37                You definitely have to want to read these things carefully and you have to have the mindset that you don't want to just look for information that validates what you already believe. And I've seen this, you know, I don't like to pick on dry needling, but I definitely have seen people who are very strong believers in dry needling, just cherry pick evidence that supports their worldview, without recognizing that there's a lot more nuance to that discussion. And I'm not anti or pro dry needling. I'm pro information. Looking carefully and realizing that there are patients who do benefit from it, but it is certainly not a blanket treatment that everybody should be using and it's a tool in your bag, like everything. So, I think it's really important to just have that seek information, not affirmation. If I can say something a few times on this podcast that will be what it is. Karen Litzy:                   27:40                Well, and then my next question would be, after having this great conversation, is there anything we missed and is there anything that you really want people to stick in people's minds, which I think you just said it, but I'll ask the question anyway. Jason Falvey:                 27:55                Yeah. And I think the other thing is like, when you are a healthcare professional, I think investing money in like high quality sources or whatever source. For me, I tend to read a newspaper in New York Times or Washington Post. I have a subscription to it. I try to support that kind of, you know, to provide financial resources to a place that I trust to provide good information because that is positive reinforcement, right? I try not to provide positive financial rewards to places that are providing this information. And you do that by clicking on their articles, right? You read a headline and it's like vaccines cause autism study says, and I clicked on that headline, I’ve unintentionally propagated and supported financially that fake news provider who now is incentivized to create more fake news. So I think it takes a lot of discipline to not fall victim to our need to read everything. Jason Falvey:                 29:02                And you know, sometimes we have to think about the greater good is not clicking on that article. Shutting it down, blocking that news source or whatever, if you really feel like it's egregious enough and not engaging with it. Creating polarization. Polarization is what creates ratings on television. Polarization is what creates ratings on radio, polarization is what gets people to download podcasts and things that are highly controversial. Polarization, you know, sells books, right? The top selling books on New York Times bestseller lists are generally, there's political books that exist, sometimes multiple political books that are on that list from different points of view. So I think it's really important that we don't support agregious, you know, fake news providers or fake healthcare news providers and don't engage with them on Twitter because that's giving them a form of a positive attention. Even if you're criticizing their work, that they can go ahead and leverage to share more. Karen Litzy:                   30:13                Yeah, I thank you for all that great information. And hopefully the listeners can really take this in and understand that what we do on social media has ramifications one to our profession and two to the people we serve. So before we leave, I have a last question and normally I ask people, what advice would you give to yourself as a new Grad? But I'm going to ask you, what advice would you give to yourself as a new Grad physical therapist in light of fake news? Jason Falvey:                 30:50                Oh, that's a great question. Beyond the sentence I said of seek information not affirmation, which I think is helpful for research and beyond, I think one of the things I would tell myself as a new Grad physical therapist in this era is I would be incredibly thankful for my English education, my bachelor's degree in English, all of the humanities and critical thinking classes that I took and all of the writing that I did because trust me, I wrote enough papers as an undergraduate that probably could have qualified this fake news cause I didn't really read the books very carefully and really had some made up opinions about what I thought was happening. So I think I can recognize the difference in that writing now. And I would tell myself, be appreciative of the education in humanities and the historical context that you've gained and use those skills. Don't forget about them. They are valuable parts of your tool bag. They are not direct patient care skills, but there among the most critical soft skills you can obtain to really do a good service to your patients and teaching them how to use those skills and taking healthcare into their own hands. Karen Litzy:                   32:13                Awesome. Well, thank you so much. This was a great discussion. I'm glad we finally got to do this. Where can people find you if they want more info or to ask you questions? Jason Falvey:                 32:26                Yeah, so I am listed on the Yale site, I am not officially representing Yale now just to put that out there, but my email address is on the Yale division of geriatrics site. I'm also on Twitter at @JRayFalvey and I'm sure you'll put that in your show notes. Those are the two things. And hold me accountable. Do you see me sharing something that you think is not a great source of information? Tell me about it. Right. And I think holding each other accountable is part of this process and doing that in a professional way is all the better. Karen Litzy:                   33:07                Thanks again for coming on. 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. Peter Fabricant on the show to discuss pediatric ACL injuries. Dr. Peter Fabricant is an orthopedic surgeon specializing in pediatric and adolescent orthopedic surgery. His clinical expertise is in sports medicine and trauma surgery of the knee, hip, shoulder, elbow, and ankle. In this episode, we discuss: -How to determine if a patient should have non-surgical treatment or surgical treatment following ACL injury -Rehabilitation considerations following Physeal-Sparing ACL Reconstruction Surgery -Setting realistic expectations for return to sport with the pediatric population -And so much more!   Resources: HSS Peter Fabricant   For more information on Dr. Fabricant: Dr. Peter Fabricant is an orthopedic surgeon specializing in pediatric and adolescent orthopedic surgery. His clinical expertise is in sports medicine and trauma surgery of the knee, hip, shoulder, elbow, and ankle. Dr. Fabricant completed his undergraduate studies at the University of Rochester, graduating with honors. He then attended Yale University School of Medicine. During his orthopedic surgery residency training at Hospital for Special Surgery, Dr. Fabricant earned a Master of Public Health Degree from Columbia University, and won several awards for excellence in patient care and innovation in patient safety. Following residency, Dr. Fabricant completed two fellowships: first in pediatric orthopedic surgery at The Children's Hospital of Philadelphia and the second in sports medicine at Boston Children's Hospital. This afforded him the unique opportunity to study with renowned mentors at both institutions, including Dr. Lyle Micheli, Dr. Mininder Kocher, and Dr. Theodore Ganley, in order to compile additional subspecialty training uniquely focused on the care of children and adolescents with sports-related injuries. He has cared for athletes and performers at all levels, including the Boston Ballet, Babson College, the International Skating Union World Figure Skating Championships, and the Boston Marathon. Dr. Fabricant is an accomplished researcher, with over 100 peer-reviewed publications and 15 book chapters in circulation. He has received multiple institutional, national, and international awards for clinical research, including the Herodicus Award (AOSSM), the Excellence in Research Award (AOSSM), and the Promising Career Award (PRiSM Society), among others. Dr. Fabricant currently serves on several research and education committees in two international professional societies (POSNA and PRiSM). He is a member of several pediatric orthopedic and sports medicine research consortiums, through which he participates in cutting-edge multicenter clinical research studies with many of the most prolific researchers in pediatric and adolescent sports medicine. He also serves on the editorial boards of Clinical Orthopaedics and Related Research (CORR) and the Journal of ISAKOS, on the Peer Review Committee for the Orthopaedic Research and education Foundation (OREF), and as a reviewer for several academic orthopaedic journals including the Journal of Bone and Joint Surgery (JBJS), the American Journal of Sports Medicine (AJSM), and the Bone & Joint Journal (BJJ). Dr. Fabricant understands the physical and emotional complexities of injuries in youth and adolescent athletes. Sports and recreational activities provide social, emotional, and physical development, leadership skills, and encouragement for children to work as a part of a team with their peers. Dr. Fabricant has dedicated himself to addressing sports injuries in the context of all of these important issues and strives to return his patients back to their sports and activities as quickly and as safely possible, while minimizing the risk of future injury and prioritizing their long-term health and well-being.   Read the full transcript below: Karen Litzy:                   00:00                Hi Dr. Fabricant Welcome to the Healthy Wealthy and Smart Podcast. I am so excited to have you on today to talk about pediatric ACL injuries. Karen Litzy:                   00:13                So we're just going to kind of jump right into it because I know our time is limited here so the reason that I wanted to do this is because I have a patient now with an ACL tear who had surgery and there seemed to be a lot of questions in the rehab world around this population. So after a confirmed ACL tear in a pediatric patient can you take us through your decision making process as to whether or not that patient will have non-surgical treatment which would mean high quality rehab or ACL reconstruction plus rehab. Dr. Fabricant:                00:53                Yeah that's a really great question. So historically kids who still had you know growth remaining who had open growth plates would kind of be held off until they were fully grown and then have an ACL reconstruction then. But we know that that's not the ideal thing to do just because they have an unstable knee they can develop cartilage and meniscus injuries that might not be repairable once they reach the maturity but there are a subset of patients who tend to do pretty well without surgery and with high quality rehab alone. And so typically when I'm evaluating a patient the ones that tend to do well with high quality rehab alone would be typically younger patients. So kids who are like under 14 years old and kids who have non full thickness ACL tear. So like a partial ACL tear like a 50 percent tear. Dr. Fabricant:                01:49                And so kids who are young and who have you know a 50 percent partial tear their ACL who have rotational stability of their knee so their knee doesn't kind of rotate during things like a pivot shift examination. Those are kids who tend to do pretty well without surgery with a period of protected weight bearing bracing and high quality rehab. When I'm seeing kids who are either older and or have a full thickness ACL tear with a really unstable knee those tend to be the kids who we recommend surgery for especially if they're involved in cutting or pivoting sports jumping or landing sports things like that. So that's basically how I approach it in general. Karen Litzy:                   02:34                And so let's talk about the surgical procedures because there are several surgical procedures one can do on a pediatric ACL patient taking into account the growth plate damage. How do you decide which surgical procedure to do with this population? Dr. Fabricant:                02:57                I think that's a great question too. So I kind of think about these kids in three groups. Dr. Fabricant:                03:04                Let's go from kind of oldest to youngest so the oldest type of kid is the kid who either has growth plates that are closed or near closed or they have very little growth remaining let's say like less than six months of growth remaining. Those are kids that I kind of think about a little more like adults. But then within that within kind of specific to your question the kids who have open growth plates. The question I ask myself are kind of are these kind of the youngest kids like prepubescent kids. So those are kids with greater than 2 years of growth remaining.  In girls, those who haven't had started having their periods yet. In boys and girls kids who really haven't had a growth spurt or who are kind of prepubescent. Dr. Fabricant:                03:53                There's kind of that group and then there's the pubescent kids who are between let's say two years of growth remaining and six months of growth remaining you know in girls let's say they've had their periods for a year, in boys they may have already showed some signs of puberty or of their growth spurt. So those are kind of the pubescent kids even though they have growth remaining and so in thinking about a reconstruction technique I try to figure out are they in the prepubescent group or the pubescent group. And then there are a couple of different described surgical procedures in each but in broad generalities the prepubescent group you need to really avoid the growth plate completely and so that can be done either with techniques where you do drill tunnels in the bone but you confine it to the epiphysis of the bone or the area that's kind of away from the growth plate or you can do a procedure where you're not drilling any tunnels which would be like the IT Band ACL procedure and that those both can protect the growth plate and they're both been well described and then in the kids who are pubescent who have growth remaining but maybe not so much growth remaining those kids you typically can drill tunnels in the bone but you just need to use a graft that's made of soft tissue because if you take let's say a bone plug from a graft and fix it across the growth plate that can inhibit their growth and cause a limb length deformity limb length discrepancy or like an angular deformity of the limb. Dr. Fabricant:                05:31                So that's kind of how I think about the two groups that still have growth remaining and taking surgical procedures. Karen Litzy:                                           And does the activity of the child come into play when deciding on which procedure to do or is it really just their kind of bony anatomy and age. Dr. Fabricant:                                        Yeah it's mostly their age and skeletal maturity and their developmental maturity. The sports sometimes come into play when you're deciding whether or not to do a reconstruction but once you kind of made the decision to do a reconstruction you know which technique you choose is typically chosen based on their skeletal maturity. Karen Litzy:                   06:11                Got it got it. And then you sort of alluded to this a little bit earlier talking about the meniscus but why is the health of the meniscus so important in the pediatric ACL patients. Karen Litzy:                   06:22                So from what I've read it seems like if there is a bucket handle tear or other repairable meniscus injury surgery is really warranted. Why is that?   Dr. Fabricant:                06:42                So if there's the meniscus is pretty precious tissue and it's really the shock absorber of the knee but it also provides secondary stability to the knee, nourishment of the joint. It provides congruence between the femur and the tibia and so it's really important to try to save as much meniscal tissue as possible and then these kids obviously have quite a long life ahead of them and many have a long athletic career ahead of them. So you definitely want to save as much meniscus as possible so if there is a large unstable meniscus tear and the knee remains unstable it's likely to continue to degenerate whereas if you go and stabilize the knee and fix the meniscus you have the best chance at preserving that tissue and getting it to heal. Karen Litzy:                   07:20                Yeah that makes sense. And now for a lot of my listeners who are physical therapists this is sort of the money question right. Karen Litzy:                   07:27                What are the most important considerations for rehab after these physeal-sparing ACL reconstruction surgeries? Dr. Fabricant:                07:36                So it's interesting there's not like a really strong evidence base about like specific things with rehab but I would tell you that kind of the way that I approach it and kind in in broad generalities typically the first six weeks are where there's the biggest difference depending on how the procedure goes. So if if it's let's say a procedure where you're drilling tunnels and fixing it with implants you know those kids can tend to weightbear relatively soon the implants tend to confer a lot of stability to the graft and allow the body to heal the graft. If there's a meniscus repair at the time of surgery, I tend to protect the weight bearing for a total of six weeks just to let the meniscus heal and in the kids who end up getting the IT Band ACL because there are no tunnels drilled in the bone and therefore there's no like screws holding the graft in place and the graft tends to be fixed to the periosteum of the bone or the skin around the bone with heavy duty suture. Dr. Fabricant:                08:39                Those kids I tend to protect for six weeks regardless of if they've had a meniscus tear repaired just because I want to make sure they've started to have some biologic healing of the graft before I let them really bear full weight. So for me the first six weeks are kind of the most critical portion where if I've done a IT Band ACL and I'm kind of relying on suture for fixation I tend to protect their weight bearing a little longer but once they hit about six weeks for me at least the rehab tends to progress the same whereas essentially all kids are kind of started to wean off crutches by six weeks starting to work on strengthening and then for me I tend to let kids start to jog around 12 weeks and from there on it's pretty similar rehab to the adult rehab. Karen Litzy:                   09:24                So why with the ACL reconstruction using the IT band, why is no lunging a precaution with this population. Dr. Fabricant:                09:37                When I was in training I had some of my mentors would say that they found that kids who load the knee from a flexed position after any ACL reconstruction tend to kind of flare the knee up especially in the early phase and so I tend to tell kids to avoid you know deep lunges and squats early on. So that's just something that I do I don't know that there's a lot of great evidence for that but it seems to have worked for some of my mentors and so I've kind of adopted it into my practice as well. Karen Litzy:                   10:13                Got it. Got it yeah. Because I read that out of Boston right. And OK so that makes a lot of sense because I often wondered. Karen Litzy:                   10:24                Well they can jog and run but they can't squat or they can't lunge. And is that obviously to protect the knee and is that also to maybe protect secondary problems like patellar tendinopathy or something like that. Dr. Fabricant:                10:38                You know right after surgery there is a bit of inflammation going on in the knee and so certainly doing like deep squats and lunges can increase the risk of further inflammation. Dr. Fabricant:                10:50                But I really do like squats like leg presses that go down to about 90 degrees of knee flexion. I really find it helps strengthen the knee without inflaming it too much. But you know the physical therapist that we work with tend to do that and the patients do pretty well and they end up building it pretty quickly. Karen Litzy:                   11:12                That makes sense. And now let's talk to a lot of these kids want to return to sport. I mean you're working with kids all the time as you know their attention spans are a little short and they're all really excited to get back to sport A.S.A.P. but according to the IOC consensus on pediatric ACL they recommend waiting twelve months to return to sport. So what is your thought on that? Dr. Fabricant:                11:43                Yeah I would say the short answer is I agree with that completely. I typically mentally prepare kids for a year to return to play. Dr. Fabricant:                11:53                I think that you know there's really three things you need in order to successfully return back to sports safely. So one is the anatomy which is really the job of the surgeon and reconstructing the anatomy. The other is you know strength and balance and coordination which is a team effort between the physical therapist and the patient and the surgeon as well. And then the third thing is just time. So it just takes about a year for the graft to incorporate and mature and remodel and kind of be biologically ready. And I think that's the hardest part about this surgery is really kind of keeping the kids engaged for a full year. I think kids sometimes hear about some professional athletes who get back to sports sooner than a year and so they feel like they want to get back sooner than a year. Dr. Fabricant:                12:39                But I typically tell families you know a couple of things. First off the average time to return to sport, even in professional athletes like in the NFL is about eleven months. So even in pro athletes who have no job other than to rehab their knee you know they don't have chores and schoolwork and things like that that it's still about a year and that's an average. So while they might hear you know on the news about people who get back after six or eight months there's also people who don't get back for 14 or 16 or 18 months. And so even professional athletes it takes about a year and then the other thing is that kids are really even higher risk than professional athletes because typically you know if there's something about the child's anatomy or their physiology or how they're moving Dr. Fabricant:                13:24                That puts them at such high risk that they're gonna tear their ACL when they're 11, 12, 13, 15 years old. They're at higher risk patient than the guy or gal who goes through you know high school and college and professional sports before tearing their ACL. They've made it through let's say 30 years of life before tearing their ACL. So I tend to try to kind of work with kids and families and say you know look you're a higher risk than a professional athlete for one and two you know all they do all day is rehab and it still takes them a year to get back to sports. So I tend to agree with the one year recommendation. I tend to let kids just because they're itching to get back. I tend to let them do some light practice with their team at the beginning of the following season. So for instance if a kid injures themselves midway through a soccer football season in the fall you know usually it's around nine or 10 months till the next beginning of the next season I say that they can do some kind of non contact practice with their team just so they can stay involved. But I do agree with the one year before they're really kind of on the field or the court competing with other kids. Karen Litzy:                   14:33                Yeah and I'm so glad that you brought up what they see on TV and what they hear or see on social media because that's something that's so pervasive amongst a lot of these kids and they think someone else did it. They should be able to do it too. So I thank you for that. And I think that advice to tell the parents and to keep reiterating that to the patient to the pediatric patient is so important because boy they just want to every day. Well when can I do this. Well when can I do that and being able to keep them like you said motivated but realistic expectations and being honest is a challenge. Dr. Fabricant:                15:14                Yeah you're totally right. I think that even setting expectations before surgery you know they kind of forget you know when their knee starts feeling pretty good around three or six months but you know I think the other important thing is that you know what they hear on TV and in social media tends to be the exceptions to the rule rather than the average. Dr. Fabricant:                15:31                So they hear about the person who gets back to sports at six or seven months but they don't necessarily hear about the people who take a year and a half to get back to sports in the pros or who don't make it back to sports in the pros. So I think you know also telling them they're probably getting a bit of a biased view when a lot of these kind of news outlets kind of sensationalize people who are getting that quickly they think it's the norm when actually it's the exception. Karen Litzy:                   15:54                Absolutely. I just had this conversation the other day about what a bell curve is and how some people are on one side some people are on the other but most people are in the middle. Karen Litzy:                   16:04                And to really keep that in mind when you see these big extremes so now is there anything else that you would like to add as far as let's say speaking to physical therapists or people who are going to be working with your patients. Anything else you would like to add as far as the pediatric ACL patient is concerned. Dr. Fabricant:                16:27                Not not really. I think we really kind of touched upon all the important topics. I think it's just important to understand a lot of people are really beginning to realize that you know kids aren't just small adults and they have their own unique considerations both with the surgery and in the rehab and in the kind of mental preparedness for sports. And so I always really enjoy working with therapists who enjoy working with kids and engaging kids because it's not just that the surgery and even the exercises are different it's the whole kind of mindset and the approach. And so when the whole team is on the same page it's always really rewarding. Karen Litzy:                   17:09                Awesome well thank you so much for taking the time out. And where can people find more about you if they would like to know more about you and what you do and have any questions. Dr. Fabricant:                17:18                Yes so I practice at the Hospital for Special Surgery so they can go to the hospital for special surgeries Web site which is a Hss.edu they can look me up on that Web site or they can Google search my name at HSS and we're here and happy to take care of our youth athletes who get injured. Karen Litzy:                   17:39                Awesome. Well thank you so much and everyone else. 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, Shannon Sepulveda guest hosts and interviews Nikki Kimball on her experiences as a female distance runner.  Nikki Kimball is an American distance runner specializing in the Ultramarathon. She is also a physical therapist in Bozeman, Montana. In this episode, we discuss: -Nikki’s journey to becoming a long-distance running athlete -The societal health and wellness ramifications of running -How Nikki’s experience as a physical therapist has shaped her running journey -Gender differences, both physical and financial, in competitive running -And so much more!   Resources: Shannon Sepulveda Website Shannon Sepulveda Facebook Oiselle Trail Sisters Nikki Kimball Instagram Email: nikkikimball@yahoo.com   For more information on Nikki: Nikki Kimball (born May 23, 1971) is an American distance runner specializing in the Ultramarathon. She ran her first 100-mile race at the Western States 100 Mile Endurance Run in 2004, and was the female winner. She was the winning female at Western States again in 2006 and 2007, becoming only the third woman to win Western States three times. In 2014, she won the Marathon Des Sables multi-stage endurance race on her first attempt. Prior to running, her main sport was cross-country skiing. She was crewed at the 2007 Western States by U.S. Senator Max Baucus of Montana, where Kimball lives. She lives in Bozeman, Montana. For more information on Shannon: Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.   Read the full transcript below: Shannon Sepulveda:      00:00:00           Hello and welcome to the Healthy, Wealthy and Smart Podcast. I am your guest host, Shannon Sepulveda, and I am here with Nikki Kimball. Hi Nikki. So Nikki, can you tell us a bit about you and what you do? Nikki Kimball:                                        What I do? My favorite subject, I am a physical therapist here in Bozeman and I also coach running, ultra marathon running. And I got into that because I've been an ultra marathon race or professional racer for almost two decades. And that's kind of what I do. Shannon Sepulveda:                              So in the ultra marathon running world, when you say Nikki Kimball, people are like, oh, Nikki Kimball. And I feel like, so Nikki is a very accomplished ultra marathoner for those of you who don't know who Nikki is. So we are very, very fortunate to have her here on the podcast. So how did you get into ultra running? Because back then it seemed like it's not as popular as it is now. Nikki Kimball:                00:01:01           No, I don't think it is, but there were still, you know, a boatload of us. I mean there are thousands of us who absolutely loved this sport and we, you know, there wasn't much money at it or anything like that. It wasn't very popular. But I think a lot of cross country skiers come into it sort of organically because of the training we do for cross country skiing is essentially ultra marathon training, which is kind of funny because the women don't get to race very far. The longest they can do is 30K at the Olympics. It's pretty pathetic. But regardless, we always trained with the guys anyway. So we would do these four or five hour run hike things in the woods. And so it was kind of doing it anyway. Nikki Kimball:                00:01:50           And in graduate school I raced a lot of 5K's, 10K's, half marathons, marathons, just kind of wherever. Cause I had a store team that sponsored me and they'd pay all my race entry fees. And so I just go do fun things. And it just like sort of saved me through Grad school because it had gave me this other thing besides studying all the time. And it made me sort of mentally clearer. I just loved it and I'm just like running makes me happy. It just makes sense to go out and run and run and run. And so yeah, at the time it wasn't super, it wasn't mainstream popular, but those of us who did it loved it. Did it all the time. Shannon Sepulveda:                              So you grew up Nordic skiing? Nikki Kimball:                00:02:41           Yes, in high school. I grew up in a town called Chittenden in Vermont, so south central Vermont town and I grew up skiing. My brother was four years older, so he was skier and the Bill Koch Youth Ski League is this big, big thing then. I don't know if it still is, but there would be these races for kids and because I mean the kids who would be racing, you know, from eight years old on, they kind of knew what they were doing, but they had to do something for like the little brothers and sisters. So they'd have these races, they called Lollipop races because you get a lollipop at the end and you might go 100 meters maybe holding your parent's hand. But I believe I was three when I first did this. I basically learned how to ski and walk at the same time, I'm sure. Nikki Kimball:                00:03:31           And so yeah, I mean I just don't remember life without competition, without endurance sports. Shannon Sepulveda:                              And then did you race in college? Nikki Kimball:                                        And I raced at Williams College, so all four years, so division one racing. Then, partway through college I decided to switch to biathlon. So my senior year I had to keep my rifle at a professor's house cause they weren't too keen on having rifles on campus. And so I raced a couple of years in biathlon hoping for the ‘98 Olympics and I raced through ‘94. Shannon Sepulveda:                              Oh Wow. So how is biathlon different from cross country skiing, like endurance wise. What do you think? Nikki Kimball:                                        Similar, really similar. I mean, it's just adding this sort of cognitive piece to it. I mean to go from skiing as hard as you can to shooting clean for five rounds is, it just requires a whole different skillset. Nikki Kimball:                00:04:37           Of patience and humility and cognition. I mean, looking at where the wind is and deciding you know, how to change your sites on your rifle, by this, you know, it's just an extra layer. And I loved that. Shannon Sepulveda:                              Do you feel like that has influenced your ultra racing at all? Like part of it? Nikki Kimball:                                        Probably not a ton. I mean, I think the calmness needed to do well in biathlon in the humility is super helpful. So those two things are good because if you're racing a hundred miles, something is going to go wrong and running. You don't have perfect races when you're beyond 20 hours, you just don't. And so having, you know, biathlon does teach a bit of that, sort of humility but also ability to change with the changing situation. You might come into the range and the wind's coming from a completely different direction than it was when you, when you cited your rifle in and you have to deal with that. Nikki Kimball:                00:05:48           And similarly, an ultra marathon is very common that you come into an aid station and the bag of stuff that you wanted there isn't, or your crew isn't there or something that you expect isn't there. And so that ability to think during the race and make changes to your plan during the race is definitely something is common between the ultra running and biathlon. Shannon Sepulveda:                              Cool. So then when you say graduate school, do you mean physical therapy? And so how did you get into running, cause it sounds like that's where the transition went into ultra running, is that right? Or where the transition to competitive running? Nikki Kimball:                                        Yeah, absolutely. Because I threw 94, I was ski racer, which is sort of a different body type also, more muscular and a lot more upper body mass.  So, you know, through 94, ski racing was the only thing I really wanted to do. And I also was kind of I hadn't raced anything long in running, so I wasn't very, and I wasn't good. Nikki Kimball:                00:06:57           I was fantastic for the middle of the back. I hadn't really realized that I had any ability in running because my abilities not in running, it's in enduring. I always qualified for nationals in D1 skiing. And there was definitely something I wasn't good at. Actually in 94, after a really successful year of biathlon doing well at Olympic trials, I wasn't expecting to make the team because I can shoot very well. Did very well at nationals. And then I ended up getting very sick with depression, losing about 20 pounds and I couldn't even run three miles. Like I couldn't, I couldn't do anything. Nikki Kimball:                00:07:55           I was just sleeping. All I did. And when I went to Grad School, I came in with a completely different body. I mean I lost all my muscle, and really  I was in Philadelphia, so I'm like, well, what can I do? So running was the thing I could do and this was way before most psychiatrists and counselors were thinking that exercise was important for running. But I sort of knew it, you know, I just knew that I could think better, I could function better, all of those things, everything better when I'm exercising. And so it was sort of natural for me to just my daily dose of endorphins that is just critical to me. Even having normal brain function. It would be like I'd have to run an hour a day just to stay sane. Nikki Kimball:                00:08:49           So then I went to graduate school and I'm in Philadelphia and I go and do this 5K race and I win it, and I'm like, what the heck? I am not a runner. This is crazy. And then the store team picks me up and then we just started running longer and longer and more and more trails and you know, so it wasn't something I never set out to be a good ultra marathon runner. It just sort of, it just was what I did anyway. And then I realized it was a support. Shannon Sepulveda:                              Yeah. That's really cool story. Awesome. So what was ultra running like when you started and how is it different now? Cause I mean, how long ago was that when you started? Nikki Kimball:                00:09:38           I started in ‘99, 20 years ago. It was still very, very competitive at the top.  But the fields were not as deep. And there wasn't, you know, it was never talked about in runner's world, I don't think runner's world even knew what ultra running really was. And it didn't really need to create a magazine, but it was like runner's world is for sort of mainstream runners and getting people into running and it's fantastic for that. But ultra running was never something that would even be considered in, you know, for their audience. And I think that's really telling now. They know now they talk about ultra running and that kind of stuff. And ultra running is now becoming appealing to your general public. It’s just not something that's freaky anymore because it's in the running media. Nikki Kimball:                00:10:32           Part of me wants to go back to the old ways where you raced and you had only water at the aid station.  The aid stations might be two hours apart and you want a belt buckle after you set a world record you know, it was great. Not that I ever set any world records, but, that's the trail runner part of me. But that was kind of Nice. It wasn't very commercial.  And now it is more so, but I'm also part of that. I mean I was in films about running several films about running. I was promoting, you know, Nike northface Hoko, which ever sponsor I had at the time. And  you know, kind of using my running to promote basic health and fitness things. And you know, I mean it just, I mean I definitely was heavily involved in media surrounding running, so the increase of popularity of running, I'm not innocent in that. Shannon Sepulveda:                              I think it's awesome. I think it's really great because not everybody's going to be fast at a 5K and some people are really good. It's completely different. Being fast at a 5K is completely different than running a hundred miles. Yeah, it's totally different. And some people are really good at it and some people are not. And some people, the accomplishment of running just running 50 miles or 18 miles or whatever, will get them through, get them on a high for a whole year. I mean, the fact that they can do that. So I think that's amazing. Nikki Kimball:                00:11:54           And it'll get them training for a whole year. Will get them healthier in an age in which sedentary lifestyles our biggest killer, or contributes to it anyway. We really need to make sports mainstream and running is so easy and it's something we don't need special equipment for, you can do it on any budget. And then you can still compete in it. Shannon Sepulveda:                              But I mean, it's like if you were a baseball player, you can't just go play baseball games a lot of the time. But if you're a runner, you can always say, I'm going to sign up for x race and train for x race. Nikki Kimball:                00:12:49           Yes. And so it’s the perfect lifestyle, lifetime sport and you can do it if you're running, you know, if you're running team, if you, let's say you want to do stuff with people, you're running team doesn't show up for a workout. You can do that work out on your own. You know, it can be as social or isolated as you want to be. And I think runners know that, you know, sometimes, you know, you and I are both physical therapists. Sometimes we have a whole day of patients. We want to go out and run the five, 10 whatever miles by ourselves because we're just, we need that break and not talk.  And then other times, you know, you want to go out with a group of 10 people and just, you know, just chat the whole way. Nikki Kimball:                00:13:40           And I swear that if political leaders could do all of their work while running, things would actually work. I mean, cause I swear every, you know, every long run you go on, somebody comes up with an idea that just seems brilliant. Shannon Sepulveda:                              Yeah. And you get to talk to people who believe different things and have actual conversations with people because there's nothing else to do, right. You're out in the woods for four hours and that's who you're with and you can talk about stuff and you're not checking your phone. And now I think it's great. Nikki Kimball:                                        Yeah. And it's something that's so foreign to us in modern times. You know, we're always sort of plugged in and we're always hanging out with only others like us and running sort of takes all that away. Yeah, I really liked that. Shannon Sepulveda:                              And I think, you know, even, you know when I get postpartum women in here and they want to run a 5K after they've had a baby and they're like, well I'm not really a competitive runner. Nikki Kimball:                00:14:37           I just, I really want to run this 5K. And I'm like, that is awesome. I really want to run it in under 30 minutes. Well that's such a great goal. Like let's do that and it's attainable and it's great. It gives people a goal of something to do.  It doesn't have to be 100 miles, you know, like it doesn't, that’s the beautiful thing about running. Nikki Kimball:                                        And I love about ultra and running in general is that different variations on running are becoming popular. Whether it's spartan racing or color runs or you know, like none of those events is going to attract every person, but it's going to attract somebody. And if somebody gets hooked because they like having paint balls thrown at them, like great, if that keeps that person from getting type two diabetes, I mean it's the cheapest medicine we can buy. Shannon Sepulveda:                              Oh yeah. And I think that that's why it's so awesome being a physical therapist because we know how important exercise is and getting people back to that. So like they don't die and they don't get type two diabetes and they don't get heart disease. Nikki Kimball:                00:16:01           And we're not rehabbing their total knee replacements because of obesity. You know? I mean they have a total knee replacements because they earned it. Shannon Sepulveda:                              Yeah. I think it's so great just to be able to have, you know, running become more mainstream so it's more accepted and people are really excited about it. I mean, when you go to marathons and you see people of all shapes and sizes completing marathons, I think it's so cool and it's so different from what it was 20 years ago. Nikki Kimball:                                        Absolutely. Absolutely. I mean, marathons didn't kind of include, they certainly didn't encourage and often didn't allow people to finish a marathon in six hours or more. And now we've got that in there just has to be a place in athletics for all adults because if this is the way we are going to stay healthy in a world that is more and more sedentary, then we need to make it fun because otherwise it's not going to be sustainable for most people. And you know, and we also need to have resources out there for people to do these sports. Nikki Kimball:                00:16:56           And I just keep seeing more and more emphasis on building trails and on making shoulders on roads so that people can safely bike or run or whatever. I think the more these sports grow, the more people demand from their local government that we have trails, that we have safe places to work out. And play and do all those things that are just going to save us money in the end because we're all healthier. Shannon Sepulveda:                              Yeah. No, I think it's great. So let's talk about how has being a physical therapist impacted your career? Nikki Kimball:                                        Probably for the better and for worse. We over analyze everything exactly. I mean, and I'm sure you remember when your first a physical therapist and you're working in general orthopedics and you see people coming in and they're in their sixties and that's old to you because you're in your 20s and you're like, oh my gosh. Nikki Kimball:                00:17:50           I have all these things that are going to happen to me. Yeah. So you start getting these ideas of things that happen with aging. So that's a little, that's actually probably good, a little cautionary tale there, but, for the first 18 years of my ultra running career, I never missed significant time from races, from any running injury. I mean, the races that I missed were mostly from direct trauma cause I fell off something or trail running is a little aggressive. And I also mountain bike and dirt bike and ski race and do all that. So you know, I definitely have had injuries, but they're usually direct trauma, not repetitive trauma. And I think PT has been the biggest factor in that. I mean also I just have good genetics. Having treated every running injury there is, I could see when one was coming up and I think that helped a lot. Nikki Kimball:                00:18:44           Oh, I've got this little thing, Ooh, that's not just muscle soreness. That sounds more like, you know, it band and Oh, maybe I should have somebody look and see if my hip is strong or if I’m overstriding or whatever. And so I think, you know, running is a huge deal and running and prevention of an injury is so much more important than fixing it. And PT has given me the patience for that, you know, like, okay, I know I need to take a week and be water running now because I've worked with so many people who didn't do that and now they're out for four or five months. Shannon Sepulveda:                              Do you see differences in injuries between ultra runners and like your recreational 5K’er? Nikki Kimball:                00:19:35           Yes and no.  Your recreational 5K’er often it's their first year running and they're much more likely to get injured and injuries that are completely preventable. Just because they just sort of get into it without any guidance. Ultra runners first of all, probably have the genetics that allow them to run that long. So they're probably mechanically more, more ready to run ultras. And then some of the ultra running injuries we see are just like, they can be really serious because we can I think once we're out there racing, to be successful, you have to be able to put pain in a little box or just sort of deflect it. And you really don't, like when I was racing, I really didn't feel pain so much cause I could just sort of play in my head with it. And so you can get people who in ultra running who will go into a race with a stress fracture and it becomes a frank fracture. Nikki Kimball:                00:20:35           And I've seen that with several ultra runners and you know, that's not your recreational 5K runner might get a stress fracture, but they'll probably actually going to go seek help while it's still a stress fracture and not going to let the bone actually break in half. So sometimes runners, ultra runners can be a little, aren't good at using pain as a guide. I think your recreational 5K runners going to come into when their knee starts hurting or their ankle starts hurting and they're gonna be like, Hey, something's funky here. And so I think those recreational 5K runners are much more likely to get injured, but their injury is also going to be much easier to manage. And ultra runners were all, I mean, most of us I think are addict to the sport and to running and to exercise. And you know, I just know how tempted I am to run if injured, you know, cause I have to work out or I'm just staring at the wall being brain dead. I mean, I really like without you know, at least a few times a week infusion of endorphins I don't function and I think a lot of our ultra runners are that way and we can so we basically go until something's really bad. Shannon Sepulveda:      00:21:51           So I'm always interested in like the mental aspect of pain.So when you were like racing in your, you know, cross country racing biathlon you're like super anaerobic, like you gotta get over that governor in your head that says slow down. So that sort of mental capacity for pain versus I'm on Mile 90, I have pain everywhere. It seems like a different type of pain. Do you classify those as a different type of pain in your head or are they kind of the same? Nikki Kimball:                00:22:20           I think in my head they're the same or similar. In ski racing I could always say, or in biathlon, well I'm going to lie down at the end of this kilometer to take a bunch of shots. So you know, you know that that pain is, is there, but I think I dealt with it mentally by, it's going to be over very quickly and it always was. So in that it's somewhat different but so in ultra running you have less intense pains but for a lot longer period of time. And so I don't get to say, oh well it's going to be over soon because this, now you have another four hours left. And I think that got me to the point where I would think of pain as this is just this neural sensation. Nikki Kimball:                00:23:09           It's nothing more than that. There is no reason to put any emotion into this sensation that's coming in. I mean, I think part of what gives pain its power is fear of pain. And in an ultrathon you have long enough to think that you have to deal with pain in a different way. And if I can just take the power away by saying, okay, I have a nerve signal telling me that my hip hurts or my knee hurts. But that's all it is. It's just a neural signal. And because I think the anesthetic effect of our chemical changes when we run, we can do it. I mean I don't think I'm really tough about pain. Like if it's just, if we're just sitting here and you know, somebody hits me, it's going to hurt just as much, but while I'm running I can take so much more. Nikki Kimball:                00:24:04           And as long as you don't fear it, it's just way, way easier to tolerate. Shannon Sepulveda:                              It's so interesting cause it's like when I hear you talk, there's such similarities to chronic pain and like what we know about chronic pain and how as like PTs we treat chronic pain where it's like, you know, these are just neural sensations coming in. The brain controls where you are, what you're doing. Do I need to get out of here? You know, and how we gradually increase people's exposure to certain things to get them out of chronic pain. So when I hear you talk, that's like exactly what I think of. Like you think about it as a neural sensation, not, you know, this emotional response that you have to like give into. Nikki Kimball:                                        Right, right. And you know, I think that ultra running can be a very good metaphor for life in many ways. Nikki Kimball:                00:24:57           And that's one of the ways, and I think that medicine, both physical medicine, physical therapy plus medicine, human medicine are starting to research ultra running, which is incredible. And I think, I think we need to look at things like ultra running for managing chronic pain. We need to look at ultra running to see. But I think we need to do more and more research to find like what is it that benefiting here? I think it would be extraordinarily hard to thrive through chronic pain. I mean, we've both worked with so many people with chronic pain and it's really, really horrible. But if you can, you know, do you just give up? I mean there's no, we don't have like a pill form now, we don't have anything that will just kind of get rid of it right away. Nikki Kimball:                00:25:56           Nothing. And so we have to be able to manage it. And I think ultra running is about managing stuff and so maybe somebody in medicine finds out what, you know, what factors allow us to thrive despite that pain, to win the race despite the pain that we're in. And certainly there's a lot of research out there on mental health. What is it, you know, we know there is, you know, six or eight different things that were changing when we're running that might affect our cognition and mental state. Like, you know, what is it we don't really know. But we know something about running is lessening the effects of depression and other mental illnesses and we know that is lessening the effects of some pains. Nikki Kimball:                00:26:44           So it's just this brilliant area of untapped research or a research opportunity. I mean, there's so much out there and it's very much in its infancy. But you are seeing people being serious about running medicine now. Shannon Sepulveda:                              Yeah. It's really interesting when I hear you say manage the pain because that's like when I have conversations with my patients that have had chronic pain for years. I have a conversation of like, this is chronic, we are going to manage it. You're going to have flare ups and you're going to manage it and it's gonna get better. But at some point you're going to have a flare up and it's going to be okay. And so when you think about managing versus curing, it's, I guess very similar to ultra running like it is, I'm in mile 80, I'm going to manage this, right, because I've got to finish it and it's going to flare up and I'm going to manage it and it's going to get better. Nikki Kimball:                00:27:37           Yes, exactly. And I think this is where all types of medicine need to come together. I mean it's neuro, psych, it's mechanics, it's all of those things. Because how else are we going to let people live quality lives with chronic pain or mental illness, any of those kinds of things. And ultra running is sort of microcosm and like, it's like, yeah, like your whole, you know, it's like a lifetime. And, you know, 100 mile race. And so I think there are really important pieces of information in there that can be applied to our world in general. Shannon Sepulveda:                              Yeah. That's so interesting. Okay. So the next thing I want to talk about is gender equity in ultra running are running in general. Both prize money, sponsorship, but also physiologically. So which one do you want to start with first? So to just talk about it, because I know you're a very good advocate for women and gender equity and this is a problem in many sports. So let's talk about the problem in ultra running. Nikki Kimball:                00:28:52           It is, it is a problem and in many sports. I must say on the good side, just to start this out on a good note the changes through my lifetime and how women are treated in sport has been amazing. I mean, when I started racing in the 70s, you know, there were oftentimes, you know, races just for men or you know, the men would get prize money and the women wouldn't get any. And that was really, really common. We just sort of expected that. Nikki Kimball:                00:29:42           And you know, all through high school and college, and this still happens unfortunately, you know, being a high level ski racer, the women, we would race 5K when the men would race 10K and you know, that stuff is still happening but getting better hopefully sometimes that's changing. And sometime in the 2000 odd you just really stopped seeing prize money be different. Because  prize money is so transparent and you know, there were still a few holdout races that would prize the men and wouldn't prize the women. And in Europe that was very common, which is kind of shocking to me. But many, many races, money for the men and you know, something cute for the women and the fights for gender equity already had enough traction behind them to finally, to really call out race directors who didn't prize equally. Nikki Kimball:                00:30:52           And with the Internet and with everything being freely, with being able to get that information really easily from your computer, race directors would look really, really horrible at this point if they weren't prizing equally. And so the last 15 years has been pretty good that way. Then we have sponsorship. And most of our contracts tell us we aren't supposed to talk about how much we're getting paid. And that's a brilliant strategy by the marketing people for, on these big companies that sponsor runners because why pay a woman what she's worth when you can pay 12 times less? And that's not an unreasonable that actually I have seen that in order of magnitude difference between males and females, why pay or that isn't, you know, if your customers, when they go to buy that jacket, don't know that, you know, Sarah gets paid 5,000 a year and Joe gets paid 10,000 or a hundred thousand a year, why would we, you know, why would they pay that? Nikki Kimball:                00:32:00           And I think that's the next area to go or to get down, get down to and really dig into hopefully the last one. There's still other subtle forms of sexism that happened, but this is still a major, major form of sexism that's happening. And I've thought through my professional career and then once I started trying to add up how much I would have made if I'd done the same thing as I did but be a male. And once I realized that I would probably have an extra house in the most expensive part of town, I decided to stop torturing myself. And so some sort of transparency there has to happen. But the other, the subtle stuff, some athlete contracts give you bonuses for getting their logo in print media or on television or all those things will still look through the sports pages in any local paper. Nikki Kimball:                00:32:58           And they're still often, you know, eight pictures of men compared to one picture of a woman. Or, you know, even if it's two men to each woman in the sports pages, that's money we're not getting because you know, you're not in the picture. I won the race. But the guy's winner gets in there and you still look at Wikipedia. If you look up Wikipedia or any of those race sites or running sites. They'll often have, you know, they'll talk about a race and they'll say, you know, the course record is held by, and it's always the guy. I also have the course record, right. But so then again, the men gets so much more promotion from media and all of that. Nikki Kimball:                00:33:46           And then that gets the sponsor's thinking that they have a better return on investment from the men because the men are like, look, here's what you know, here are all the newspaper articles I was in, magazine articles I was in. So those more subtle types of sexism are harder to fight. And I think some of us are doing it. Gina Lucrezi is an ultra runner and very solid alternative, but also really great supporter of women's ultra running and has started a company called trail sisters that is huge and just getting bigger and bigger and it is to address some of these issues and also address other physiological issues that women have to fight, have to face. These things are happening. It's just not as fast as I'd like. Shannon Sepulveda:      00:34:41           I know it's so hard. I mean, I feel like the same thing happens even with like small companies and like they've just had to like fight tooth and now just to even like get, you know, compared to Nike or something like that, just even get themselves and they're a running company for women, but, no matter what it seems like we're fighting an uphill battle. Nikki Kimball:                                        Yes, we are. And you know, I remember it just a few years ago, I had a couple of women runners I was treating and I was like, Oh, you know, we get into the talk about sponsorship money. And I'm like, well, they've got to be doing better than I did. And you know, both of them were like, yeah, we're about 25% of what the men were. Nikki Kimball:                00:35:29           I'm like, well, that's better than I did at my worst. At least they're not getting one 10th, but yet again, it's still, it's not okay. Shannon Sepulveda:                              It's not. Okay. And so what do you think we can do? Nikki Kimball:                                        I think we talk, we keep open dialogue. We support people like Gina who have trail sisters. We support brands like Oiselle who are trying to make a difference. And I think that each of us you know, each female athlete is one cog in the machine of getting female athletics taken seriously. I mean there was a time when women weren't allowed to run a marathon because our uterus would fall out, which makes a lot of sense as a women's health specialist. It's gross when it happens. But each of us just does her part to make it a little bit more fair. Nikki Kimball:                00:36:30           The unfortunate thing is each of us doing our part makes us less sponsorable. Cause if I'm out there whining about the sponsors treating me poorly versus my male counterparts, they're not going to want to sponsor me. But at this point, it doesn't matter  I'm past my professional career anyway. But I do know I probably could have been more quiet and you know, tried to look cute and race that way and because you need and probably that would have been better for sponsorship. Cause you definitely notice that the women getting on covers of magazines, it's not necessarily the fastest ones, but they're always cute. And that's not so much the case in the mens. I mean, I'm sure men face it in some ways, but I don't think that sponsorship has as much to do with how they look. And if they're willing to put pictures of themselves in a sports bra as their profile picture on Facebook or whatever. It's just a huge, huge topic. Shannon Sepulveda:      00:37:19           It is. I know it brings me back to, I played tennis when I was younger and so it brings me back to a New York Times article awhile ago on Serena Williams and Sharapova and it was just like, how much more money she got.  She's pretty.  Nikki Kimball:                                        That sort of Sharapova thing happens everywhere. Shannon Sepulveda:                              So let's talk about physiology. When are the women going to beat the men? Nikki Kimball:                                        Women beat the men when the race is long and difficult and has really bad conditions. Nikki Kimball:                00:38:24           Men do have a physiological advantage. Yeah. They absolutely do.  That's why we need a men's race and a women's race because they absolutely have a huge physiological advantage. However, when stuff gets bad, women thrive. It was so cool to see. I know that if I'm in the last 10 miles of a hundred mile race and I come upon a guy, I'm going to beat him. If I come upon a woman, it’s on and that's not just because we're competing against each other because I see this in my practice as well. Due to biological differences we do tolerate pain better. Is that biologically something that happens so that we can survive childbirth, you know, I don't know, I think it is a real thing. Nikki Kimball:                00:39:17           Like I think that pain probably hurts more for a guy then for a woman on average. And that's totally on average, but women just push themselves, so they're just able to push through so much. All the times I've been in a national or world class event that I've been on the men's podium, which has been three times it's been bad conditions. One of the hottest years at Western states, I was third out of the men and you know, there were a lot of men there who could have beaten me, but they, you know, it's super hot and they're just dropping like flies and the women are just kind of like were fine. So there's gotta be, you know, something going on there and how much of it is so is social construction and how much of it is biology and how much of it is psychology and you know, all of these things playing a role. Nikki Kimball:                00:40:13           I do know that we do relatively better to the men when things get tough. Shannon Sepulveda:                              It's like grit. I wonder if, I'm just thinking about, since I'm a women's health PT, like sleep deprivation, I wonder if women deal with that better than men do just because of we have to, we have newborns. Same thing with pain, like you have to deal with it in childbirth. Nikki Kimball:                                        And whether we have kids or not, right? We still have those genetics to say, how would humans continue to continue? Evolve, how would any of that happen if we went, couldn't go nights without sleep and a very, very painful pregnancies and deliveries. And then come back from the aftermath of delivering a baby, which is just like, it's just something that doesn't happen in any other part of our lives. Nikki Kimball:                00:41:11           We just don’t go rip tissue, men don't experience that. I haven't experienced that and I'm not sad to miss that. We have to be able to do that and it would make sense evolutionarily that we have some, you know, women have some capability to withstand and thrive through pain that men may not have as much access to and we also have to forget about it and do it again. Shannon Sepulveda:                              Right. That's the other thing. And I often wonder that I'm like, Gosh, we just forget about that so quickly. Like with childbirth. It's like in a couple days or a week, you know, you forget about the pain. And I often wonder that with like, you know racing. you just forget about it. You're like, oh, I forgot how much that hurt. Nikki Kimball:                                        And you remember that at mile something in the race and you're like, while you're racing, you're like, why did I sign up for this again? Nikki Kimball:                00:42:12           And that's regardless of sex because we all feel it. And we all come back and do it again. There's something greater about running and racing than there is about pain. Shannon Sepulveda:                              Do you feel like physiologically in the last 20 years, like women have made incremental gains as far as like ultra running? Are you feel like it's always been like the popular. Nikki Kimball:                                        No, I don't think physiologically we really have changed. But I think that, and this, it goes across from men and women, is that there's just more people doing the sport. So we are with greater numbers. We're going to have more fast people and those more fast people are going to teach other, the ones who come behind them. Nikki Kimball:                00:43:16           And like records always fall, right? Like why did nobody run a four minute mile until Roger Bannister did? And then everyone starts running, well, not everyone, but many, many elite men were running for a minute sub four minute miles. It wasn't that he was physiologically different. He was just the one to be able to say, no, that's not a barrier. You know, and I think that every time one of us breaks a record, it gives the person behind us that confidence that if the course record used to be 20 hours in and now it's 19, well now we know we can break 20 hours. And then so everybody comes to I think there's such a huge mental component to this because we certainly don't evolve that quickly. And granted, there's so much more media attention and money. Nikki Kimball:                00:44:06           I mean, like people are now guys are making a livable wage. So few of them, you know, from running, maybe a couple, maybe some women are, I don't, I don't know. I don't think so. But we're starting to see, you know, we're starting to get a lot of gain. And also, you know, my generation of ultra runners, the women were all, we all had to work full time who aren't getting paid or we weren't getting paid well. And so, you know, I think of course records going down and people getting faster, and that's just a natural evolution that happens in every sport. I mean, the science behind it gets better, the training gets better, the food gets better, I remember one year, this guy writing, oh, my time at western states would have won in 1970 whatever. Nikki Kimball:                00:44:55           And I'm like, let's talk apples to apples in 1970 you would have been in a canvas shoe and you might've had a potato chip and a couple bottles of water. I find that very frustrating. I do think that each generation, it's still going to be the same qualities that bring those top people up. We do bill, like I wouldn't have run the times I did had people not done similar things before me. I wouldn't have even known that that was something to go for. And so each of us who publicizes the sport and who does good things in the sport makes it easier for the person coming up behind him or her. Shannon Sepulveda:                              How long does it take for an ultra runner to peak? Like how many years? Nikki Kimball:                00:45:45           That's a really good question. Honestly the science isn't there. We are evidence based practice for us physical therapists is so, so important. How do like do evidence based practice on somebody who's an ultra runner? I tried to extrapolate from studies done on a marathon or maybe, but they're not even that many studies on those folks. So you know, I really don't know that we know that, but I do know a couple things. One is that people tend to have a race career of somewhere between like three and 10 years where they're really, really good, but they don't seem to have much longer than that. Like, there's a steep drop off in speed at some point. And is that mental, is that physical? Nikki Kimball:                00:46:38           I’m not sure how linked it is to actual chronological age. You know, you might fly in your twenties and then by 31 you're kind of done, or your best 10 years might be 40 to 50. Like it just, it seems that there's some equation out there between age, miles on your body and you know, hard races run and length of duration of your running career that would sort of point to, you know, when you might be best. But I've seen, you know, I peaked at 36, I've seen people peak in their forties, people peak young, you know, so it's all these n of one groups. I mean, it's really, I love to know more it, but it's just so multifactorial. How would we ever study it? Shannon Sepulveda:                              And everybody has different backgrounds and high school in college. Shannon Sepulveda:      00:47:39           Right. So this would be a great transition to talk to you about hardrock this year. For those of you who don't know, Nikki came in second. And we were all cheering her on like on irunfar.com, so just tell us about that, your age and how that impacted you. Nikki Kimball:                                        Yeah, hard rock was amazing. It was easy to get into it in the nineties and now is so popular that thousands of people apply for 140 something spots. So anyway, I've tried to get into it for years and I finally got in and I knew that at my peak, I would run that course really, really well. It was really made for me. It's super, it was really high altitude. You know, you're going over many peaks over 13,000 feet. Nikki Kimball:                00:48:39           You're not getting below 10,000 feet very often. I mean, it's just, it's just fantastic and it's exposed and it's rocky and it's gnarly. And it's just a steep and fun and 31,000, 33,000 feet of gain and a hundred miles. It's awesome. So part of me really wanted to run it when I was younger and really, really strong because I'm hours slower in a hundred mile race than I used to be. I mean hours. So for this race, you know, finally get in, I know I'm not at my best. I'd also been battling an injury from a snowshoe race that really, that finally took me out later in the year. I had actually been training for about four months because of this injury had sort of taken me out for a while and I had four months of really fantastic training going into that. So not a lot, but I still had 30 years of competition to go back on, or 40 years actually of competition to go back, fall back on. Nikki Kimball:                00:49:41           So, you know, so I get there and I know I'm not at my best, but I also know that two of the other top women in the race are also in their forties. And you know, none of us were all way past our prime. And one person who was, who was young, who, you know, who won it, you know, she's 20 years younger than me, she better be able to beat me. So it was just this magical race where we just start, you know, you just running along and talking to people cause that's a big part of ultra marathon culture is amazing and shifting with the influx of money and influx of people self promoting on social media. That stuff's really, really frustrating. But, hardrock the spirit of hard rock is very much in that old school, ultra running. Nikki Kimball:                00:50:34           We all want to get into the finish. I mean, yes, we're going to compete against each other, but we're also really supportive of each other. And we are having a few people in the sport who aren't supportive of their competitors and that's really, really sad. But at hardrock I ended up, you know, in this group of people, one who was a PT, a pre PT student of mine. He and I along with Darla, ask you the Darla ask you and somebody had a couple of other people ended up in this group and the six person group and Jeff was my student. He and I were having a competition to see who could tell the most bad jokes. And so that was really fun. And this is the first like 20 miles. We're just kind of like chill and having fun and you do things like talk and tell horrible jokes because it makes the time go cause you can't race for all 30 hours, you're going to race for the last couple. Nikki Kimball:                00:51:28           Sort of having that community around me just made me happy. I was running well, you know, running up towards the front and I had a bit of an explosion. Like, I just, you know, you have really bad patches and I had this massive just meltdown after one aid station and I just kind of walking up through the woods and frustrated and I know, and all I'm thinking is even five years ago, I would be, I'd be four miles ahead of where I am right now. And it was really hard and I've been dealing with the slow down for at least eight years at this point. And I just laid down in the middle, you know, like mile 29 I just laid down in the woods where nobody could see me and just sort of thought about age and really had this sort of amazing epiphany of like, I was just, I mean, I laid there for like 15 minutes. Nikki Kimball:                00:52:34           But just thinking about, you know, why, why am I expecting myself to still be on the podium for the men and all these races when these men are now 20 years younger than me? And, you know, this is like, like I am asking my body to be what it was when I was 30, and when I was in my mid thirties and I’m 47. Like it was amazing to finally, after fighting and fighting and just being like, why am I slowing down? This is so frustrating. I'm training just as hard and I'm getting slower and now that the sports popular and people are winning with times that were easy for me at one point in my life. And, you know, just that sort of Sour Grapes of, uh, and it finally sort of occurred to me that, you know, in this little part of the race, and this is what ultra running does, is it pushes you so far that you have to think beyond the way you would think in normal situations. Nikki Kimball:                00:53:30           And it finally sort of dawned on me, and this should have come more easily than this, but that I should be celebrating what my body can do instead of what it can't. I mean, I'm 47 and still running, you know, a hundred mile race with 30,000 feet of gain and being on the podium. Like that's huge. And I'm doing it with people I've run with my whole life and with people who, with a former student of mine who is now just graduated PT school and he actually ended up second for the men. So we ended up sharing the podium spot and you know, he's 20 years younger than me. And it just made me think about what's important in ultra running. And really what drew me to it is that I love running in the woods and that I love the mental clarity that comes with running. Nikki Kimball:                00:54:28           And I love the community of people who do this sport. And you know, like you sort of getting back to that despite a massive slow down in my racing was critical. And it's something that I've just been fighting. I've been fighting a cancer, my body changing rather than sort of managing it. Like we talk about managing chronic pain, managing depression, managing these things. We had to manage our aging and instead of just, you know, I was totally know my body doesn't obey the laws of physiology. I'm not aging, Duh, Duh, Duh and, but you know what I am. And I had to give myself a little permission to do that. So hard rock really, really gave me that back. I mean, yes, I was probably five hour slower than I would have run it when I was 35 but I should be 47 and I have 90,000 miles on my body. Nikki Kimball:                00:55:28           Like I shouldn't be fast anymore. Shannon Sepulveda:                              And you still came in second which suggests you got faster, like literally like this epiphany and then you're like, I can just do this. Nikki Kimball:                                        Yeah, kind of cause I had, you know, been caught by a bunch of people and then I just sort of gave up the results. This is hard rock. Like this is the race. People sell their soul to get into like, I'm here in the most beautiful mountains of San Juan mountains are stunning. I am having this catered hundred mile trek through this beautiful country with amazing people. That's what it is, you know? Yeah. Winning races is cool and that's fun and it's great, you know, like it's a huge ego boost and all that but it’s pretty shallow. Nikki Kimball:                00:56:22           It is fleeting. Like you might win now, it doesn't mean you're going to win the next time. I mean, you know, there has to be something much, much bigger than results to get you to do the sport. And I think giving up any care of where I finished and just being like, you will finish this, you know, it's a gift to be able to get into this race unless you're injured, you better finish. It was just a good sort of cap to my running career. Shannon Sepulveda:                              Yeah. It almost seems like that's almost a gift of aging because maybe you couldn't think like that when you were 35 and you did have another race. You know, like, I could never, I always did have the next thing and now you're like, I can just do this for fun. Nikki Kimball:                00:57:13           Right. And I can coach other people and coach them in a way where I attempt to use my physiology but my physical therapy knowledge and help them to run without injury or to get any injury that comes up. We treat it immediately, we immediately manage it. We don’t run somebody into the ground and there's so many people coaching. There's no oversight in coaching, you know, who maybe took a three day course and have a certification. That does not make them a knowledgeable coach. And we're seeing that all the time. And so I like sort of, I love that I get to coach and I usually I keep about eight clients at a time because I don't want more than that because then I can't take care of them. Nikki Kimball:                00:58:11           I can't help them. And I want people to love running and I want it to be, I want it to be healthy. In a lot of the people I work with used running as part of their mental health treatment plan. And if you're treating depression with running and you have an injury, it's disastrous. You could die. Keeping people running healthy is my new thing, you know, like that's my, you know, it's like, okay. Yeah, it was great to, you know, be the best ultra runner in the trails runner in the world for a while. That was awesome. That was really fun. It was great. Now it's more about like, what running's really about and what am always has been about. But I probably lost sight of when, you know, traveling the world and you know winning stuff. Shannon Sepulveda:                              So let's talk about your coaching because it would be pretty cool to be coached by a world champion, technically one of the best in the world. So tell us about your coaching and what you do. Nikki Kimball:                00:59:23           And so if my clients, I coach people locally, I mean, you know, I sort of just starting, I've taken people under my wing my entire running career and sort of coached without coaching, you know, and now if I coach people locally, it's amazing because I actually get my hands on them, you know, I can do a screen of where are they tight, where are they strong, where are they weak, where they loose, where, you know, is there something funky going on with their running? Has somebody tried to change their running gait? Because that usually messes stuff up because you have all these people who, you know, went to a CI running course and think they know my biomechanics and usually massive changes to people's gait gets them injured. Nikki Kimball:                01:00:11           I just like being the person who runners can come to for physical therapy and for coaching who could hopefully do a better job of predicting and avoiding injury. I've treated runners for 20 years as a physical therapist. I mean because our evidence isn't great, we have to combine mechanical knowledge with physical therapy evidence on sports that might be similar and on our experience, I mean I can't, I just look back to the 1990s. I'm like, how the heck did anyone I treat get better. You know, like it was luck. Cause you know, I think of all the mistakes I made in my first, and I'm still making mistakes, but the horrible mistake I would make, things I would miss and my first 10 years of treating runners, I mean just, I mean I think that's what I can offer. Nikki Kimball:                01:01:10           And coaching is something that's just well beyond what, you know, your person who never studied physiology or mechanics or something and there are some people who are self taught coaches who are very, very good, but they have a lot to catch up on. Shannon Sepulveda:                              And do you coach remotely to your work with like physical therapy remotely? Like you do the screen, tell me what you found. I'll do the coaching. Nikki Kimball:                                        Absolutely. Absolutely. And I think that's critical. The hard thing is knowing who the physical therapist is in that area. I have a Bozeman client right now whose wife is on sabbatical from the MSU. So He's traveling around. So when he's in another place, like who do I send them to for PT? And I don't insist, I mean I need hands on the people who I coach if I can, like I want to know how they're doing, but I'd certainly don't insist that they use me as a physical therapist that's referral for profit and I don't, I'm not okay with that. And there are fantastic running PTs in town. Nikki Kimball:                01:02:19           I've got great people to send my people to and sometimes they come to me often they do and that's great too. But if I'm missing something, I want to call in another therapist because why not, why not use that knowledge that's there? So really what I found is the best thing I can, the best thing I've come up with, with getting, working with a PT, if I don't know the area, is having the athlete go to the running store, they're running specialty store and say who's good here. Not to say that it's always going to give you the best result, but, you want to go to a therapist who has seen runners, who's worked with runners, because it's just a different skill. I mean, you're not going to come to me for neck pain because like, no, I give you really a problem. Nikki Kimball:                01:03:06           So I think that can help. And then physical therapists who specialized with treating runners were super geeky about it and we love when our patient comes and says, Hey, can you talk to my coach? She's also a PT or ex phys. I mean oftentimes or physiologists. I mean, you know, like what I, you know my strength and in biomechanics I also have a weakness of physiology cause we don't study it as much. So it's great to be able to talk, you know, if one of my patients says, Hey, I want you to talk to my coach. And they sign their release. It's fun to talk to their coach and be like, Hey, and you just, you know, the coach is going to see if it's something different than the PT is and you know, and you really work together. I love that part of it. Shannon Sepulveda:      01:03:51           Oh yeah. I mean even with me and when I have, you know, women who come to me that leak when they run and I'm like, I'm really good at making you not leak when you run, maybe making you not have prolapse symptoms when you run. I'm not your performance coach. Like you go see experts and experts and an expert and they're going to like Dork out on the stride and you know the form and everything. Right. But I can help your pelvic floor when you're running. Exactly. And that's why we specialize. I was like, you know, you can geek out with running. Nikki Kimball:                01:04:33           Like I could go to so many courses and I don't have time to do that. It's not my forte, but these people are really good at it. And the thing is you're really good at women's health, pelvic floor stuff because it's what you do. And you applied the geekiness of pelvic floor health that I applied to running. So of course, yeah, of course. I want my person with incontinence to see you and my person who was a runner to see me and I think if we all shared it would be great. Shannon Sepulveda:                              It would be so great because as you realize how much more you don't know, even when I have an injury, I go see a PT, like I'm not treating myself. I don't do stuff right. I never do it. So I think your PT tells me, he tells me to do it, I do it. And they do hands on things that are just so different. And so I go see a PTs all the time for my stuff because I'm really good at what I do and they're really good at their niche and what they do. And PT is such a huge field that you can't be good at everything. Well, so where can people find you if they want coaching? Nikki Kimball:                01:05:20           I've always done it word of mouth, but it's Nikkikimball@yahoo.com is sort of my public address that people can reach me at. Facebook doesn't really work because I get frustrated, but don't answer stuff. I just love coaching people of all levels, you know, but again, you know, I'm going to coach somebody for mostly ultra running or I love coaching, people in their fifties, sixties, seventies for shorter distance stuff because I think masters in veteran athletes, you know, athletes over 50 have, you know, they have so much to gain from sport and the book knowledge I have, there is no way I could have coached people people past, you know, 45 and before I realized a massive slow down myself. Nikki Kimball:                01:06:46           It doesn't matter that you get it intellectually. You don't get it until you feel it. And when I'm three minutes a mile slower than I was at my best, you know, you know, you know, age is something. Shannon Sepulveda:                              It is, it totally is. I mean, it's the same thing when, you know, I have pregnant women that I've never had a baby before and then want to run a, you know, I thought I could run a 5K like eight weeks after I had a baby before. Because when you don't know, I know it happens to you and then you're like, oh yeah, like I do get sore with age. Childbirth does something to your body, right. You don't know until you experience it and you can't expect someone to know that you can't. Nikki Kimball:                01:07:39           The other thing, I mean, it's not like all parents throughout history haven't told their kids. You just wait. Sony. I mean, but it doesn't matter. We can say those things. It doesn't, it doesn't, you don't get it until you go through it. I mean, and I think book knowledge is super, super important and evidence and all that, but experience can't be discounted. Shannon Sepulveda:                              Well, and it's also really nice to have someone that has gone through it and knows because you want someone that has been through it and knows what to do and has experienced that. So they can have empathy for you as a person, as an athlete, and assist you. Nikki Kimball:                01:08:16           And also, you know, if it took me nine years to come to terms with my aging as an athlete, well, why would I expect my 57 year old runner to be okay with running a 30 minute 5K when she used to run a 20 minute 5K? Like how? Yeah. You know, like, it's important, you know, to have gone through that too, you know, I don't know, you know, seeing as it took me forever to teach myself that lesson and I still don't think I'm completely there. I don't know how well I do helping people through that. But I wish I had had some buddy who had gone through that slow down with me when I did. Shannon Sepulveda:      01:09:12           Thank you so much for coming on the podcast. We'd really, really appreciate that.     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 Align Conference in Denver, Colorado, I welcome Kory Zimney and Jessie Podolak on the show to discuss why language matters to patient care.  Dr. Zimney is an Assistant Professor within the Department of Physical Therapy at the University of South Dakota, Senior Faculty with International Spine and Pain Institute (ISPI), and researcher with Therapeutic Neuroscience Research Group and USD Center for Brain and Behavior Research. Jessie currently owns and operates her community's first direct-pay physical therapy practice, seeing a variety of patients with acute and chronic pain conditions. She has been teaching pain science and manual therapy techniques at continuing education courses since 2013. In this episode, we discuss: -How language affects your actions -Looking at language through the patient perspective -What is negative effective priming -Ways that you can enhance your communication style -And so much more!   Resources: Align Conference Kory Zimney Twitter How to make stress your friend Ted talk   For more information on Kory: Kory Zimney, PT, DPT has been practicing physical therapy since 1994 following his graduation from the University of North Dakota with his Masters in Physical Therapy.  He completed his transitional DPT graduate from the Post Professional Doctorate of Physical Therapy Program at Des Moines University, Class of 2010. At this time, he is in the candidacy phase in the PhD PT program at Nova Southeastern University.   Currently Dr. Zimney is an Assistant Professor within the Department of Physical Therapy at the University of South Dakota, Senior Faculty with International Spine and Pain Institute (ISPI), and researcher with Therapeutic Neuroscience Research Group and USD Center for Brain and Behavior Research. His primary teaching, research, and treatment focus is with pain neuroscience, therapeutic alliance, and evidence-based practice for orthopedic injuries of spine and extremities.  He has published multiple peer reviewed research articles in these areas. Past work experiences have been with various community-based hospitals working in multiple patient care areas of inpatient, skilled rehab, home health, acute rehab, work conditioning/hardening and outpatient.    He has completed the Advanced Credentialed Clinical Instructor program through the American Physical Therapy Association and is a Certified Spinal Manual Therapist (CSMT) and assisted in the development of the Therapeutic Pain Specialist (TPS) through the ISPI certification program; and has a Certification in Applied Functional Science (CAFS) through the Gray Institute.   For more information on Jessie: Jessie received her Master's Degree in Physical Therapy from the College of St. Catherine, Minneapolis, in 1998. She completed her transitional DPT from Regis University, Denver, in 2011. She has been teaching pain science and manual therapy techniques at continuing education courses since 2013. Jessie currently owns and operates her community's first direct-pay physical therapy practice, seeing a variety of patients with acute and chronic pain conditions. She has special interests in manual therapy, Pilates, spine and running injuries. She is a certified clinical instructor through the APTA and has completed her Therapeutic Pain Specialist certification through ISPI.         Read the full transcript below: Karen Litzy:                   00:00                Hey everybody, welcome back to the podcast. I'm your host, Karen Litzy coming to you live from the align conference in Denver, Colorado. And I am fortunate enough to be sitting here with Kory Zimney and Jessie Podolak and we're going to talk about the workshop that they did yesterday and will probably do again tomorrow on moving our language and why language matters around people with persistent pain. So my first question is why does it matter? Jessie Podolak:                                      Well, words are powerful. We started off by just doing some cool quotes that words change worlds, right? And words can pierce like a sword.  The tongue of the wise brings healing. And that's just ancient wisdom, right? We've known that words just have so much power. They shape our perceptions, they shape our action.  We know even from the research, just how we look at something.  So for example, one of the studies we cited was if crime is presented as a beast, okay, crime is a beast versus crime as a virus. Jessie Podolak:              01:12                When crime is presented that way with just those two words. And we survey people and we say, what should we do about crime? Those who hear crime is a beast, 71% say we should increase law enforcement. 51% of those who hear crime has a virus say we should increase law enforcement. So the word evokes more of an action response when we hear the beast versus virus. And other one was the economy, is the economy stalled or is it ailing? If the economy is stalled, we jump start it, right, stimulus package. If it's ailing, maybe we take measures that are really going to do long term change. We look at education levels or socioeconomic things and what can we do with this economy? So words shape so many things in general and in healthcare, the word surrounding pain, can evoke a lot of fear. Jessie Podolak:              02:08                They can evoke a lot of a knee jerk reactions of what needs to get done. It can kind of force us to look at these more short term solutions. And I think that's been a theme emerging throughout this conference is that there's so many things that we do that are helpful in the short term but can actually be harmful in the long term. So the words that we have surrounding pain, probably lend themselves many times to short term solutions. And if we want to look at really a sea change in how we approach pain, we've got to think and consider our language. Kory Zimney:                02:45                When we look at what we're just talking about, you know, a lot of people, I think they look at it and they go, well that's just a little change. You know, it was only 20% different. What's the big deal? And to me, you know, and it's all about nudges, that a lot of times it's just these little changes that can make huge difference for some people. And I get for a lot of people it probably wouldn't make a big difference, but if it did make a difference for a person, why wouldn't I want to try to maximize every little opportunity that I could get? And I know some people look at it like, well, I don't think language is that be all, a lot of people I can tell arthritis and they don't have a problem because I used that word and I get that. But what about that one person that it did make a difference for? How do you know it didn't make a difference for somebody? And if we have good evidence that shows that these little changes can make a difference, why wouldn't we try to maximize every little bit of that? Karen Litzy:                   03:33                Yeah. And I think that harks back to Kory to what you said this morning about everyone in the room has probably treated one person in pain and that's great. You treated one person, but you can't extrapolate what works for one person to a population. And so I agree that I think in as much as saying, do no harm, changing words around that might connect with someone I don't think is going to be incredibly harmful. By reframing words that maybe we know might be a little harmful. Like arthritis or what are some other ones from yesterday? Jessie Podolak:                                      One for me was wear and tear. How often do we say wear and tear. And what's the first thing that pops into your mind when you hear wear and tear? What's an object? Yeah, the tire. And what's that gonna do? It's gonna blow. Jessie Podolak:              04:24                Right? So if I say you have wear and tear, what is kind of even a subconscious thing? They're just waiting for it to blow. And how does that influence your movement? How does that influence the adventure you have in life? How does that influence your whole being? Just knowing I have wear and tear for some people they might say, well I don't care. I'm going to wear it out. I'm going to grind that thing to the ground. But for others they might say, oh my gosh, these tires have to last me another 20 years. I better take really, really good care and back way off. So wear and tear is a hot button one for me. Kory Zimney:                05:03                But yeah, so it's just those little phrases that are so easy for us to throw around. But we have to recognize that the lens that the patient looks through is probably different than the lens that me as the therapist with all my education and training on how I look through it. And I think that's just, again, taking that patient perspective is something that we all can hopefully try to do a little better sometimes. Karen Litzy:                   05:28                Yeah. And one thing from yesterday's class that I had never heard of before was negative effective priming. So can you explain what that is and then how we use it maybe not even knowing we're using it as therapists. Kory Zimney:                05:43                Yeah. It’s really kind of what you talk about is kind of what you start thinking about. And so if I'm telling you how you're going to lose, if you don't do your exercises, you won't be able to do these things. And just create more of a negative type of attitude to everything, in everything the patient sees then will be directed more towards the negative.  Where if you can flip it to more of a positive type outlook as far as when you do this, you'll be able to do these things and you can do that. And again, always flipping it to more of a positive direction. So again your just priming them, nudging them, turning them towards things that they can do as compared to, you lost this, you won't be able to do that. So, it's those little shifts and changes to focus on those positives. As a clinician, you know, you struggle like our patient’s so negative. And then we come up with these negative phrases sometimes and it's like, well, how are we helping prime them the right direction? Karen Litzy:                   06:34                Right, and what are some examples of maybe common negative priming that we may do as therapists? Kory Zimney:                06:41                If you don't do your exercises, you know, that shoulder's gonna only get worse. You know, if you're overweight, you know, this puts lots of extra pressure on your knees, they're more likely to wear out. It’s just those little negative type of things. It's so easy. We can look at, we were talking about what they lose, you know, the kind of the gain aspect or the loss aspect. And oftentimes we tend to talk about the losses and patients will get focused on that, on the negatives. That's just human nature that we focus on negatives.  As a clinician, if we're adding to that, it's only going to multiply more. Back in younger days as a clinician, I'd always get so proud of, you know, if I could get their problem list to 10, I thought, how cool am I am double digits. Kory Zimney:                07:24                You know what I mean? Just get that problem list as long as possible, you know, but really looking at the optimism list, what things can they do? You know, what things can they do better? And you know, isn't that, how cool is that? That you can do that? In focusing on those things and what they can do better, what things they can do instead of on what things they've lost, what things they couldn't. So that's that kind of priming a kind of nudging more into a positive direction compared to our traditional, you got dysfunction, you can't do this, you're broken. Jessie Podolak:              07:50                Yeah. And even the way we asked that question, Lindsay had just a really nice thing this morning that she talked about with goals instead of, you always think of, you know, what are your goals? And that's kind of an obscure thing, but I think she asked it in a way that was something like, tell me something that you'd like to do more of, be better at, or return to doing that you currently can't. It flipped it because it started, you know, there's this great quote from a Ted talk that I love by Kelly McGonigal called making stress your friend. It's awesome. She has this quote in there near the end where she said, you know, it's so easier to run towards something than away from something. And if you look at your patients, what are they right in their goals? Jessie Podolak:              08:29                I want to get rid of this pain. I want this away from me. I want to avoid it. It's so overtaking their life that they're running from it. But if we can just direct people towards what is to come and even get them to maybe cast a little vision, which I know is scary. Right? And you don't want to have false hope. We talked a lot about that, about how to balance reality and honesty. And sometimes to say, I'm not sure how this is going to turn out, but I'm with you in it. Right? But I think, you know, this is the worst I've ever seen, or man, this is the biggest trigger point I've ever felt, no wonder you hurt.  Those things come from a place of pity or sympathy which it's well intended, but it's not as far on the empathy and compassion scale that we want. Jessie Podolak:              09:26                We want that empathy and compassion of, I see where you're at and where you've been, but I'm with you as we go forward, I guess how I look at it. Karen Litzy:                                           Absolutely. And I think that sentiment of yes, I'm with you, but being honest, so doesn't mean everything's pie in the sky. And I think that's where people, when they hear about this, explain pain, quote unquote or PNE, they think, oh, you're just talking away the pain and you're not being honest. You're not being realistic. But that's not what we're saying when you're talking about language and talking about communicating with someone who has persistent pain. So one of the examples we used yesterday was like hippo A and we said, you know, yes, you're, you may have pain and we're going to work on strengthening.  There is a chance you might need surgery, but if you do, you'll be stronger going in. So you have to be honest, you can't say to someone with severe hip OA, you'll be fine. Just do a couple exercises. It's just not realistic. And then when the person isn't fine, that's a steep fall. Jessie Podolak:              10:18                Yes. And it goes back to this, not swinging too far on the pendulum away from the bio, it's still bio-psychosocial. And how do you explain something that there are biomechanical issues in a way that's not scary that still honors the bio, but that kind of de-catastrophizes or softens, it's really just about softening and responding. Like watching the patient's nonverbals. You can tell when you're starting to freak somebody out. And so then you make the adjustment and you just be very, very present. Jessie Podolak:              11:12                So it's certainly our language, but like, as you know, Kory talked about is communication. And I really like what Jonie said about pain neuroscience communication versus just education, I the smart therapist I'm going to teach you, silly patient about how this works. No, this is about communication and dialogue and how do we do that? Karen Litzy:                                           Yeah. And Kory, I think you said this yesterday, but correct me if I'm wrong, I think you said that the body is not fixed rather a robust ecosystem that has the ability to change and grow. Kory Zimney:                11:54                Yeah. And that was actually a TPS grad that we have that talked about that. The beauty of the amazing plasticity and I mean I go back to when I used to, you know, work somewhere in our rehab unit and when a patient came in with a stroke, you knew there was brain damage and you could see the MRI report. But the beauty is you had no idea what they might be able to function and do afterwards, right? Because you'd look at those areas that were destroyed, where the infarct was and stuff like that. And some of them amazingly regained function and the ability to walk and their ability to transfer and get out of bed. So you just always had this ultimate optimism, you know, as the traditional neuro type of Rehab Therapist, when somebody would come in with their stroke or spinal cord and in their ability to be able to do things. But for some reason in the orthopedic world, we just have this like, oh, well, yeah, sorry. Karen Litzy:                   12:38                Yeah, sucks to be you. Kory Zimney:                12:44                We just create this, like the body can't be adaptable to these things. And now that they've done the imaging studies on normal people, we're all walking around this stuff. We've all had this beautiful adaptability, whether it was from a neurological orthopedic, any kind of change that's gone on on our body, but we don't ever appreciate, and look at that from that optimistic again in realistic sense, you know. But again, we know that if you have a little tear in your meniscus that might be an issue. Yes, it's a huge bucket handle and you can't straighten your knee out and it clicks every step. Yup. That's probably a major deal. But otherwise a lot of people can get by with that. No, I don't know with absolute certainty, but the beauty is we should be able to find out in four to six weeks because we can train the body, help it become more adaptable. We can explore different motions and movements and see how you do with it. And if it still doesn't, the awesome thing is we do have surgical options, to make that better. And so that's just that beauty of appreciating the adaptability of the human body. And I don't know that we, for some reason, we seem to have lost that appreciation to some degree. Karen Litzy:                   13:46                Yeah, and I think that's something that I know I'll be using with my patients just to say, listen, you are this robust ecosystem, and I think if we share that with all of our patients, I think they may have a mind shift change there. Jessie Podolak:                                      Yeah. If you think of ecosystems, so many things go into it. Yeah. Right. It's not just the musculoskeletal. I think just that if people could really view the body as juicy and more robust and just multifactorial, and I think that's where maybe we got off track is we just started seeing the body as a machine. Karen Litzy:                                           Which I have to say is my pet peeve. I hate when people say, your body's just like a car. I'm like, no, it's not because the car doesn't breathe. We're not mechanics. We're not this. Like that is not how it works. Where I'd like to think as people we’re a little more complex and in a very good way, right? So now what would be the thing that you want people to take away from why language is important when it comes to working with people with persistent pain. Kory Zimney:                14:56                For me it's just being mindful of that, you know, taking that moment and again not to as a therapist, don't overthink it either. Don't think, oh, what words can I say? And if I said arthritis all crap, their patients going to catastrophize and never be able to walk again. No. But just be mindful of it and be present with your patient. Because when you're truly present with your patient, you can see that look in their eye and you can get that sense that they may be getting a little bit worried or catastrophizing or a little anxious and stuff like that. So it's that ability to just be present and mindful that words do matter. But again, not so overly mindful that you freeze and you don't act either. We still have to just be human, just being a part of that. And again, that's just that communication piece that really is what we're talking about. Jessie Podolak:              15:38                I would just echo what Kory said. It's just be with your patients. Care, invest in them. Some of the patients who it takes every ounce of energy they have just to make it to your appointment. Realize that they're giving you the trust and kind of the gift of their time and their precious energy. And so, even when you have that busy day, even when you know you're kind of sucked dry, just to give them that time that you have with them and to slow down a little bit, listen, be mindful and you know, I just think it's just about being a little softer, just softening out the rough edges and being that safe place. You know, Louis Gifford, one of our heroes said reassurance is an analgesic and sometimes we can't reassure that that hip is going to not need surgery, but we can reassure that I'll be with you. We’re in this, I'm in this with you. So that's what I would say. Karen Litzy:                                           Awesome. Well, thank you so much, Korey, Jessie, I appreciate both of you and I really enjoyed your talk yesterday, so thanks so much for coming on.   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 guest hosts and interviews Duane Scotti on social media marketing.  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: -How to decide which social media platform is right for your marketing strategy -What social media content will best build loyal customers -The benefits of scheduling out social media content in advance -And so much more!   Resources: Duane Scotti Twitter Duane Scotti Instagram Spark Physical Therapy Facebook Spark Physical Therapy Website  The Clinical Outcomes Summit  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.   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 Janet Kantor with Duane Scotti, a physical therapist from Connecticut who is joining me today on healthy, wealthy and smart. And today we're talking about doing a specific niche on social media and really just nailing it. You are nailing it, Duane. So first of all, thank you so much for coming on. Duane Scotti:                00:19                Thank you for having me. This is awesome. I'm very happy to be able to talk to you about this topic today. Jenna Kantor:                00:26                Yes. So I would love to know first, how did you choose what social media platform you were going to put most energy on or also I've seen you on Instagram, but you may also be on other platforms and I would just love for you to expand on that. Duane Scotti:                00:41                Great question. When I was looking into kind of getting into social media and using it as a platform, I thought about what is my audience, right? So most of the patients that I treat are adolescents, so I basically treat gymnast runners and dancers and a lot of them are on Instagram. So I started the Instagram account and started learning everything I could learn about Instagram, but their parents are on Facebook. So a lot of, you know, their parents are on Facebook and there's different groups on Facebook. So that's been beneficial from that standpoint. So those are really the two platforms that I utilize. I do have a Twitter but I haven't used it. Primarily because that's more for professional and other PT’s and that's not really my target audience. Jenna Kantor:                01:27                Right, right. Absolutely. I like how you hit the nail on the head regarding Twitter specifically, I'm not as active myself. I have something set up where it automatically posts, but my heart isn't there because that's like you said, not where my target audience is. And I like how you bring that up. So how does your content differ from Facebook where the parents are, to Instagram, where the kids are? Duane Scotti:                01:52                There's not too much differences in terms of I do post the same content basically to both platforms. The messaging is a little different if I'm sharing it to a group. So specifically at our local dance studio, we have a closed group so my messaging is going to be a little bit different, kind of targeting the parents and looking out for their dancer, as well as the stories on Instagram. So the stories are on Instagram are a little different, but the content posts that I do on a daily basis, they are going to be the same post that just instantly goes over to Facebook and I'll shoot it over there from Instagram. Jenna Kantor:                02:27                And you just mentioned a little bit about you have kids who are going to these dance schools. There's a relationship you already have with these parents that's helping you build these groups. Would you mind elaborating a little bit more on how that came about? Duane Scotti:                02:44                Yeah, so, well I guess first off, I do have two daughters. One is a dancer and one is a gymnast Jenna Kantor:                02:49                Shout out to your kids. Duane Scotti:                02:51                So they are at the local gym, the local dance studio that I've been affiliated with awhile. I also taught at the local studio, I was a dance instructor there. And you know, obviously those relationships, the families, they kind of have known me and trusted me for years and I've helped out their dancers before. So those are kind of how those relationships have been built. It's really more of me just being present and being there for, you know, picture day and you know, I'm there doing, you know, kind of complimentary screenings and things of that sort. So you kind of develop that rapport and relationship with the families where you kind of earn their trust, that you're going to be kind of looking out for their dancer. Jenna Kantor:                03:34                You know, you hit upon something that I think is so valuable. I actually interviewed Karen Litzy the other day for her own podcast, this podcast in which we are interviewing for right now. And she was talking about these relationships and how she just lives her life and through the things that she's already passionate about. She's made these relationships and help those relationships grow. And it sounds like that's what you have hit upon, which you agree. Duane Scotti:                04:01                Absolutely. Absolutely. Relationships are everything and from a practitioner standpoint, your relationship with your patient and their families are important. But then expanding beyond that and you know, things are a lot different than the healthcare world. And when I first graduated, you know, it was prior to direct access time and everything was about trying to foster that relationship with your referring physician. Now it's a completely different animal. You know, my relationships I'm fostering with are the communities in which I serve. So looking at the gymnastics community or it's the relationship with the coaches, right? And having, you know, I'm just thinking about the first facility that I started in, it was talks with coaches, not just one saying, Oh yeah, I'm a physical therapist, let me treat your gymnast. But it was many talks, many conversations you developed that rapport, that relationship, and then that turns into, hey, can you help this gymnast out? Duane Scotti:                04:56                Oh we have another one. Can you help this one out? And then you kind of foster that relationship over time and then you wind up seeing, you know, your practice or your business kind of growing from that standpoint. And it's really kind of getting into our communities and for me at least that has been successful is having those relationships with, you know, the dance studio owners, the gym owners, now we're treating out of an aerial silk studio. So really you develop that relationship and then they recommend your services to people that are in their circle, right. And their business because they trust you. So I think those relationships are definitely, definitely important for kind of long term success. Jenna Kantor:                05:38                Yeah. And it just makes it more enjoyable because you honestly enjoy each other and so I think that's great. So let's go back to the social media stuff. Your content itself, I mean, I've seen the video of you dancing with your daughter, which was great. What was it? The diggy? Duane Scotti:                05:53                That was the Kiki challenge. Jenna Kantor:                05:56                I think that video pretty much went viral. Am I correct? Duane Scotti:                06:00                Yeah. That one was definitely my best performing video. So yeah, it was fun. That was something that, you know, a lot of people were doing that. And I think you saw on the news like a dentist had done it. I was like, you know what, we should do this as a physical therapist and just showcase what physical therapists do. So, you know, my daughter's a dancer and she was interested. I said, Gabby, let's do it and let's do a little dance. So we just kind of put it together real quick and that was fun. And that's the thing I do like about social media. It's really nice. You can have fun with it. We are professionals and we always have professional interactions with our patients, but we also have fun with them. Duane Scotti:                06:37                Right. And we're human, we’re people.  So just kind of showing some of that human side I think has been definitely beneficial. And you know, if you look at your insights on, you know, Facebook or Instagram, the posts that do the best are the ones where I am not trying to be super serious and I'm not showing the best technique and the best tool in my toolbox that I know it's more of me just being genuine and it's more of you know, doing a silly dance or you know a picture with the family or you know, something that's kind of outside the box. Jenna Kantor:                07:14                It lets people feel more connected to you. So let's go into more on Instagram because Instagram unlike Facebook, Facebook you can schedule posts for free, Instagram you can’t right? So are you using one of those paid for platforms to post or do you just post daily and what is your schedule that you abide by to be consistent? Duane Scotti:                07:40                Well, you hit a really important point is that consistency is key with Instagram and Facebook. It is one of those things and it's just like anything we do in life habit, right? Exercise goals, running goals, wherever it is. Getting to the gym, you gotta be consistent and I don't know, people for different things what like two or three weeks to form a habit and then it becomes a habit. And for me that's been helpful where now it's just part of my daily routine and scheduling it in advance and doing batching and kind of putting videos together, putting, you know, writing, you know, batching all your posts together. It's definitely helpful. It makes it easier. But unfortunately Instagram does not have, like you said, where you can schedule out your posts, so you do need to post it. Then I have heard of other platforms that you can utilize to put your posts in, but it still will send you a reminder to your phone saying this post is ready to go. And then you'd have to open Instagram and actually post it. So that is the limitation in terms of time management. So it is “work” where you need to think about it. Hey, I have to post on this day. I've thought about and you know, and maybe in the future trying to delegate a bit of that out, just to ease a little of the burden of having to do that. And I actually trialed that shout out to Nikki when I was on vacation. Jenna Kantor:                09:04                Hi Nikki. I don't know who you are, but thank you. Duane Scotti:                09:07                She did an awesome job and I wrote all the posts in advance and she did the posting for me when I was out of the country and I couldn't post. So I think it's a doable model, but you still needed to write the post. And because I think, again, going back to being human and genuine, right? So a lot of these bigger businesses, you know, they have marketing people who are doing their posts, but you can tell it's more from a marketing angle and standpoint. It's not that person being genuine and who they are. Jenna Kantor:                09:34                That was so eloquently said. I don't know if we'd go out for coffee, but good, good job. Duane Scotti:                09:41                Right, right. So that is, you know, on Facebook they do have the scheduling, but if you're going to wind up forcing an Instagram, again, like I said, you can just shoot it over to Facebook then. So yeah, I unfortunately don't have a scheduling system that will just like send them all out. Which would be nice. Jenna Kantor:                09:58                And then for the content preparation, do you pretty much do like on Sunday you prepare for the week or do you kind of do daily? Do you have a system for that yet or how do you do that? Duane Scotti:                10:10                Sure. I don't do that specifically on Sundays, but on Sundays I do iron all my outfits for the week. Jenna Kantor:                10:15                You buy clothes that you need to iron? That's lesson number one. You're supposed to buy shirts that are iron free, like you don't need an iron. So let's start there. Now move onto the creating of content. Duane Scotti:                10:33                Yeah. So it's really whenever I have free time, so there's no specific day where I'm like, okay, Sunday is the day that I'm going to do all that. It's whenever I have a chunk of time, then I have a calendar. I have a plan for what's going to be coming out when and then it's a matter of all right, I'm going to do these videos, whether I'm going to write some captions in the videos from adding music, whatever the case may be. And then I have all those ready to go. So that's like my videos ready to post folder on my phone there. And then I will have the write ups. So then whenever I have free time it's like, okay, let's write up this post that post that post. And so then it's kind of done in advance. Ideal world is I would have like a full week's worth of content and I found that is so much better because it's not stressful thinking about because your day is busy, right? Duane Scotti:                11:17                So I teach during the day, you know, doing the practice in the evenings and on the weekends. And you know, if I get to the point where it's, oh, I don't have a post today, it’s stressful and then you have the pressure of coming up with something right on the spot. And so having it in advance, it's a lot easier where it's ready to go, the writing is done, the post is actually done, the videos are done and then it's a matter of just literally opening up the platform and hitting the plus button and there's your video and copy paste, boom, boom, boom and then you're off and running. Jenna Kantor:                11:48                Yeah. And you're hitting upon why I'm actually considering investing in an Instagram, a paid for platform to post for Instagram because this is where the value of being able to schedule it out really comes in because you could schedule it out for a year. I mean, imagine that you just hammer it out, you know, you're like, I love you children. You go play, you get to watch movies this whole weekend while I create content. And then you pull them in, you say, hey, you know what, I would like you to create choreography to five songs. So then you could do the family thing a couple times. But yeah, I think that is a key thing to maybe even tap on. I'm actually brainstorming for myself, not even giving you advice because for me, Instagram personally is a platform that I'm just about to start going for. I took the time with Facebook first, I'm very on top of that and now Instagram is my next target to like create those habits. So it's really good for me as a practitioner to hear what you're doing, what your experience is and how possible it is, so thank you. Duane Scotti:                12:58                Yeah, I know. And on Instagram, you know, it is a little different from Facebook in that I feel like you need to write a little less. And attention spans are a little different on Instagram. So, you know, those things are different and obviously the hashtags are important on Instagram, whereas Facebook, they're not. So you know, knowing which, you know, tags to use can help bring your reach to a wider audience and kind of your target audience. So you do have to give some thought to the actual tags that you are going to use on Instagram, which I think helps, you know, get your stuff seen. Jenna Kantor:                13:35                Yeah. How did you find the Hashtags for you? Because you could sit there and say Hashtag dance and see that a lot of people post dance, but if you're going to really target the people in your area, how did you get those hashtags? Duane Scotti:                13:48                So I do some local hashtags. I'm still looking at towns, right. So Wallingford, Connecticut, Cheshire, Connecticut, North Haven, Connecticut and we'll look at those local tags. And I don't know if anyone really truly knows the answer to the algorithm. But it is, you know, do you go with the hashtags that have the most numbers or because there's so many things posted on them anyway your stuff's never going to be seen. Or do you go with some that aren't in the millions or the hundreds of thousands so you can get into your niche, right? So I try to make them relevant to whatever the post is and then relevant to my target audience and you know, looking at if it is something on the ankle and ankle pain or maybe you're someone searching for that or ankle sprain I use those tags. Jenna Kantor:                14:38                Yeah. That's great. Well, thank you so much and my last question would be do you consider yourself an expert on social media? Duane Scotti:                                        Definitely not. Jenna Kantor:                                        That is where I think it's perfect to end for all you practitioners. We have worked so hard to get our licenses to work on these patients in physical therapy or honestly in any health career that you are pursuing. You don't need to be an expert. You just need to start. And the more you do, the more curious you get and the more you will learn. And Duane Scotti here is definitely a perfect example of that. So thank you so much for coming on this podcast and sharing your knowledge. Duane Scotti:                                        Yes, thank you so much for having me.     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 in Austin, Texas, I welcome Justin Moore on the show to discuss the American Physical Therapy Association.  Dr. Justin Moore, PT, DPT, a physical therapist and veteran of both the profession and the association with more than 20 years' experience, leads the American Physical Therapy Association in the role of CEO. He has been with APTA for 18 years and has held numerous positions, including executive vice president of public affairs, leading the public policy agenda and payment and communications departments, leading its federal and state affairs advocacy departments and serving as the association's lead lobbyist on Capitol Hill. In this episode, we discuss: -How the APTA strives to provide an inclusive experience as a macro organization -What Justin would change about the APTA -APTA’s role in the World Confederation for Physical Therapy -Justin’s biggest takeaway from the Graham Sessions -And so much more!   Resources: Email: justinmoore@apta.org Justin Moore Twitter Justin Moore LinkedIn World Confederation for Physical Therapy Congress 2019 The Healing of America by T.R. Reid Book   For more information on Justin: Justin Moore, PT, DPT, a physical therapist and veteran of both the profession and the association with more than 20 years' experience, leads the American Physical Therapy Association in the role of CEO. He has been with APTA for 18 years and has held numerous positions, including executive vice president of public affairs, leading the public policy agenda and payment and communications departments, leading its federal and state affairs advocacy departments and serving as the association's lead lobbyist on Capitol Hill. Moore also previously oversaw APTA's practice and research departments. He has been honored for his contributions to physical therapy and public policy by receiving the R. Charles Harker Policymaker Award from APTA's Health Policy and Administration Section and the Distinguished Service Award from APTA's Academy of Pediatric Physical Therapy. In addition, Moore has written, presented, and lectured on health policy, payment, and government affairs issues to a variety of health care and business groups across the country.   Moore received his doctor of physical therapy degree from Simmons College in Boston, Massachusetts, in 2005, his master of physical therapy degree from University of Iowa in 1996, and his bachelor of science degree in dietetics from Iowa State University in 1993. He was honored by Iowa State University's College of Human Sciences with the Helen LaBaron Hilton Award in 2014 and the university's Department of Food Science and Human Nutrition's Alumni Impact Award in 2011, and he was the Family and Consumer Sciences' Young Alumnus of the Year in 2003. He also recently completed a 3-year term on Iowa State University's College of Human Sciences Board of Advisors. Moore was part of the inaugural Leadership Alexandria class in 2004 and served on the Northern Virginia Health Policy Forum Board of Directors.   Read the full transcript below: Karen Litzy:                   00:01                Hey Justin, welcome back to the podcast. I'm so happy to have you back. So we have a couple of questions to get through today and we also want to talk about the first half of Graham Sessions. So we are recording live at Graham sessions in Austin, Texas. And I've got a couple of questions for you and then we'll talk about your big takeaways from the morning session here at Graham sessions. So first thing is, and this will probably be addressed at Graham sessions tomorrow, but what is the APTA doing the American Physical Therapy Association doing to address the current needs of physical therapists, physical therapist assistants and students to ensure their membership is quote unquote worth it? Justin Moore:                00:44                Yeah, it's a great question.  It's a question I get often and unfortunately don't have always a great answer because it is such a personal and passionate issue of how do you find value inside this community of APTA. And as you know, value has two meanings, an economic meaning, do you get a return in your investment? And so we look at the physical therapist and the physical therapist assistant of investing in APTA and do they get a return, so there's an economic part of this question, but there's also a principal part. Do you value APTA? And we'd like to focus on that. And then how can we really engage the physical therapist and the physical therapist assistant and really showing value to APTA and getting value from APTA. And I sort of look at it in Adam Grant's philosophy of give and take, you know, the transactional or economic value is what do you get from APTA? Justin Moore:                01:38                And then the give is what do you give to APTA? We're really blessed by our members giving to us and increasing the value for all. And I think the value at the end of the day, the take home value that PTs get from APTA is we're an unabashedly, aggressive about increasing the opportunities for physical therapists. So if you believe in that mission and that value, how do we continue to connect you to your colleagues? How do we continue to build a community that's going to make this career you've chosen make a difference in people's lives, but also return a fulfilling career to you. And so get that return on investment and that value. So, another thing I'll just tie is our board of directors has been really aggressively looking at how do we continue to be relevant to the next generation of clinicians. And we know healthcare is changing. We know business is changing and we have to be getting better at being relevant at the point of care. We have to get better at promoting the value of our profession and we have to get better at connecting our experts. And right now, I think that's what our strategic planning process is about, is how do we become more relevant to those individual clinicians and professionals. Karen Litzy:                   02:50                And I think that's different from a couple of standpoints. One and we’ll probably talk a little bit about this tomorrow, is that APTA is obviously a macro organization. There's 101,000 members. So how do you incentivize members from one not dropping off, So a retention issue, right? And two, how do you attract them in to have that feel of more of a micro organization? Right? Cause it's all about the details and it's all about incentives.  So how can the APTA, which is a very large organization and it needs to be that way. It can't be small. So how do you give a macro organization a micro feel? Justin Moore:                03:35                Yeah, absolutely. It's our greatest challenge. And I think, you know, one of the things that is very good about APTA is we interact with probably 95% of potential members in a five year period. So we have 80% market share of students, 30% market share of practicing professionals. It's a little less than 10% of physical therapist assistants. So we do engage with almost our entire community over a five year period. But we have to return value in the short term to keep them a member. And the greatest challenges that is, how do you let this very diverse clinical community, how do you build a spirit and harness the power of inclusion? So people can find their people so they can find their community inside this large network of professionals. And sometimes APTA has been too complex, too fragmented, and too divisive to achieve that objective. Justin Moore:                04:29                And so we have to look at those themes on a pretty regular basis is how do we become more inclusive? And so how do we help people find their people, their network of individuals, because they're going to get great value in that if they're going to be a better private practitioner, if there going to be a better pro Bono clinic operator? If they can connect to their people that's going to return value, how do we reduce the fragmentation? We all are committed to promoting the value of PT Well, if we're talking about the value of a certain part of PT, we're constantly competing inside the PT world. It really dilutes our impact. And we know that from data is we're a pretty fragmented community. And so we've got to reduce that fragmentation and build unity. And have to be better working together. Justin Moore:                05:17                We're not unified.  The bigger you get, the harder it is to feel the intimacy. We had a consultant work with APTA’s board one time and he put up a matrix.  He said, you can be three of the four things in the quadrant, but you can't be the two things that are across from each other. And the two things that cross each other in that matrix were intimacy and strategic. And so to be a strategic organization, can you still be intimate in an association of one where you address every need, every one, and we have to figure out, we're going to be a complex organization, but we have to figure out how to give an intimate experience, but be strategic in that intimate experience. Karen Litzy:                                           And it's a challenge. It's a challenge for a large organization, but it's good to hear that that's on the minds of the people at APTA. Justin Moore:                06:06                Yeah. I think we've realized that we have fallen short at times of really being able to connect people, really giving people a sense of inclusion. Even though we've tried to be inclusive. If it is not conveying that to the end user or member and they don't feel included then we're missing the mark. Karen Litzy:                                           One thing it's not about is the money. Justin Moore:                                        We can give you in economics, I always tell the story is, you know, it is a federated model, has a complex new structure, but APTA dues are 295 in the realm of that, it's a pretty low price point inside of professional associations.  If you compare us to other medical associations, other nursing professions, it's a pretty low price points. We probably return economic value for transactional value to the member, and show that value pretty well. But if they don't value their experience, it doesn't matter what the price point is. And so that's what we really have to work to achieve. Karen Litzy:                   06:59                Yeah. Not Easy. I look forward to seeing what comes out in the next couple of years there. Okay. Moving on. If you can end with, maybe we already said this a little bit, but if you can change one thing about the APTA organization, what would it be and why? Justin Moore:                07:13                I think it would be to harness the power of inclusion. We've really been focused on that and how do we create a community that at times has been competitive or fragmented and how do we bring them together for commonality and unification around promoting the value of PT, promoting the brand of PT and we're going through a process right now at APTA of rebranding and we're going to be launching that in the next 12 months. And what we found is we went through the research on doing that is we're conveyed way too many opportunities to put your own perspective of what the value of PT is. And we need to really get unified and more inclusive in that march toward promoting our value. Karen Litzy:                   07:57                Simplify the message a little bit more.  It is hard because within physical therapy you have so many options of workplaces and how you work and who you work with and states and personalities. And I mean the list can go on and on. I would imagine having that sense of inclusivity among 101,000 members, but 300,000 PTs across the country is not easy when everyone is so diverse, diverse in race, religion, gender and diverse in practice settings. So it's like you have to not be, I'm trying to do everything but a master of none. Justin Moore:                08:43                If you're trying to do everything, you're actually doing nothing. That's sort of been a challenge for APTA. They're trying to be all things to all people and was at times maybe a little bit mediocre at everything. So we really have to do that. And I think the common theme is we've done some analysis both on the data side and then actually a social listing. And two themes come out about the PT community is we're pretty divisive. So when you guys see this is people like to tear other people down or can say that they're better at a certain thing than others. So if we could get away from that divisiveness and correct that, that would be great.  If an outsider was looking at our dialogues, it would not be a positive experience.  Karen Litzy:                   09:36                I’ve had a patient tell me like what you guys really don't get along.  I’ve seen some conversations on social media. And I was first of all shocked that a patient would actually bring that up so people are looking and they are reading. Justin Moore:                09:44                We've had outside consultants that have look at this and they said they can't believe two things. How some of our acting members tear us down. And so these are people who have already made a decision to join us but yet like to tear down the organization. And then what we found is when we were out looking at the research on our next strategic plan and looking at net promoter scores our highest distractor group, was some of our longest serving members, and essentially we figured out we're not engaging their expertise well enough. And so that was sort of a wake up call for us instead of saying, oh, why are former leaders tearing us down? We said, wait a minute, they're feeling lost. They're feeling not included. They have given a lot of time to this association and now they feel like they've been dropped off a cliff. And so how do we give them a parachute, how do we give them a glider? What can we do to keep them in the spirit of inclusion? Karen Litzy:                   10:36                I think that's great because you know, in some conversations I had yesterday, someone brought up to me that it was really great and it was that the APTA has 101,000 quote unquote experts. So the organization is not the expert. They're the facilitators of all these experts that they have at their fingertips. And just think how much the organization can do by being a stellar facilitator of all those experts. Justin Moore:                11:05                APTA is a vehicle. We don't practice, we don't do research, right? We don't do, we do a little bit of education. We do a little bit for professional development, but we can be a vehicle where our educators can educate, our researchers can publish, our researchers can have access to funding and our practitioners can get that. So we have to really leverage our role as convener. Our role as networker. As a funder. The very basic principle of association is people come together for collective success. So they give us dues you use to put into a collective operation for PR, for advocacy, for all those things. And we've got to get better at that. Include that spirit of inclusion. Karen Litzy:                   11:46                Perfect. Alright, next question. So the World Confederation of PT Conference is coming up in a few months in Geneva in May. So how is the APTA improving its outreach and involvement in the international world of physical therapy? Are you going to be in Geneva? Justin Moore:                11:54                Yeah, it's a big priority for APTA to be an international partner and contributor to global PT. And so WCPT is one part of that. It's not our inclusive effort. But APTA has a long history of involvement with WCPT including being one of the founding countries and including having at least a couple of presidents I believe. So, most recently, Marilyn Moffat was president of the WCPT. So we have a longstanding commitment and contribution to WCPT and the conference in Geneva will be a great community of international leaders where we can go and be in a posture of learning. So a lot of times we're not going to, we go and have a delegation at WCPT, but we're really going to interact with our colleagues in Australia and the UK and the Netherlands and really learn from their successes and how we can apply those back here. Justin Moore:                13:01                I think this morning at the Graham sessions when we heard T.R. Reid and it's a great book. I highly recommend it, but he went around and experienced healthcare in different countries.  That's sort of what we do at WCPT. We go and we talk to the Netherlands of how did they stand up their registry? How did the UK be frontline in primary care, how did Australia get this great expertise in sports and orthopedics and manual therapy? And so what can we do to really leverage that global community to improve care back in the US as well.  WCPT is just like APTA, it’s an organization. And so we have a responsibility as a member. It's interesting, WCPT doesn't have members that are individual physical therapists. Their membership is the organizations that comprise the countries. Justin Moore:                13:49                And so we are one of about over a little over a hundred member organizations at WCPT and we, you know, we take that responsibility very seriously and always are looking for opportunities to contribute to their objectives and especially when they're aligned with our objectives. Karen Litzy:                                           I’m looking forward to going to Geneva. I can't wait. I think it's going to be awesome and I'm actually going to be staying with some international PTs. So one from Canada and one from Ireland. I go to a lot of international conferences. It has really changed the way that I practice, it has changed my outlook on the profession as a whole. And what you find when you talk to therapists from different countries, we're not all that different. The way we practice, the challenges that we all have in these different countries are very similar. And I found that to be very eye opening. Justin Moore:                                        As a physical therapist who's gone into association management, I've gotten huge value from some of my colleagues of other physio therapy associations. Justin Moore:                14:46                So Cris Massis at the Australian physiotherapy association, he's just been a great role model. Someone to learn from. And it's nice because it's safe. You know, we're not competitors. He's got his lane. I got my lane and he's been a great resource. Mike Brennan, who was at the Canadian Association a few years ago has been a great reference and resource and I've just been able to observe a lot of these international CEOs and how they conduct their business. And it's been a great learning opportunity for me as well, a little different clinic than the practitioners. Karen Litzy:                   15:20                The parallels are there and the APTA, we’re as clinicians trying to learn from each other and as heads of organizations you're trying to learn from each other. Justin Moore:                                        It's one of the strongest things is the opportunity to interact with those other CEOs. Karen Litzy:                                           So before we finish up, what were your biggest takeaways from the morning here at Graham sessions? Justin Moore:                                        Well, I thought my biggest takeaway, or I don't know if it’s a takeaway or my biggest observation is a lot of thought provoking conversations are already starting. And this concept, and we're going to face this all the time, this concept of what is next in healthcare reform that was started by a T.R. Reid’s presentation, but also what does that mean for physical therapy and where do we need to change our lens? Where do we need to change our focus and how do we need to adapt to be part of the solution, not part of the problem was a key theme. There's a lot of brains in that room, and so I'm looking forward to how they process over the next several hours and come up with solutions. It's easy to point at the problems, but the solutions are always more complex. Karen Litzy:                   16:29                So thank you so much for coming on.       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 guest hosts and interviews Jim Dunleavy on the New York House of Delegates.  Jim Dunleavy is Chief Delegate of the New York Physical Therapy Association Chapter.  James Dunleavy graduated Cum Laude with a Bachelor of Science in Health Education from Manhattan College in 1976. He received a P.T. Certification in 1977, followed by his MS. P.T. in 1983 from Columbia University. James was a Co-founder and acted as its first President of the Acute Care Section from 1992-1997. He served as an APTA Director from 1998-2004 and received the APTA‘s Lucy Blair Service Award in 2005. Currently, James is the President of the New York Physical Therapy Association, an office he took in 2006. In this episode, we discuss: -What is a motion? -An overview of how the delegate assembly functions -Jim’s advice for new graduates who are looking to get involved in professional organizations -And so much more!   Resources: Jim Dunleavy Twitter New York Physical Therapy Association   For more information on Jim: APTA spokesman James M. Dunleavy is administrative director of Rehabilitation Services at Trinitas Regional Medical Center in Elizabeth, New Jersey. He also serves as adjunct faculty in the Transitional Doctor of Physical Therapy Program at Rutgers University. As an active member of APTA, he founded the association’s Academy of Acute Care Physical Therapy and served as its president for 5 years. He has held various volunteer positions within the association, including serving as a director on the APTA Board of Directors. Dunleavy also has held many volunteer leadership positions on APTA’s New York Chapter Board of Directors, including treasurer, district chair, district director, and president. In 2005 he received APTA’s Lucy Blair Service Award. He was the first recipient of APTA’s Acute Care Section Leadership Award, now named after him. He received a bachelor’s degree in education from Manhattan College, a master’s degree in physical therapy from Columbia University, and a doctor of physical  therapy degree from Massachusetts General Hospital Institute of Health Professions.   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 Jim Dunleavy who is the NYPTA chief delegate. And I am very excited to be interviewing this morning. So first of all, thank you so much for agreeing to be interviewed on the wonderful, healthy, wealthy and smart. So delegate, chief delegate. Would you mind explaining what that is for anyone who does not know and what that is related to within the New York Physical Therapy Association? Jim Dunleavy:               00:30                Well, the chief delegate actually leads the delegation from New York to the national house of delegates each year. I'm basically the organizer. I do the assignments of motions. I hold webinars and phone calls with the delegates during the course of the year to get them up to speed with the issues that are facing us that are brought before the house of delegates each June. Jenna Kantor:                00:58                Yeah, it's excellent. And I'm on that email list and so I'm always just going reading, having different physical therapists help transcribe it for me. So thank you, you just are so good at keeping us up to date with that. So for you, I'm just wondering on a weekly basis, how much time do you need to put into your job? Jim Dunleavy:               01:17                I would say it varies. It gets more as we get closer to the house of delegates each June. The APTA has gone through kind of a metamorphosis and has created almost a year round type of governance process. So, the motions are starting to be brought out in concept form, usually early in the fall. In the past it's just been we get it in March, we read it, we go to the house, that's it. But now we have to really look at it almost as a year round job to keep people on top of it. Make sure we see what issues are coming possibly before the house. And giving our input from New York as to how we feel about these motion concepts and then the full blown motion will affect us in New York. Jenna Kantor:                02:15                So when you're saying motion, what do you mean by motion? Is that a new law? What is that? Jim Dunleavy:               02:20                We run a house of delegates. It's similar to a mini Congress or a mini house of Representatives. And so the issues that come before that house have to be in the form of a motion, which is a clearly defined statement, whether it be a policy, whether it be charging the APTA to do something, whether it be a philosophical or sociological position. And the group will review it, they will discuss it, they will argue about it and then they will vote on that motion. Jenna Kantor:                02:54                Oh, so it's like when it goes to the Senate or Congress. So if I was to think of the school house rock video where they're singing, I'm just a bill. Do you like that reference? Yes, but honestly, that's where my brain needs to go cause I'm massive beginner with this. So I right now I'm an alternate, which I'm very just honored to even be an alternate for the possibility of going. So I was wondering what is it like, let's say day one at the delegate assembly? Is it just people just kind of, you know, is it, how are things brought in order? Is there an introduction? Are there, is there a ceremony with candles and, and you know, it was some sort of like traditional dance. What happens on day one at the delegate assembly? Jim Dunleavy:               03:49                The candles and the dancing, that's a good idea. Maybe we'll get them going a little bit more. First two things. One, you mentioned the term delegate assembly. The delegate assembly is actually New York's own little congress, little house of Representatives. What I'm chief delegate of is the delegation of New York that goes to the national house of delegates. So in New York, we're a little different than other states. We have 10 districts. We have representatives from each of those districts come to our delegate assembly, usually in April or May, where we review all the things that are going to come before the house of delegates plus vote on any bylaw changes or other issues that are going on in New York state alone. In terms of how it's structured, you have delegates are voted upon to go to the house of delegates by our delegate assembly. Jim Dunleavy:               04:51                So that's one set. Then in addition, each district has the ability to designate one person. So there's 10 and then whatever is left in the order of the voting in the delegate assembly, those people are on our alternate list. So, believe me, it happens every year. We have people who drop out for various reasons. In fact, I have one right now that I have to replace, so I don't know where you were on the list, but you might be getting a call from me later. I have to keep track of that and I have to constantly update the APTA delegate list and the chapter deligate list. So they get all the information that they need either as now an active delegate and not an alternate. Jenna Kantor:                05:44                If somebody was an alternate, like my situation and then I'm down at the end of the list. But I'm also, honestly, I really am grateful to be on the list especially as a new Grad. So I'll take it, so if I was able and fortunate enough to, you know, be able to fill in for someone, does that make me for the next year as a regular delegate or am I still considered an alternate? Jim Dunleavy:               06:10                The delegation is a one year service time. So we will vote this coming April I think is the delegate assembly. We will vote for the delegates going to the 2020 house of delegates. This group of delegates that are going to Chicago in June of 2019, they were voted upon last delegate assembly. So it's a one year cycle. We've actually talked about changing that to maybe get a little bit more experience in four people. So we're talking about maybe changing the bylaws to two years of service. I'm not sure yet, but it is a one year service time. Jenna Kantor:                06:58                Okay. Very good to know. Alright, so let's go back to day one. So we're at the house of delegates day one. So apparently there was no dancing ritual.  So what is the order usually on day one at the House of delegates? Jim Dunleavy:               07:24                For the New York chapter, what we usually do is our delegation comes in usually the day before the house opens. And I usually try and hold a, what we call a caucus meeting to just orient everybody, go over any changes that I'm aware of and in any of the motions, prepare the delegates for the next morning, which are the interviews for people running for national office because the house of delegates is the voting body that votes for president, vice president and so on. We have interviews of those candidates all morning and we have I think four rooms or five rooms that we have delegates in who asks these candidates questions, we will then come back as a delegation together. We will talk about the candidates, make our selection and then start to work on the motions. Then after that, usually in the late afternoon, early evening, the house of delegates starts and it's a pretty impressive place if you've never been there because you have over 400 plus of your colleagues from around the country sitting in front of a large dais with the speaker and other officers there. And we run a parliamentary rule meeting with the idea of making the best decisions for the profession in the United States. Jenna Kantor:                08:53                This is honestly very exciting to me as much as I'm calm as I'm saying this, like it's just, it's getting my heart beating and I'm like, I want to be there one day.  This is just a random, silly question, but Lord knows anyone who knows me, I love random silly questions. So if I was to be interviewing for any of these amazing higher positions, that can make a great difference. If I did the splits or broke into a song and dance, would that help my position or possibly pull things back or maybe would you cast me in a Broadway show instead? Jim Dunleavy:               09:24                I'd probably go with the Broadway show. Probably doing the song and dancing in an interview here, I don't think the culture would really take to that very well. I think though that the culture in the interviews is changing with the age of the delegates. We talk a lot about millennials. We talked a lot about all of them, gen x’ers and everything else. And how we have to change our communication style in order to reach out to our newest members and future leaders. I've seen a change in culture and that it's a little bit lighter, but I don't think we're doing the song and dance just yet in the interview process. Jenna Kantor:                10:18                So no Hamilton rap? No, no, no. Okay. Okay, good. Just good to clarify it. In the hallway, right to take care of those nerves. So when going in the rooms, this honestly reminds me cause I have the musical theater background of auditions. It really does. So for you guys on your end, as you are interviewing these people, I mean aside from the buckets of coffee that you're probably having to just stay really focused. You really need to see that people are right for these positions. Do you try to make it a friendly environment or like what kind of environment are you trying to create to help that person who is being interviewed? Jim Dunleavy:               10:59                Well, I think we're trying to make it a level playing field because what we have done is we have agreed to do a set questions in every room so that the delegates that are in each room gets to hear each candidate's answer to the same question. Then each room does have an opportunity to ask some of their own questions. So when I ran for APTA board and I had to do these interviews myself, that was not the case. I had no idea what was going to be thrown at me in terms of questions. You could be asked anything. I think now it's at least fairer, it's a level playing field for the candidates. They know they're not going to get any serious kind of Gotcha questions cause we went through a period of time where people thought that was fun. So I think it's a much easier experience for the candidate then perhaps maybe it was when I ran. I think people still get insights into these people. Jenna Kantor:                12:16                Absolutely. And for working with your team when you are discussing, cause you're saying people are in different rooms, you know, you have the different rooms and are you guys all, is it say Melanie goes in, she gets interviewed in one room. Does she get sent to the next room and the next room? So all three groups interview? Jim Dunleavy:               12:37                Yes. The candidate will get a schedule for the morning, what rooms they have to be in.  So usually very close to each other Jenna Kantor:                12:48                And muscle relaxers. Anything for the nerves, right? Jim Dunleavy:               12:51                Absolutely. Yeah, there is. And there is a candidate's lounge where they set up food and coffee and everything else. So you have a place to go and cry when you mess up in the interview. It really is a very well oiled machine how they do it. So what I'm going to have to do as chief delegate, I'm going to have to basically divide up our delegates equally for each room. And then I'm in one room with what we call the Northeast Caucus, which is all the states, pretty much in the northeast. But they'll be New York delegates probably somewhere in the neighborhood of six or seven, maybe eight in each room. So they can hear the differences in the different questions and then I will bring them all back together after the interview session and go through that and make sure that everybody hears what was said in every room by each one of the candidates. Jenna Kantor:                13:48                Oh, that's so smart. Yeah. I really like how you guys have a system because that's not easy to even develop that system that works for everyone. So I think that's really, really cool how you guys have that organized. So you're done with all these interviews, you have to decide that night for that or was that during the whole weekend that that's part of the house of delegates? Jim Dunleavy:               14:09                It used to be much more laborious until we went to electronic voting. So after the day of our interviews that evening, the house will open and one of the first orders of business is that we will all vote on the candidates. And then at the close of that session, which is usually around eight o'clock that night, the results are posted both outside the house of delegates room. And on these huge screens that we have in the house of delegates proper. Jenna Kantor:                14:40                Wow. Wow. Well organized. So you've done the interviews and now we're at lunch. Jim Dunleavy:               14:49                Up to the interviews, I bring my delegates back to a caucus room that I've got assigned and we start to talk about the candidates and start talking about the interviews. Jenna Kantor:                15:02                Okay. And then after that discussion, what's after that? Jim Dunleavy:               15:07                Then later in the afternoon, we're going to have what we call motion discussion round tables where chief delegates and some delegates if they want to come, can come. But we come and discuss strategy issues and or changes in motions, get more information on particular motions that are going to come before the house. And usually we have two or three of those in the course of the days that we're together. So that once we get to the floor as many of us as possible, have the same information about a particular motion. Jenna Kantor:                15:44                Oh that's so great. So you can get on the same page. That's brilliant. I really liked that. That's so smart. And that's the new thing you were saying. Jim Dunleavy:               15:50                Well we used to do it a different way. We used to have these called motion discussion groups where motions were assigned to a room and then you would run around and trying to listen to the information that way. We're going to try these round tables where I'm assuming it's going to be set up, like each table is going to be a motion and you could go to whatever one you want, and just do that for a period of time. I think that's a good change. Jenna Kantor:                16:18                I love that. I like how you guys are always trying to fix a problem, solve and improve. That's really incredible. And then we get to the meeting after everybody's on the same page. Everyone understands what's going on. Everyone then comes together. There's that vote at the beginning, right, like you said. And then is it all run by Robert's rules? Jim Dunleavy:               16:39                Yes. Everything we do is via Robert's rules. We have a speaker of the House who's basically our facilitator, making sure everything moves forward as quickly and efficiently as possible, but also within the realm of Robert's rules of orders. So everybody is dealt with in a fair way. We don't want people, we have very small states. For example, we have states that may only have two delegates there. New York is a larger state. We have 25 delegates. So if you're looking to influence votes in order to get something passed, you're generally going to try and go to the California's, the New York's, the Illinois’, the Florida’s, the Texas’, to try and garner as many votes as you possibly can for whatever issue you're trying to support. So the smaller states need to have protections. And so I think the caucus process of them being assigned to the caucuses from throughout the United States, they get much better information before they meet because then they're just not talking amongst themselves and they also have the ability to create relationships with some of the larger states. So we all know what everybody is doing. Jenna Kantor:                17:57                What do you mean by caucus? Would you mind defining? Jim Dunleavy:               18:00                There are caucuses set up throughout the United States. The one New York is in is called the northeast caucus. It's actually the oldest. We have states from Maine down to DC, I think it is on the east coast. Jenna Kantor:                18:17                Oh. So it's like a region essentially? Jim Dunleavy:               18:19                It’s a regional Caucus. Now that caucus does not have any authority in terms of voting. We don't block vote. We don't try and get everybody together and vote one way at a particular issue. That's not the purpose of the caucus. The purpose of the caucus is to share information, to perhaps bring a motion concept like I did with the New York motion this year to the caucus to get viewpoints and ideas. And perhaps as a caucus, ask for information, ask for changes in the way we do things, and send that to the house officers. So it's an information gathering, sharing and actually very stimulating meeting. We have one in the fall and we have one in the spring, and we have one here. We had one here the other night, so we're looking I think in March or April to have one. It's up in Vermont, I think. And then the one in the fall, I don't remember where that one is, but basically it is part of a year round governance process where we'll be talking about motion concepts at all of these. Jenna Kantor:                19:38                And for those who don't know, we are actually at the combined sections meeting, which I did not say. So when he's referring to here, he's talking about here in DC 2019. Yes, yes. This is excellent. So during Robert's rules, how was it handled for someone who's new and they're not familiar with what even Robert's rules is? Is there somebody who teaches them when to raise their hand or say a motion or a vote of where somebody to just make sure, for lack of a better word, that they're in line? Jim Dunleavy:               20:16                It can be intimidating the first time for a new delegates especially when they first walk into the house and they see the physical enormity over get it. You don't get a sense of that until you're there. It's also very, I find it very exhilarating to have all our colleagues together in one place. What APTA does, it's a PowerPoint slide presentation to orient new delegates to the process. We have an orientation handbook in New York where I do a conference call and we're probably going to move to a webinar format next time, with all the new delegates each year. So I basically go over what their role is, what to expect, some of the mechanics of what they need to do. And even with that, I know some of them are still not totally clear, we did that in November. And so I'm still getting questions. So, the good part is I'm getting the questions. In the past, I remember when I was a new delegate, we had no such orientation. It was, here you go and you're done and you just deal with it. Jenna Kantor:                21:42                Oh, just praying that you just rose your hand the correct way. Jim Dunleavy:               21:47                Exactly. Right. They do have a lot of resources now. In New York, we usually buddy up, the new delegate with an experienced delegate. So if they feel for whatever reason, they don't feel like you can find me or talk to me, they have this other person that they can reach out to. Jenna Kantor:                22:09                Yeah, that's wonderful. I definitely could see myself wanting to lean over and be like, what are they talking about? And you know, would you mind defining this? So I think that is a great thing that's already in play to get that mentoring. I could definitely imagine myself, and this has been advice from others that the first year, not that  I wouldn't vote on things, but to spend more time just being quiet and listening because there's so much to take in. Would you agree? Jim Dunleavy:               22:37                Absolutely. It takes time to get used to the process. And so you have to, early on as a new delegate, you have to spend your time dealing with the mechanics of what's before you. But there are also situations where new delegates may feel very passionate about a particular issue that's coming before the house. And so how we've done it in our chapter, is we've tried to keep it as open as possible. I do not restrict our delegates from getting up and having their say at the mic. And what I have noticed is I think the newer delegates are much more better equipped, I guess the best way to handle that situation. I know in the past and I was one of them, the first time up to the mic in front of 400 of your closest friends can be a little intimidating. I've seen with our newer delegates, a much higher sense of confidence in and a knowledge base and again, the passion that they bring. I think we're going to have a number of delegates here in New York for many, many years to come that will be great representatives of the chapter. Jenna Kantor:                24:06                I love hearing that. It's very exciting. I'm so grateful to have somebody like you in New York who's really leading us with such clarity. And I just want to thank you. Thank you. Thank you. Thank you for coming on to this podcast because this is going to be a resource that I'm going to be sharing out with people who are interested, a lot of students for sure. Cause I'm definitely, even though I'm still a new Grad so I still have that, you know, flowery perspective. So for you to take the time and sit with me on the last day of CSM when we're very exhausted. I am truly grateful. So thank you Jim Dunleavy for coming on. Do you have any final words of advice you would like to give to anyone regarding the house of delegates? Jim Dunleavy:               24:50                Well, I would just say for everyone to get involved. In New York you have multiple places to get involved. You can get involved at your local district level. That's where I started. Somebody invited me to a meeting and here I am years later doing these types of things and also having served in national office and creating a section. It's been a wonderful, wonderful part of my career. You always get paid back 10 fold, what you give. And so I would say get involved. Call the chapter, call your local district representative, find out when the meeting is locally, and start that process there because the thing that drove me was going to a meeting that a friend brought me to actually when I was in PT school. And I left that meeting thinking I do not want these people making all these decisions without me talking about this. And that was kind of my driver. You know, people have different drivers, but I think get involved because that's the only way the profession is going to move forward. Jenna Kantor:                25:58                Thank you. Thank you so much. Those are excellent words of wisdom. Thank you for coming on.     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!