Healthy Wealthy & Smart

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475: Dr. Chris Napier: The Science of Running Feb 03, 2020

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LIVE on the Healthy, Wealthy and Smart Podcast Facebook page, I welcome Chris Napier on the show to discuss the science of running. Chris Napier is a Sport Physiotherapist with a PhD in running biomechanics and injury prevention. He has an appointment as Clinical Assistant Professor in the Department of Physical Therapy at the University of British Columbia. In this episode, we discuss: -How to bring a wearable to market for running retraining and injury risk reduction -What to look for when investing in wearable technology -The importance of translating the research to both the clinician and athlete -Science of Running: Analyze your Technique, Prevent Injury, Revolutionize your Training -And so much more! Resources: Science of Running: Analyze your Technique, Prevent Injury, Revolutionize your Training Chris Napier Twitter Email: chris.napier@ubc.ca Chris Napier Research Gate A big thank you to Net Health for sponsoring this episode! Check out Optima's Top Trends For Outpatient Therapy In 2020! For more information on Chris: Chris Napier is a Sport Physiotherapist with a PhD in running biomechanics and injury prevention. He has an appointment as Clinical Assistant Professor in the Department of Physical Therapy at the University of British Columbia. In addition to working on research projects, Chris continues to be a practicing physiotherapist with Restore Physiotherapy and Athletics Canada. He has competed at the national level as a successful middle-distance runner, earning medals at the Canadian Track & Field Championships in 1996 and 1997. He is also an accomplished marathon runner with a personal best time of 2 hours, 33 mins. Read the full transcript below: Karen Litzy: 00:01 So welcome everyone. So for those of you who are watching live, thank you so much for taking the time out of your day and coming on to watch and learn. Oh good. I'm just making sure that it works. So I just had to check on my iPad to make sure we're live and we are. So thanks so much for taking the time out. As we go along. I may ask you just to kind of write in the comment section where you're listening from. If you have any questions, by all means, definitely, definitely ask. Now is your chance, I'm sitting here with Dr Chris Napier. He is an expert. He is a new author. We'll be talking about his book, the science of running in just a little bit, but Chris, just to kind of allow people to get to know you a little bit more. Why don't you kind of give the listeners and the viewers here a little bit more about you. Chris Napier: 01:05 Sure. well thanks again for having me on Karen. I feel like I've really made it big time. Now. I'm on the Karen Litzy podcast. It's huge. So thanks again for having me on. So I'm a sport physiotherapist. I've been practicing for almost 20 years now. And, I've worked with a range of sports. But I sort of ended up coming back to the sport I'm most passionate about. The one I love which is running. About 10 years ago I started really focusing more on running and it was basically because I'm a runner myself. Out in the community running with the various sort of recreational races training with different clubs and so then and talking to people who are running all the time. So it really sort of just made sense for me to kind of work a bit more clinically in that field. Chris Napier: 02:00 And at the same time I was getting interested in pursuing more research. And so I started my PhD in about 2012, 2013. And I focused on running and I was really interested in being able to quantify aspects of running in terms of running form and biomechanics. So my PhD was on running biomechanics and sort of clinical interventions using gait retraining to prevent injury. And so I finished that in 2018 and I've moved now more out of the lab so to speak out of the biomechanics lab but still interested very much in the mechanics of how we run. And I'm now working with a group of engineers at Simon Fraser university doing my postdoctoral fellowship there where they actually develop a wearable. And so we're doing some really cool stuff there in terms of actually developing potentially products that will be available to clinicians and to runners to measure their gait. Karen Litzy: 03:13 Very cool. And I will also add that you are sort of at the helm of the third annual world conference of sport physiotherapy in Vancouver this year. It was an amazing event. You and the team you guys did such an amazing job and I'm sure that's the feedback that you've have probably got from the conference, from the people who attended. So I just wanted to give you guys some more accolades and a nice shout out cause it was a really, really well run conference with some great info. Chris Napier: 03:48 Yeah, that is the feedback we've had, which was fantastic to hear from across the board. And, I'm really looking forward to our continued support for your therapy candidate conferences, which will be a biannual event and as well the next world Congress, which will be excellent, I'm sure as it's being hosted in Denmark. Karen Litzy: 04:08 Yeah. Yeah. That'll be fun. And that's in 2021. So that'll be a good time. And again, if you're watching live, I know I saw a couple of viewers watching live at the end of this, hopefully we're going to give away Chris's book. It doesn't come out until February 4th, but if you write your name or a comment or where you're watching from in the comment section, you're automatically in the running for a free copy of the science of running by Chris Napier, which is very exciting. So Chris, let's talk about wearables. So when I think of wearables, to me it makes me think of like a Fitbit or maybe an Apple watch or something like that. So in your introduction, you'd said that you're working with a lab as a postdoc. So when you say wearables, is that what you mean or are you talking about something else? Chris Napier: 05:11 Yeah, so I mean a wearable is really a broad category. And you know, for anyone who follows the consumer electronics show, which was just recently in Las Vegas you know, I think that area is huge right now across the board. And, we think of it very much in the health lens. But really a wearable, wearables, anything you can wear on your body that tracks something whether it's, you know, your heart rate or your breathing rate or your pulse or your blood pressure or skin temperature or joint angles, impact forces. I mean, it goes on and on. Really anything we can measure through something we can wear. So, you know, by nature it's something that's portable often, you know, connect with some sort of app either on a Bluetooth device or we'll sort of record onto the actual hardware itself or download later. Chris Napier: 06:15 But you know, that's the other side of it is, you know, beyond the wearable, the actual interpretation of the data and the visualization of that and that sort of thing. That's a whole other field as well. But the lab I'm in is looking at wearables that can measure health-related metrics. And so some of the projects we have going on there are looking at recovery from stroke or looking at you know, more fine motor function, that sort of thing. And my area specifically is looking at an application to running. Karen Litzy: 06:53 And so when, you know, I think about application to running and you think about, you know, perhaps using a wearable to enhance someone's running, whether it be their running gait, their endurance, their times. And what I think of right off the bat is a running analysis where you've got someone on a treadmill and you've got multiple cameras and they've got dots all over them and all their joints, which is not something that every clinic has the ability to do because those setups can be quite expensive. So what are you doing within your research that might be a little different and offer clinicians something that might be more practical? Chris Napier: 07:40 Yeah, so what you described there that sort of motion capture 3d motion capture analysis which is sometimes done on an instrument, a treadmill, which will give you force information as well as the joint position movements. But that was my PhD. So that's what I did. I looked at basically a snapshot of people running and then assume that that's how they ran when they left the lab. Which is a big assumption, right? And so what we're doing is we're trying to get those same measurements but in something that can be worn outside of the lab and in the natural environment which gives us it opens a whole other world to what we can measure. We can measure things where, you know, rather than on a treadmill, which might be unnatural for a lot of people, we can measure them running on the road or through trails or uphill or downhill. Chris Napier: 08:40 We can measure how their mechanics changed throughout the course of a run. You know, so we can see what happened when they start to get fatigued. We can measure in a race situation you know, when people perhaps run differently cause they're pushing themselves to their limits. And we can also measure over time, over a weeks or training blocks so we can see what happens to people's mechanics. As a more chronic sort of fatigue sets in. So there's a lot of stuff that we can study. And, in our lab we have sort of the ability to embed some of these wearables into garments. And so essentially we're developing smart garments. And we published a recent paper looking at using a set of running plates to measure hip, knee and ankle kinematics during running. And, we developed this and I think it compared to the gold standard, which is still the three D motion capture and these tights do very well at measuring that movement. Which is exciting cause then, you know, we can start to produce these and runners can start collecting data wherever they run. Karen Litzy: 10:01 Yeah. Which obviously seems a little bit more practical than, like you said, just being on a treadmill. We know running on a treadmill is definitely different than running on the road or the track or real life situations. And is that something that a, let's say your average physical therapist practicing PT like myself, if someone comes to me with a running related injury and I mean, I don't have access to a three D running analysis, is this something that I would be able to say to this potential patient he lives in? I have some wearable technology that you can use that might give us a better picture as to what's happening when you're running. Chris Napier: 10:49 Yeah, I mean, we're not there yet, but that's certainly where we're going. So, you know, I guess potentially we could, we could put this pair of tights on a runner and we could track their hip, knee and ankle kinematics while they run either on the treadmill in the clinic or we could send them outside and have them go for a run and come back. And or you know, these could be something that the clinic can loan out or rent out and maybe patients keep them for a week so we can track their running mechanics over the course of a week. And then that could potentially be uploaded to a cloud or brought back to the clinic and downloaded so that you can look at their data over time. And what we're using our strain sensors to be able to measure kinematics. Karen Litzy: 11:38 And what does that mean? What's a strain sensor? Chris Napier: 11:40 Well, essentially these are thread like sensors that the amount of strain produced can give us an idea of how much movement is occurring. Karen Litzy: 11:52 That's sort sewn into the fabric. Chris Napier: 11:54 Exactly. And we've done, you know, a lot of the research we do is looking at where we need to place these and how many sensors we need and that sort of thing. And so that was the big work sorta involved in developing these tights is to figure out how many, you know, can we get away with just having three or four sensors which reduces the you know, the cost of energy and also the amount of processing involved and where can we put those to optimize you know, the metrics we're looking at. But you can also then add inertial measurement units or I am use which have accelerometers and gyroscopes in them, which can then add a whole other layer so we can look at you know, impact. We can look at angular philosophy and things like that. So, you know, we're looking at integrating those things right now as well. Karen Litzy: 12:53 And all of that can be so knit fabric of a pair of tights. Chris Napier: 12:57 Yeah, yeah. We're talking about pretty small. Karen Litzy: 13:01 That's wild. And so, you know, you did a study kind of taking these tights and looking at, well, how many sensors do we need and where do they need to be placed? And was this sort of a preliminary study, cause I can understand the need for knowing how many sensors you need and where to place them and then kind of recruiting a larger amount of runners to kind of study to see does this do what it says it's going to do it in a nutshell. So right now, just so that the viewer isn't, so that I myself get a better idea. So right now you're sort of in that developmental stage where you're looking at where to place them and how many, and do they work? Chris Napier: 13:48 Yeah, we've done that. So basically this study was that, so we were happy with where they are and the number for what we want to measure. And so now what we're doing is can we use these to give us information about you know, the fatigue state that runners are in. So, you know, when we're getting into machine learning and that sort of thing as well with this. So you know, can we classify a runner as being fatigued or not? For instance, based on the information we're getting from these tights or, you know, and then as I said before, like, can we get these out now and actually get people using them so we can start collecting large data sets. You know, that's where it gets interesting. Can we get these out to hundreds and thousands of people to be able to start collecting data on those numbers and really start to refine the technology and perhaps see some interesting patterns. Chris Napier: 14:49 And you know, there's some of the studies coming out of refurbish lab in Calgary have been doing that. They use the now defunct Lumo device, which I am used situated on the waste. And they've done some really interesting work with Christine Claremont leading that and Learn Benson looking at sort of classifying situations or types of runners based on the data they've gotten from those devices. So we'd be looking at maybe doing some similar work with ours. Karen Litzy: 15:30 Yeah, I mean, very cool. And, I guess the next question is why should we care? So as physical therapists or even as runners, like, yes, this technology is cool, it has the potential to give us a lot of data and a lot of information, but why do we care about that? Chris Napier: 15:54 Yeah, exactly. So, you know, I think first of all, we have to figure out, is this going to give us information? That is I think we can be happy that it would be reliable, but really we're looking at the validity. Are we getting information where we're going to see patterns that lead to injury. And that's again, that's kind of where we're going with this. But at this point we can't say that that's where we need those large numbers. And hopefully I think that's what we will find is that we can kind of see trends. I mean, there may be a time where, you know, these are sold in running stores and people just wear them and the…

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474: Dr. TaVona Denise Boggs: How to Avoid Burnout Jan 27, 2020

Show notes

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome TaVona Denise on the show to discuss burnout in physical therapy. Atlanta-based business accelerator, success coach and avid cyclist, TaVona Denise lives and breathes by the motto, "success is 80% mental, 20% skill." With certifications in life, weight and wellness coaching, her specialty is helping new entrepreneurs get past fear and overwhelm, get their business up and running, so they can help change the world. In this episode, we discuss: -Burnout in physical therapy and the tools you need to take the next steps in your career -Why a gratitude practice can help shift your mindset and elevate your to-do list -The importance of a coach that can identify your blind spots and keep you accountable -How to channel your fears and build confidence so you can tackle your biggest goals -And so much more! Resources: TaVona Denise LinkedIn TaVona Denise Facebook TaVona Denise Twitter TaVona Denise Instagram TaVona Denise Website A big thank you to Net Health for sponsoring this episode! Check out Net Health's 4 Ways to Increase Patient Engagement! For more information on TaVona: Atlanta-based business accelerator, success coach and avid cyclist, TaVona Denise lives and breathes by the motto, "success is 80% mental, 20% skill." With certifications in life, weight and wellness coaching, her specialty is helping new entrepreneurs get past fear and overwhelm, get their business up and running, so they can help change the world. Shortly after finishing college she started her first two businesses, but found herself burned out because they were not using her gifts. TaVona then used her skills as a physical therapist to start a physical therapy contracting company. Finally her own boss, the problem was, she basically created a job for herself, which was not the life she had envisioned. It wasn't until TaVona found the world of coaching, that she was not only able to successfully lose 80 pounds and keep it off, become an award-winning athlete, and build the business that would eventually provide the lifestyle she wanted. Speaker and author of, Unstoppable Success: How to Finally Create the Body, Business and Lifestyle You Want, TaVona teaches entrepreneurs the steps she used to create lasting success as a lifestyle, in weight loss and in business. She believes there would be less addiction in the world if people were courageous enough to walk in their purpose. She is on a mission to help people find their zone of genius and make money by making a difference. Read the full transcript below: Karen Litzy: 00:01 Hey TaVona, welcome to the podcast. I am so happy to be interviewing you live here in Nashville, Tennessee at Graham session. So welcome to the podcast. TaVona Denise: 00:10 Thank you for having me. Karen, I'm so excited to be here and to be speaking with you today. Karen Litzy: 00:15 Yeah, and I'm excited to have you because what we're going to talk about today is when a therapist, we'll stick to physical therapy, but this really could probably apply to most people in healthcare, let's say. But we'll stick with physical therapists because that's what we are. That's what we know. And we're going to talk about when, as a physical therapist, you kind of hit that crossroads in your career where you're not sure if what you're doing is what you want to continue to do. So TaVona, yourself as a physical therapist and as a coach, I'm sure you've seen this quite a bit. So can you talk to when therapists get to that crossroads and what you've learned from interviewing over a hundred different therapists? TaVona Denise: 01:03 Yeah. Well, it's a fascinating thing. I started to notice whenever I would remember to ask somebody, like, what year, how many years have you been in the game? What's going on with you? When they're coming to me for life coaching and they're thinking about making a change. The number 15 kept coming up. Every time I would write it down, they're like, yeah, I'm at year 15 I don't know if I was attracting them because that's about when I started to feel like, okay, I've been doing this 15 years. I know my job inside and out, backwards and forward, and I don't think I can do this for the rest of my life. And at that time I wasn't even 40 so I have plenty more work, work years left and I can't keep doing it. And so I just find that, especially for the women, either it's 15 years if they've gone straight through and sometimes it stretches to 20 if they have gone back into part time to rear their children. Karen Litzy: 01:56 Okay. And in talking with all of these therapists, have you found any common themes that they get to this 15 to 20 year Mark? And they're like, Ugh, now what? TaVona Denise: 02:09 Well, that's exactly what they say. It's like, now what? I know my job, I don't necessarily want to keep practicing in this way. I feel stuck. I don't know what to do next. And part of the problem is they do not have a passion for research, academia or management. And so many of them are thinking, well, should I leave the profession? And if so, what does that look like? What does that mean? Am I throwing my degree away? And so what are the options? There are several. I think one of the things that we have to do is take a look at, well, why did you get into the profession in the first place? And can you reconnect with that? Are there aspects outside of what you're doing that you can bring into what you do now to help judge it up and renew it? To me, some people have reinvented themselves and said, okay, well maybe I don't necessarily want to stay on the rehabilitation side, but maybe I want to practice prevention and wellness. So I think for some people that's an easier transition because they get the sense of I continue to use my degree and leverage it to do something that still helps people. Karen Litzy: 03:20 And if let's say I'm coming to you and I'm saying, Oh TaVona I just, I don't know what to do, I'm really stuck. I'm getting, you know, I'm starting to feel like I'm not making a difference anymore. So how would you, we can kind of go through a mock coaching session here. So what are some things that maybe you would want to ask me or want to know from me that maybe can help me figure out what to do next or what's your process like? TaVona Denise: 03:51 It really, really depends. Just like in an evaluation situation, like no two people are alike. So it depends on how they present, how they come to me. But I really want to know what do they enjoy at their job and what do they enjoy as a person working in a profession. Because sometimes there's an opportunity for a person to create a position for themselves or to create a program. And some of the clients that I've worked with have become what I call intrepreneurs. They have taken their skills, their expertise, their specialties, and then develop programs within the organizations that they work in, which it's a challenge. It's not as risky as being an entrepreneur and going off and doing it for themselves. They get to stay in that environment and not lose the years of service and PTO and all the perks and things. It's kind of like playing with the house's money so they get to do that. Sometimes it's a matter of just feeding the hobbies and things and taking time for themselves that they're not doing. Because we always hear the analogy of you have to put your own mask on first before you serve others. And so as caregivers, that's what we do. We care for others and sometimes we are forgetting to care for ourselves. So sometimes that's the approach we take. I find a lot of people, and this is also a strange one that I'm thinking about. A lot of people need to declutter their homes. Karen Litzy: 05:14 Yes. 100% yes. I'm just going to say yes to that. I'm Marie Kondo in my home like five years ago and I have to tell you, decluttering my home kind of decluttered everything else for me, even part my practice and my thought process and I was able to then expand and do things that I couldn't even imagine were possible. So proceed. TaVona Denise: 05:42 Yes, 100% it was interesting, I listened to a coach that specialized in a relationship. It was one time and she was like, you need to make space in your closet for the person that you want to come in and so if your closet is jam packed. There's no room for anybody else. And I think about that too. Now that we're talking about this, the decluttering process I think gives people space, like you said, expand space to think, to breathe. So that, that like every time they pulled into the garage and they see all the boxes in the junk, it's irritating them. And so that's just one more thing. If they can declutter that, that's something that they have control over where it doesn't have to do with the manager sucks, the coworker sucks, the patient's suck and all of this thing, we've got to go to all these meetings, we don't like you can control your space. So I think that's part of the empowerment process and having them have a sense of control over their lives and looking at how we do anything is how we do everything. TaVona Denise: 06:32 Yup. And so once we take a look at that, then they can use the skills that they learned to, to go into other things. And it really goes into thought process too. So a lot of people are holding on to things that they shouldn't be. It's beliefs that they shouldn't. Stories that they shouldn't, grudges that they shouldn't. And we literally unpack that stuff as they start to declutter their homes. And I also found that when I decluttered my home, I mean I have a garage, but when I decluttered my home, when I would come home after a busy day of seeing patients, I was coming home to a space that was calm and that was peaceful and comfortable. And so I wasn't adding stress of ah, God, I gotta go home, I gotta put this away, I have to do this, I have to, I didn't have to do anything when I got home except take the time for myself and relax a little bit. TaVona Denise: 07:30 And so for me, I felt like that was really helpful in almost like avoiding burnout, if you will, at that stage of my career, which is about the 15 year Mark. Karen Litzy: Yeah, I think you made an interesting point about the word have to, whenever I hear someone say I have to do something, my antenna goes up because it's a very disempowering thing to think I have to do something and whatever we have to do, we kind of resist. And so part of the resent and resent, right? So the burnout is coming from this resistance like, Oh, you can't tell me what to do. And so if we can just make that subtle shift to I get to do this thing, sometimes just that subtle shift of people thinking that they have to go to work. And this is really important for those who are considering building a business and they need to bridge, they can't just quit what they're doing in bridge, you know, it requires a lot of effort and energy to start a business as you know. TaVona Denise: 08:28 And so if we have that resistance and that resentment towards our job, that is actually paying the bills, right? We are exhausted at the end of the day and then there is no mental energy or emotional energy to put into our new baby over here. And so just one subtle shift. If listeners can think about anytime they say, I have to go to work, can you find the shift who I get to go to work and really be grateful and thankful. The things that go into work is providing you the opportunity to practice new skills, to make connections, to pay your bills without worrying about what it's doing to fund the software or the whatever that you need to in order to start this other venture. Karen Litzy: 09:09 Absolutely. And I think I'm so glad that you brought up the get to versus the have to, because I admit I'm a have to girl sometimes and so now I am going to remember to say I get to, because you're right, when you get to, you're coming from a place of appreciation and of gratitude and we all know there's a lot of research out there on how gratitude can make you happier and gratitude can make you successful, can contribute to making you successful. And so I think that's a really important shift. And now what, are there any other, let's say little shifts like that that the listeners can do if they get to that point where they're like, Ugh, work, I don't want to do it. TaVona Denise: 10:00 Well, one favorite exercise I like to give people, especially if people are just zonked at the end of the day and they like to carry work home with them. One thing I have people do is put a journal or notebook. It doesn't have to be fancy or expensive in the car. And so what it does is when you get into the car, you get the opportunity to let your brain have it. Say they get the fuss out, whoever they want to from the day they get to say everything that they didn't get to say. They want it to say they think they shouldn't have said and all of that on paper. And just that bit of detachment from it. They can more easily evaluated and see the truth or the lie of it. And when they do that one, the brain gets to say it and then let it be done. And I've found that many people have thanked me because in their relationships get better cause they don't go home complaining to the partner or the spouse. The other thing that it does is it gives a clear break from the day. So the brain can say, okay, we're done with work. I've said my say and I can go to the gym, I can go enjoy time with my honey, my children, my whatever. And there is that separation. Karen Litzy: 11:06 And in your experience in coaching, a lot of therapists, do they return to work? Do they switch gears? Would you, if you were to put a percentage on it, and I know that's probably tough and I'm making you do this on the spot here, but if you were to say, you know, after we came up with better strategies, they found the joy in their work again, or after coming up with better strategies, they were like, Oh, I think I want to do X, Y, Z. TaVona Denise: 11:34 I think it's so it's an interest in it, but it may be a 25 go back to work and they're excited and they're like, Oh, I'm renewed. 25% is like, thank you for those skills. I want to turn the page to the next chapter of my life and do my own thing. Whatever form comes in. And then there's this 50% that's kind of in the middle and they either don't move forward to practice the skills all the time. And we see this sometimes with fitness and anything in life, right? And I think, and here lately I've been wondering about that person, like what makes that person not move forward? And I've come to understand that that person is very much afraid. So we talked about those over 100 interviews I did last year. And in my note, taking some variation of the word fear came up in 90 something percent of those interviews. TaVona Denise: 12:34 And I thought to myself, well, what is really going on here? And what I've been thinking about here lately is how we in healthcare are taught to follow certain protocols and we're breaking out of that now, right? So people are not recipes and things like that, but there's still this underlying mentality that we need to have certifications that we need to follow rules that we need to play inside the lines and get it perfect and get it right. Because, I come from acute care background. So things that I do we do could literally kill…

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473: Dr. Howard Luks, Knee Osteoarthritis Jan 20, 2020

Show notes

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Howard Luks on the show to discuss knee osteoarthritis. Dr. Howard Luks, MD is an Orthopedic Surgeon practicing in Westchester and Dutchess Counties in New York. He specializes in the management of complex knee and shoulder injuries with a focus on ACL injuries, Patella Dislocations and Shoulder Instability. In this episode, we discuss: -What is knee osteoarthritis and how is it diagnosed? -Modifiable risk factors for developing knee osteoarthritis -Indications for a total knee replacement -The importance of managing expectations for good patient outcomes -How to strengthen the physician therapist relationship for more patient centric care -And so much more! Resources: Howard Luks Website Howard Luks Twitter Howard Luks Facebook Howard Luks Youtube A big thank you to Net Health for sponsoring this episode! Check out Optima's Top Trends For Outpatient Therapy In 2020! For more information on Dr. Luks: Howard Luks, MD - @hjluks - is a patient centric, Orthopedic Surgeon who has been in clinical practice for 20 years. Dr Luks utilizes his passion for patient engagement and his expertise in medicine and social media to educate a global audience through his website, twitter, facebook page and YouTube channel. He serves as a consultant, board member and adviser to many companies in the mobile health, online health platform, and medical decision making start-up spaces. He served on the External Advisory Board of the Mayo Clinic for Social Media - a recognized leader in this space. "Technology is not about replacing physicians ... instead, we must remember, change brings opportunity — and we must use these changing times to scale great physician thought leaders." - Howard Luks Howard Luks, MD (@hjluks) is an Orthopedic Surgeon practicing in Westchester and Dutchess Counties in New York. He specializes in the management of complex knee and shoulder injuries with a focus on ACL injuries, Patella Dislocations and Shoulder Instability. As an early adopter of Twitter, Howard Luks MD also runs a blog (>100,000 unique monthly viewers), a Facebook Page, a YouTube channel and a personal site to educate, interact and engage a worldwide audience. Read the full transcript below: Karen Litzy: 00:01 Hi, Dr. Luks. Thank you so much for coming on the podcast and really looking forward to this today. Howard Luks: 00:06 My pleasure, Karen. I'm looking forward to it too. Karen Litzy: 00:09 Okay. So today we're going to be talking about osteoarthritis. You had a great tweet thread back in, I believe it was the end of June, beginning of July, 2019 on osteoarthritis and got a lot of positive responses from people and I really wanted to talk to you a little bit more about osteoarthritis. First thing is what it is and what it isn't. So I will hand it over to you. Howard Luks: 00:40 So the reason why I decided to put that thread up was based on the fact that I keep hearing people become worried thinking that their body is wearing out and that our arthritis is a mechanical process and wear and tear process. So they're going to stop walking. They're gonna stop riding, they're gonna stop running, they're gonna stop their exercise. So in other words, they're going to increase their risk of dementia, heart disease, hypertension, diabetes, and other metabolic disorders because they think they're saving the lifespan of their knee. So in order to get across that osteoarthritis is really a biological process where the articular cartilage is starting to degenerate for various reasons and that their activity actually, if anything is beneficial is what led me to write that whole series of tweets. And I followed up with another one a few months later. That then started to throw in all the exercise patterns and activities that people can in fact pursue, especially with respect to runners. See, since I seem to attract a lot of runners, I wanted to be known that running is not damaging for a knee that doesn't have any significant mechanical issue or is recovering from a fracture. Karen Litzy: 02:22 And when we talk about osteoarthritis, oftentimes people will come to us as physical therapists and they'll say, Oh, well, you know, it's bone on bone. That's what the x-ray shows bone on bone. So how do you respond to that? And how should a physical therapist respond to the patient in those scenarios? And in a way that doesn't undermine the physician that referred them to us, but being consistent with the evidence. Howard Luks: 02:51 It's quite a challenge, right? I mean, yeah. The interesting thing I always talk to our residents about is that, you know, I'm 56 now and I'm just starting to get really good at patient interactions and discussions and conversations in the office just in time for me to retire. And I talk about the fact that words harm, images, harm, and you really can't unsee your MRI or xray report. So it all comes back to communication and education. And that's one of the biggest problems in healthcare today, right? We're RVU driven. You guys are strapped if you're a network, you know, you can't make a living of $40 per hour. And so we're all seeing more people in less time and that really threatens our ability to have a good, actionable and meaningful conversation with people. Yet it's absolutely critical that we do so. Howard Luks: 04:02 So if I put an X Ray up showing bone on bone arthritis, I then immediately enter into a conversation about how you really treat people, not an image. And that even though they're bone on bone, you know, most likely I'm talking to someone who doesn't have severe quality of life limiting knee pain more often than not, and you know, a bone on bone knee that's relatively dry, meaning it doesn't have a significant effusion, it's really not going to be too terribly painful. You know, the bone itself isn't what hurts, you know, bone marrow edema hurts, synovitis, hurts. But not the bone itself. So I explained that I've run with people that I know have bone on bone arthrosis yet. I explained that I've also replaced knees in those with less severe arthritis because they had severe synovitis or bone marrow lesions that just wouldn't go away. Howard Luks: 05:16 So it's important to talk about the fact that the xray has only one small part of the overall evaluation and a very small part in determining what the treatment or treatments could be or should be. And that it really it's their story. It's their history, it's what they're telling us. And you know, when it hurts, how often it hurts and how severe that pain is. That's more important in terms of how we craft our treatment plan. And when, you know, I had a patient today actually asked me, well, when, when do you know, as the patient, when do you know that you need to have a joint replacement surgery and we'll stick with the knee. Karen Litzy: 05:58 So when your patients come in and they asked you that question or you talk to them about the possibility of a total knee replacement or a partial knee replacement, what do you say and how does the patient know? Howard Luks: 06:23 Huh, that's a great question. And it's one that I'll get probably 15 times tomorrow so the discussion usually goes as follows. It's, you will know you're going to wake up one day and say, I just can't take this anymore. I've tried X, Y, and Z. I've done my exercises, I've lost weight, I have adjusted my diet. I've tried over the counter medications, Savage's bombs, ointments, suction cups, tape and everything else that their friends have told them to try and their pain is limiting their quality of life. So that's, you know, a very important part of the decision making process is you have to dive into their goals, right? You can run into a lot of trouble with people between 40 and 65, 40 and even 70, depending on how active they were, because you might have someone who's miserable, but it's simply because they can't play singles tennis anymore. Howard Luks: 07:37 Right? It's like having someone with shoulder pain in your office because they can't hit a second lob as like they used to. You know, that person who's going to be really unhappy with the results of surgery. Same with the knee replacement in someone who can't play a second set of tennis but could easily finish, you know, a three set doubles match. So we have to determine when the patient feels that their quality of life has suffered long enough that they wish to move forward. Then we need to dive into what their goals are. It should be simply that they want to get through their day without this horrible knee pain. Because if it's anything other than that they may not be all that satisfied with the end results of the surgery. Karen Litzy: 08:33 Yeah, that makes a lot of sense. There's a big difference between the person who's having trouble walking from, you know, their bedroom to the bathroom or like you said, the person who can't get in another set of singles tennis. They're very, very huge quality of life differences there. Although that second set of tennis might be disappointing. It's different than not being able to walk a block. Howard Luks: 08:57 Correct. And we know, you know, both of us know there are significant number of knee replacement patients who have persistent pain after surgery and who are not happy with the overall results. And many times that might trace back to false expectations. So it's a really important discussion to have. And we also know there are many different patients out there. You know, there are some who have achiness and pain when they roll out of bed, but by the time they're done with their morning shower, they feel fine. Yet those people, some of those people might tell you that they want to have their knee replaced. So again, it's really important to dive deep into the reason why these people want to move forward and what their goals are. Karen Litzy: 09:54 Yeah, I think that's a great point. Thank you for that. And now I just want to go back to one thing. When we were talking about osteoarthritis, one thing we didn't talk about were factors that may lead people to be at risk for osteoarthritis. Do we know what some of those factors are? And if so, are they modifiable? Howard Luks: 10:14 Sure. So first, you know, the, the big category now that requires everyone's attention is our metabolism. You know, we are bombarded daily now, especially on Twitter with all the ELA facts associated with a typical or standard American diet full of ultra processed foods. I'm not gonna get close to the Quito vegan world and subdivided. However, it's really important that people start to read this literature about the dangers of ultra processed foods. It's very clear that a calorie is not a calorie and that a hundred calories of ultra processed foods versus a hundred calories of real food is going to have very different metabolic affects on us. And we're finding that people with high homocysteine levels have a higher incidence of heart disease, cardio metabolic issues as well as joint related issues. We're finding the same with uric acid levels, which will my car lay with your fructose intake. Howard Luks: 11:38 So high fructose corn syrup, we find a correlation with lipid disorders and the prevalence of osteoarthritis people's weight will certainly have an impact. A lot of people don't know that what each step you take, you're putting, you know, five to seven times your body weight across the knee with each step. If you're achieving 10,000 steps a day, you weigh 250 pounds, you have an extra 60 pounds on your knee across 10,000 steps. That's a lot of an added weight across that knee. Now for those who do not have osteoarthritis already, that might not initiate the process for those in whom the process has started. An MRI studies on asymptomatic people show that the process has started in a majority of us over 50, then that excess weight and force or stress burden is certainly going to increase the risk of developing a more rapidly progressive arthrosis. Howard Luks: 12:50 Now by far the most common causes are genetics and people with structural issues. So a varus or Bodine or valgus or knock kneed that will set you up for unit compartmental changes or changes in either the middle or the lateral compartments. Why we seem to see a pretty severe patellofemoral disease and in some middle aged women, I'm not exactly sure, perhaps it's some degree of underlying map tracking. But in terms of the modifiable risk factors, without a doubt, our weight, our activity level, it turns out as we, as we just said, that's right. This is less common in runners. Cartilage likes that cyclical loading and likes to be exposed to force in a cyclical manner. I think we hit on many of them. Karen Litzy: 13:54 Yeah. And then the only other thing I can think of is previous surgeries. So we know like ACL having an ACL surgery or ACL disruption, the majority of those people do develop osteoarthritis later in life. Especially if you're, you know, most of them happen when you're younger, usually. Howard Luks: 14:13 True. So you're absolutely correct. So upwards of 50% of people who have had an ACL tear will go on to develop arthritic changes. Even having just one Hema arthrosis, you know, blood in your joint elevates your risk of developing osteoarthritis because it changes the chemical compounds that's present in the knee. Once that has happened, now you'd go ahead and you add a mechanical issues such as a meniscus tear and your risks really start to go up dramatically. Karen Litzy: 14:54 Yeah. And, I mean I have seen patients in their forties you know, who have had multiple ACL reconstructions on their knees cause they were high level athletes in their younger years. And those are people who, you know, we were talking about the people who can't play tennis versus the ones who are having trouble walking down the street. Those are the people that are having trouble walking down the street and they know it, but they're doing everything they can to not have the surgery as well. So it's, it's an interesting group. Howard Luks: 15:25 Correct. And they're not harming themselves. I don't care if you're limping if you can get away without having your knee replaced, you should do so. Karen Litzy: 15:37 Absolutely. Absolutely. Certainly, certainly I think, you know, oftentimes people will hear, Oh, it's knee replacements are not that bad. It's not like it was years ago, but I mean, it's not great. Howard Luks: 15:49 Huh? Yeah. So there's, you know, the only surgery without risk is a surgery on somebody else. Yeah. If you're assuming an infection after a knee replacement has a low incidence, right. A 0.7 0.8%, but it's a life altering permanent problem. You know, you're going to need one to three operations to try and eradicate that infection. And if it's a nasty bug, it's going to end in an amputation. So, you know, are there a lot of amputations that happen each year because of knee replacement infection? No, but there are not zero. And there are a significant number of people who have persistent pain. I've looked, I perform a lot of knee replacements and I think it's a great operation for the right person. So there are significant upsides to a well functioning knee replacement and the vast majority of people are not going to get infected. However, when you start to push indications and you start to stretch them if you get int…

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472: Ryan Burklo: Financial Planning for Entrepreneurs Jan 13, 2020

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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Ryan Burklo on the show to discuss financial planning for small business owners. Ryan Burklo, RICP® is a financial planner, host of the podcast Holistic Finance, and co-owner of Quantified Financial Partners. Through his work as a financial planner, he works with medical practice owners to protect their practice, keep them financially efficient and assist with their eventual exit. In this episode, we discuss: -How to manage debt financing and make it work for you -What is tax efficient cash flow planning? -Retirement options for small business owners -The conversations you need to bring up with your financial advisor -And so much more! Resources: Quantified Financial Website Holistic Finance Podcast Ryan Burklo Twitter A big thank you to Net Health for sponsoring this episode! Check out Optima's Top Trends For Outpatient Therapy In 2020! For more information on Ryan: Ryan Burklo, RICP® is a financial planner, host of the podcast Holistic Finance, and co-owner of Quantified Financial Partners. He lives in Seattle, Washington with his wife and two kids. After learning his son had a stroke while in utero he became an avid volunteer for Pediatric Stroke Warriors. He learned much about the medical professionals who cared for his son and truly enjoyed working with them both on a personal and a professional level. Through his work as a financial planner, he works with medical practice owners to protect their practice, keep them financially efficient and assist with their eventual exit. His firm and his personal mission is to simplify finances so that you can focus on what you enjoy most. Read the full transcript below: Karen Litzy: 00:01 Hey Ryan, welcome to the podcast. I'm happy to have you on. Ryan Burklo: 00:06 Thanks for having me. Appreciate the invite. Karen Litzy: 00:08 Yeah. And you know we're getting onto the end of the year and people are starting to think, look back on the year, look forward to next year talking about their businesses and maybe how they can move forward, expand, stay the same. Lots of stuff. But today we're going to talk about kind of the business side of things. And I absolutely love having people like you on the program because I didn't go to school to be a financial planner. I don't, I don't know what I, you know, this is not my specialty. So I love having folks like you on because I feel like I learned so much from you guys, plants and seeds in me that make me think, Hmm, maybe I need to make some changes in my practice. So thank you for coming on. Cause I'm definitely excited. Ryan Burklo: 01:06 Yeah, I again appreciate being on. I actually started laughing when you said you didn't go to school to be a financial planner cause I was about to say neither did I. I think very few of us actually go to school to officially become a financial planner. I think it just kind of molds it's weighing falls into our lap. You know, life's events occur in the next, you know, you're, you know, you're in the industry and so it's very interesting. Had you told me that I would be a financial planner when I got out of college, I would have said you're drunk. I love what I do. Karen Litzy: 01:41 Yeah. And here you are helping and I should mention that you do work with a lot of medical practices. Ryan Burklo: 01:50 Yeah, that's really a majority of our focus is helping medical practices on the business side and merging that with the person side. Cause eventually we all exit our practice in some way, shape or form. And it turns into the personal side. So, you know, the two are married, yet business owners tend to only focus, they focus more on the business side because you know that that's the fun side. That's what they do every day. Karen Litzy: 02:19 Exactly. Exactly. And so it's great to have people like you guys to help guide us through that. And now, you know, I've been taught, this has been in the news quite a bit. I had, you know interviewed someone a couple of weeks ago about debt and we hear debt a lot in the news. Mainly the focus is student loan debt, but there's all kinds of debt, right? And when you're a business owner, you may be in debt, you may not be in debt. But my question is, can debt work for you? Can it be a good thing sometimes. Ryan Burklo: 02:56 Yeah. Yeah. I mean the quick answer is absolutely yes. You know, you brought up the media and everything we're hearing in the news and right now it's a lot of student loans. But you know, oftentimes there's also, you know, just debt is bad is the mantra and you should pay it off as fast as possible. And in some scenarios that makes sense in other scenarios that doesn't, you know, really depends on what kind of debt it is. You know, credit card debt for the most part isn't the best that I have because it tends to be high interest rate, right? You're getting in the double digits, 16, 17, 20% or so. But then there's other debts. Student loans can be one of them. You know, mortgages on real estate and other debts that are lower interest rates and you have to look at it at, if I'm going to put a dollar towards that debt, if I put my dollar elsewhere, how would that act? Ryan Burklo: 03:52 How would that do differently? Right? And so the simple example of that is, you know, right now you can get a mortgage really, really inexpensive, you know, 3.8% or something like that on a 30 year mortgage. And so if your dollar can be put back into the business or put elsewhere and beat 3.8 at a relatively low low risk, well then you'd be better off putting your dollar elsewhere. Cause then you'd be making money on your money so you're leveraging that debt so your money can work harder. Whereas the credit card debt that I mentioned, you know it's a 20% interest rate. Well now I used to be 20% that's a lot harder and the risk is a lot higher. Karen Litzy: 04:38 Got it. So, so for instance, if you take on the debt of a mortgage, whether that be, you know, let's say you bought a building for your practice or you bought space for your practice and like you said, the interest rate is 3.8% then that might be a good thing for your business because you're putting that money to better use for you or the equity is in the building is good. Is that kind of what you mean? Ryan Burklo: 05:07 Well, to put it in another way, if you had $1 million of cash or $1 million sitting somewhere and you went to buy real estate and real estate was worth $1 million, we get to put the whole thing down, the million dollars sitting wherever it's sitting versus getting a debt and having to pay interest on that debt. You have to analyze what could that million dollars would be doing for you, and if that million dollars could be doing something better than a 3.8% yeah, we were just talking about why would you give the full million dollars to the bank. Got it, got it. And then you have the flexibility between it. All, right? Even if you're, maybe if you're just breaking even some people will get nervous about that too. We'll, again, you've got $1 million. How much more can you do with other stuff in your business because you've got that rather than just giving it to the bank, what type of flexibility do you possibly lose? Karen Litzy: 06:15 Got it. Got it. Ryan Burklo: 06:16 So that's just a simple example that I like to use. And that's not to say that you shouldn't pay off some debts. It does go by case by case, but you have to look at what your dollar could be doing elsewhere. And does that make more sense rather than only looking at it, well, Ryan, I'm going to pay more interest over 30 years. That's 100% true. And what could that dollar the other dollars be doing over the next 30 years? Karen Litzy: 06:42 Got it, got it. So it could mean the difference between investing it into something that's going to give you a higher return or putting it to use elsewhere instead of hiring another doctor. Ryan Burklo: 06:54 Well, another position that's going to grow revenue by X percent, that might be the better solution. Karen Litzy: 07:04 Got it. Got it. See, this is why, you know, my brain does not work this way. This is why I need someone to kind of break it down and explain it to me as if you were explaining it to like a fourth grader. Ryan Burklo: 07:18 Yeah. Well, my industry doesn't like to do that, but we like to confuse people. I try to make it as simple as possible because that annoys the crap out of me. Karen Litzy: 07:25 Yeah. I appreciate that. All right, so that's a great way that we can kind of make debt work for us. If you have, are there other ways, I guess that you can make debt work for you? Any other easy, simple examples? Ryan Burklo: 07:48 I threw a couple of examples just in that one. It's really about, again, it's just leveraging what you currently have. And so if you can get a loan, well, you know, let's just say we have a bit of a widget maker, right? And the widget maker needs to buy a machine to make more widgets. And they've got, they can go get a loan on it for X percent or they can just buy it in full. Well, what makes the most sense for your business? How are you leveraging your money to make it work as hard as possible for you? So it's a constant analysis of leveraging where the leverage is. Does it make more sense, can your money work harder outside of giving it to the bank? Karen Litzy: 08:43 Got it. Yeah. So if you were to pay in full and you can make more widgets and sell more widgets to make more money, that might make more sense than making payments on that piece of equipment. Ryan Burklo: 08:54 Exactly. Karen Litzy: 08:55 Got it. All right. Excellent. Now I got it. Thank you so much. Sorry for being a little slow on the uptake there. Now the other thing that I really wanted to talk about is this idea of tax efficiency, cashflow. So in going through your website, I saw this and I thought, hmmm. Karen Litzy: 09:16 This is really interesting to me because I don't know that I'm being as efficient as possible. So can you explain what tax efficiency cashflow means under the lens of, you know, your small business owner? Ryan Burklo: 09:31 Yeah. So there's two sides of taxes, right? There's the taxes that you're going to pay now, right. Where the income that came in the door minus the deductions and everything that we can take as a business owner, what's leftover and what we're going to pay on taxes from that on the business side as well as from the income side and that's based on the rules and laws that are in place this year, 2019 then there's the tax side of what am I going to get taxed on 15 years from now, 10 years from now, 30 years from now, depending on where my money and my assets are sitting. That's the side that most people don't really consider because what they're only considered is I want to pay as little money in taxes this year. Karen Litzy: 10:21 Yes, yes. Right. Ryan Burklo: 10:24 So the next question you have to ask yourself, okay, 10 years from now or five years from now or whatever time period that is, where do I think taxes are going to go? And obviously we can't predict this. Oftentimes it depends on who's in office and what's going on in the economy, all that kind of fun stuff. But if you're of the opinion that taxes are going up, should you have a lot of money and assets where you have not paid taxes on yet? Karen Litzy: 10:54 Yes. All right. I got it right. Ryan Burklo: 10:56 Yeah, exactly. Because you've deferred the tax. So essentially if it taxes went up, now you're gonna pay more in taxes. Conversely, it taxes go down within, you wanted to defer the tax. And the problem is, is we don't know. And so much of this is, Karen Litzy: 11:11 It's a gamble. Ryan Burklo: 11:13 It's a balance is what I put in. So we talked about financial balance quite a bit and it's because we don't want all of our eggs in one basket, right? We don't want all of our assets to be tax deferred because what happens if tax go up? Conversely, like I just said, if taxes go down. Whereas we have our assets in different buckets now we can actually control what tax bracket we're in five, 10 20, 30 years from now. Just like kind of what we're doing right now in terms of lowering our tax bill this year. Karen Litzy: 11:47 And so when you're looking at balancing and not having all your eggs in one basket, where would those eggs be? Ryan Burklo: 11:57 Yeah, so it depends on what you're building in your medical practice or in your business. If your plan is, you know, take a solo practice, you know, at one doc and you know, the chances of a one doc practice being able to sell it is not very high, especially they're required. They're the ones that bring in the money anyways, right? You can't sell something if you're the person that you're trying to sell. So oftentimes those types of practices, they have to build side retirement accounts. Okay. Right? These are your traditional IRAs, your simple IRAs, your standard retirement accounts. And so you could be putting a bunch of money into those accounts where you deferred the taxes. So that's one asset. But we could be talking about, it's also an event. Conversely, if you've got the multiple doc practice, we've had a couple of partners and maybe it's an inside, say on, you're actually transitioning one doc out. Well, how do you consider the taxation of the business? What's the cost basis, and then how are we going to sell it? Oftentimes in insider sales, what they call that, oftentimes no one writes a lump sum check and says, here you go, doc, you're gone. It's normally let me pay you in installments over the next 10 years. I see. Okay, so now you have more taxes going on there. Karen Litzy: 13:27 Oh, cause you, yeah. So you, if you are the doc that left the practice, you're paying taxes on that money that is coming to you in installments. Ryan Burklo: 13:37 Correct. And if you're the doctor bought them out to pay that doctor, you need the revenue of your practice to be doing a certain amount. So there's taxations on both sides of that equation. Karen Litzy: 13:50 Right, right. Oh my gosh. These are things like, I really thought you got bought out in one lump sum. That's why when you said that I started laughing, I'm like, Oh, okay. Yeah. I guess installments does make more sense. Ryan Burklo: 14:04 Yeah. Do lump sum sales occur. Absolutely. That's not, that's not what normally occurs. What normally occurs is here's a 10 year buyout plan. Karen Litzy: 14:15 Got it. That does actually make a lot more sense. Ryan Burklo: 14:20 So yeah, the steps that I have our clients consider is, you know, which type of practice or which type of business are you, are you wanting to build for one? Are you building the business where you're at? And essentially you just kind of run off into the sunset and business kind of goes with you or you trying to build a practice or a business that you can actually sell. And early on it's kind of hard to know that, but as you're growing, you start to picture, you start to build towards one of those. And once you know that now you can get more efficient with your money and what's going on and where to put it, how to get after it. While it's taking into considerations, obviously we don't want to pay a lot of taxes right now, so how does this all come together in one cohesive plan? That's the conversation that people should be having with their advisors. Karen Litzy: 15:14 Gre…

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471: Joseph Reinke: Student Loan Debt Solutions Jan 06, 2020

Show notes

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Joseph Reinke on the show to discuss student loan debt solutions. Joseph Reinke is the CEO and founder of FitBUX, Inc which is introducing innovative finance products and technology to the student lending industry with a specific focus on physical therapists. In this episode, we discuss: -How family, work and financial goals effect your loan repayment options -Why refinancing public loans may not be an optimal strategy -Practical examples of loan forgiveness strategies -The personal and societal importance of financial literacy -And so much more! Resources: FitBUX Website FitBUX Courses A big thank you to Net Health for sponsoring this episode! Check out Optima's Top Trends For Outpatient Therapy In 2020! For more information on Joe: Joseph Reinke is the CEO and founder of Fitbux, Inc. FitBUX is introducing innovative finance products and technology to the student lending industry with a specific focus on physical therapists. Thus far in FitBUX's beta test, they have helped PTs develop financial strategies on over $11mn in student loans. Joe has been in the finance industry for over a decade and is one of the few CFA Charterholders in the world who has experience in both wealth management and business valuation (globally, there are only 120,000 CFA Charterholders). He has hosted numerous live chats about student loans with SPTs across the country, presented at the California Student Conclave, appeared on podcasts, and written numerous financial blogs. Read the full transcript below: Karen Litzy: 00:01 Hey Joe, welcome back to the podcast. I am happy to have you back. Joe Reinke: 00:07 Glad to be here. It's been a few years. I know that we see each other at different conclaves and different events and stuff, but it's been a few years since I've been on the podcast. Karen Litzy: 00:16 It has. I know, I'm happy to have you. And, we'll talk a little bit about what a difference a couple of years make in a second. But the first thing I want to get to is student loans. So let's talk about first, cause I know you have a lot of data on this. You have a huge data set within fit box. So what is the average debt? And we'll stick with physical therapists. We don't have to go across the board, but the average debt for physical therapists loan debt. Joe Reinke: 00:45 Yeah. So PTs or student loan debt. So we now have about 7,400 students and our platform, it comes out to about $900 million of student loan debt. The average is about $144,000 for PTs. We have some other graduate students that we also work with too. Before PTs, it's about $144,000 in debt. And like you just said too, it's like a moral, I know when we first came on the podcast years ago, we had like $30 million or something like that on the platform. And when I tell people we have like 850 $900 million down there, like, you know, congratulations like you know all the growth that you've had. And I look at it, I'm like, that's disgusting. Like the fact that there's graduates and it's like, okay, $900 million of debt, that must be a lot of people. It's like, no, that's only 7,400 people. Karen Litzy: 01:35 Yeah, it's criminal, it's criminal. So let's say you've got 900 million in loans, the average of $144,000 which is mind blowing. So what are the options for these students coming out to help repay that loan? Joe Reinke: 01:54 And the first challenge is trying to figure out how these things even play a role in the bigger picture. But then the government doesn't do us any favors. So right now there's nine different student loan repayment options and it's a minefield trying to figure out which one you should use. How does it play a role? Like what happens if I do this? What happens to my retirement, what happens to family planning? Can I get a mortgage? All these different things. And instead of just being like, okay, I'll pay back my loans, here's the answer. You've got gotta dig through all these things and that's where people get lost. So what we've done is simplify that into two strategies. Either you're going to pay off your loans, or B, you're going to go on some type of loan forgiveness strategies. And the pay off loans is really dominated by the headlines of refinancing because that's what we get bombarded by in terms of advertisements. Karen Litzy: 02:38 And what exactly does that mean when someone says they're going to refinance? Joe Reinke: 02:43 Yeah. So refinancing means you go to a brand new lender and they offer you a brand new rate and a brand new loan and you're literally replacing your old loans with a brand new loan to get a lower interest rate. Okay, so like I know PTs they get bombarded by low road, which is one of our partners, but they get bombarded by a low road because a low road has a partnership with a PTA. So they just get bombarded. So we get everybody, everybody comes to us and like, well, I'm thinking about refinancing. I was like, well, why? It's like, well, I've got these things. That's what I see in my mailbox. And on the other side of that, they hear all these headline news articles about loan forgiveness and public service loan forgiveness and whatnot. So those two things dominate the headlines. But really it's even upload from that is either you're going to do a payoff strategy or loan forgiveness strategy. Joe Reinke: 03:34 And what I mean by a payoff strategy is what we typically think about when we get a loan. Like you get a mortgage or a car loan, you make payments over a certain amount of time after that, it's over. You could do different things to be strategic with that. Like instead of doing a 10 year plan, you can do a 25 year plan. So you can make prepayment strategically and save money. You can do refinancing, you can see if refinancing is right for you. And those are the big things with the payoff strategies is just figuring out what's the most effecient way to make my payments. Now, unfortunately, one of the problems is that the loan servicers don't always apply your prepayments correctly, so you got to stay on them and make sure they're doing the right thing. But that's, that's a whole nother topic on that. Karen Litzy: So quick question. When you say making prepayments, can you define what that is? Joe Reinke: 04:16 Yeah. So when you have a payoff strategy so most of us on average, so like when a DPT graduates, they actually have between 10 and 20 loans. So when I say $144,000 in debt, it's not just one loan, it's like 10 to 20 loans. They're all different sizes, they're all different interest rates. And so what a required payment is the payments. They add up every payment on those loans and then say here's your required payments. So they might say it's $1,000 a month. So on that required payment, you don't have any say on that. You have to make that payment every single month. And then you don't have a say where it goes. They just throw it across all your loans equally. Okay. A prepayment is like the complete opposite. Joe Reinke: 05:06 You have a hundred percent control of it, meaning you determine the dollar amount, you determine when you do it, but most importantly you can determine which loan that you want to go towards. So like if you wanted to pay your higher interest rate loans faster because that would save you the most money, you can do that. So the trick with payoff strategies is just knowing that general idea of the difference between a repayment, a PR, a required payment. And a prepayment is, well, how can I drop my required payment so I can increase my prepayment? Right? And so that's a lot of the tricks that we go through and mix and match the different plans to allow people to do that. And then you throw a refinancing on top of that and you can save even more. So that's really the payoff strategies. Karen Litzy: 05:58 Yeah, it would seem to me that everyone should refinance to a lower percentage but like why wouldn't someone do that? Joe Reinke: 06:03 It really depends. I'll give you a few examples. We might work with a travel PT for example, and with travel PTs. First of all it's harder because of the stipend. This is for OTs and nurses as well. It's a stipend, so it's actually hard to get qualified because they don't qualify that as income. So like we have nine lending partners, only three of them will do travelers first of all. So that makes it a little bit harder. But in that situation you're traveling so you don't know the cost of living when you're moving from place to place. You don't know how long it's going to be between contracts and you don't know, most importantly what your income's going to be when you stop traveling. So it's really hard to lock yourself into a refinance loan, even though you can always refinance again later, you might not qualify later to refinance. Joe Reinke: 06:54 So oftentimes we do do refinancing with that, those types of individuals, but it's more strategic. So instead of doing like a 10 year loan, we might do a 20 year loan and instead of doing all their federal loan debt and refinancing, it might only be three or four of their higher interest rate loans. So just in case there's something there that they can't do they're not obligated to this huge monster payment every single month. So that's one example. Another example we see often times is, I'll give you an example. I just actually talked to somebody today. She had about $210,000 in student loan debt and she's paying it off. Mmm. And my thing was the tail are like, look, you know, slow down. Because when you do your budget and you're doing paper and pencil, all the numbers always looked like they make sense. But this individual just started working. Joe Reinke: 07:49 They've never had a budget in their life. They've never had like real expenses in their life. It's like wait three or four months because you might decide that you can't make those payments. You rather do a loan forgiveness strategy and if you refinance, you can't do a loan forgiveness strategy anymore because private loans don't qualify for loan forgiveness strategies anymore. So just different situations will dictate. Does it make sense? And then sometimes the refinance rates are just not that good. So it just doesn't matter. Yeah, exactly. It's like stay there and just chip away at your loans. And I'll give you one more example, Karen. When you refinance, you also consolidate your loans. What that means is you merge your loans into one big, big, big loan. Karen Litzy: 08:37 Got it. So for instance, if you took a loan from a bank or a federal loan or whatever, when you refinance did, so let's say you have a federal loan, does that federal loan is no longer a federal loan, it becomes a private loan. Joe Reinke: 08:54 That is correct. And instead of having like 10 you might only have one big, big, big loan. So sometimes what happens, you have to understand how federal loans work though too. Like I said earlier, you have 10 to 20 loans, so every time you pay off one of those loans, your required payment actually drops. With the refinance loan, it won't drop because you have one monster loan, you never pay it off until the whole balance is zero. So sometimes people come to us and say, look, what am I goals is to buy a house in five years? And so if that's the case, we might turn around and say, okay, we'll stick in your federal loan. Because if you keep making prepayments and you pay these specific loans off, your required payment would go from $1,000 down to like $500 when you want to buy your house. Joe Reinke: 09:37 Why is that a big deal? They use the required payment in the ratios for qualifying for a mortgage. So a lower lower required payment on your student loans, the easier it is to qualify for a mortgage. So that's some of the analysis that we would do to say, okay, well how much does a refi actually save you versus are you better off just trying to drop your monthly payment over time so you can qualify for your number one goal buying a house? And so that's what I meant earlier when I said these things. It is more than just the student loan strategy. Karen Litzy: You've got to look at how does this thing play a role in the bigger overarching strategy, right? Because oftentimes I would think the student loan debt isn't the only debt. So can you explain how maybe you have to work around other debt as well and how to navigate all of that? Joe Reinke: 10:27 Yeah. And I'll give you an example. We just did a poll and we also took some of the data from our members as well. And it was something like 68% have more than one form of debt. So that could be cars, mortgages, credit cards. And again, another example, I just talked to somebody today, and actually we get this probably four or five times a week where somebody calls us to talk about their student loan debt and we noticed that they have credit card debt. Okay. And we're like, look, you want to do this strategically with your student loans to drop your required payment as low as you can and focus on paying off your credit card debt. And it's like, I didn't even think about that. It's like, yeah, credit card debt, socks, get all of that stuff like as fast as you can and use the flexibility of refrigerator loans. Joe Reinke: 11:10 That's another reason why you might not run a refinance is because the federal loans are more flexible. There's more options of what you can do. So if you have other debt, it may be allow you to pay that off faster. And that's why sometimes people go into the student loan forgiveness plans also in the short run is the drop that lower payment focus on something else and then go back to their student loan strategy and say, okay, now I'm going to go focus on that. What do I need to do to focus on my student loans now. Karen Litzy: Got it. So it's all part of a bigger plan. So let's talk about quickly the student loan forgiveness because that's been in the news lately. I feel like there's been rumblings of that. It may not exist anymore, Betsy Devoss may cut it or what's the story? Joe Reinke: 11:51 Yeah, so there's actually two different forms of forgiveness. Okay. And this is where people get confused. The actual repayment plan you're on is called an income driven repayment plan. And the government also says that these are things our student loan forgiveness plans. Long story short on these plans, your payment is based as a percentage of your income. And the payments really low is like 300 $400 a month. But for most of us, that means that we're not paying the interest that's being charged on loans, which means the balance of your loan Rose. And that actually will happen for about 20 or 25 years. And then under normal loan forgiveness at that 20 year Mark or your loans are forgiven, but you have to claim it as income and pay taxes on it. Joe Reinke: 12:44 So your balance of what you owe will grow because they just add the interest of your balance, just like in your differing interests cause you're not making payments. Happens in these plans. Okay. So then you worked for 10 years or 20 years or whatever, and then your loan is forgiven. So in these plans loan forgiveness, they last for 20 or 25 years. Department of education forgives them. Okay. However, in this country, it doesn't matter what type of loan it is, it can be an auto loan, a mortgage, student loan. If it's forgiven, you have to claim that as inco…

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470: Gratitude: 2019 In Review Dec 30, 2019

Show notes

Happy holidays to the Healthy, Wealthy and Smart family! This is a special episode where all the amazing women behind the show come together to discuss 2019 and what's to come in 2020. Thank you for supporting us and we hope to continue to provide great conversations in the new year! In this episode, we discuss: -Why you should enlist a team to help grow your business -How to gracefully ride the ebbs and flows of entrepreneurship -Prioritizing your mental health to avoid burnout -New year intentions from the team -And so much more! Resources: A big thank you to Net Health for sponsoring this episode! Check out Optima's Top Trends For Outpatient Therapy In 2020! For more information on Jenna: Jenna Kantor, PT, DPT, is a bubbly and energetic woman who was born and raised in Petaluma, California. She trained intensively at Petaluma City Ballet, Houston Ballet, BalletMet, Central Pennsylvania Youth Ballet, RDA Choreography Conference, and Regional Dance America. Over time, the injuries added up and she knew she would not have a lasting career in ballet. This lead her to the University of California, Irvine, where she discovered a passion for musical theatre. Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia. During her education, she co-founded Fairytale Physical Therapy which brings musical theatre shows to children in hospitals, started a podcast titled Physiotherapy Performance Perspectives, was the NYPTA SSIG Advocacy Chair, was part of the NYC Conclave 2017 committee, and co-founded the NYPTA SSIG. In 2017, Jenna was the NYPTA Public Policy Student Liaison, a candidate for the APTASA Communications Chair, won the APTA PPS Business Concept Contest, and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media. Jenna Kantor currently holds the position of the NYPTA Social Media Committee, APTA PPS Key Contact, and NYPTA Legislative Task Force. She provides complimentary, regularly online content that advocates for the physical therapy profession. Jenna runs her own private practice, Jenna Kantor Physical Therapy, PLLC, and an online course for performing artists called Powerful Performer that will launch late 2019. Jenna continues to perform in musical theatre and lives in Queens, New York with her husband and two cats. For more information on Julie: Dr. Julie Sias, PT, DPT is the Producer of the Healthy, Wealthy and Smart Podcast. Julie received her Doctor of Physical Therapy degree from Chapman University. Julie loves to gain new insights and inspiration from the guests of the show in order to enhance her physical therapy private practice in Newport Beach, California. For more information on Lex: Alexis Lancaster is a student intern on the Healthy Wealthy and Smart podcast. She earned her Bachelor of Science degree in Biology, a Graduate Certificate in Healthcare Advocacy and Navigation, and is currently in her final year of the Doctor of Physical Therapy program at Utica College in Utica, NY. Lex would love to begin her career as a traveling physical therapist and hopes to eventually settle down in New Hampshire, where she aspires to open her own gym-based clinic and become a professor at a local college. She loves working with the pediatric population and has a passion for prevention and wellness across the lifespan. Lex also enjoys hiking, CrossFit, photography, traveling, and spending time with her close family and friends. She recently started her own graphic design business and would love to work with you if you have any design needs. Visit www.lexlancaster.com to connect with Lex. For more information on Shannon: Dr 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: Karen Litzy: 00:00:07 Hey everybody. Welcome to the last live podcast of 2019 I am your host, Karen. Let's see, and today's episode is brought to you by Optima, a net health company. Optima therapy for outpatient is a software solution enabling therapists and staff to do their jobs efficiently and accurately. Their software provides anytime, anywhere access to documentation, even while disconnected, which is huge, and workflows that streamline patient care and save valuable time. You can check out Optima's new on demand video to learn what's in store for outpatient therapy practices in 2020 with some of the biggest industry trends along with tips and best practices to successfully navigate these changes. Karen Litzy: 00:01:14 Learn about these trends for the new year at go.Optimahcs.com/healthywealthy2020 and we will of course have a link to this in the show notes under today's episode. And I also want to thank net health not only for today, but for being such an amazing sponsor to this podcast. We couldn't do what we do every week without their help. So a huge thanks to net health. So definitely check them out. And notice I said we now it's because of course I cannot do this podcast alone by any means. And today I am so excited to have the powerhouse team behind this podcast for amazing physical therapy entrepreneurs for strong, amazing women who help bring this podcast to life every single week. So in this episode, I'm happy to have on doctors. So they're all doctors, Julie Sias, Jenna Kantor, Shannon Sepulveda, and Lex Lancaster. And what we did was I had a conversation with Jenna and Julia. Karen Litzy: 00:02:18 You'll hear that in the first half of the podcast. And then in the second half of the podcast with Lex and Shannon and we talked about what our sort of our year in review, what 2019 did for us as people and as women and as entrepreneurs and physical therapists. And one theme that came across was that we're all doing things that make us happy and that in 2020 we want to continue that and we want to sort of construct the life that we want to see us leading. So that's in our personal lives and also in our life as physical therapists. So the amazing thing is Lex, Jenna and Julie are new grad physical therapists. Jenna and Julie have started their own practices. Lex has her own business outside of physical therapy, helping people with websites and graphics. Shannon, has an amazing practice in Bozeman, Montana. Karen Litzy: 00:03:20 She has started her practice about two years ago. It has grown exponentially. So she talks about how she did that. And it's amazing. We talk about what I have coming up in 2020 including an online course to help all those physical therapists or occupational therapists out there who want to start their own practice in a way that feels good to them in a way that's going to make them happy, bring them joy. And also the most important thing as physical therapists is our job is to get people better. And in our conversations in this podcast, we talk about how what we do as individuals not only affects us, but it's exponential. It affects everyone around us, our communities, our friends, our families, and of course the patients that we serve. And we're so grateful to that. And of course, as the host of the podcast and creator of the podcast, I just want to thank all of these women because without them I wouldn't be able to do this. Karen Litzy: 00:04:14 There's no way I can do this on my own. Like one of my guests said, Stephanie Nickolich and we mentioned this in the podcast is if you try and do it all, it'll keep you small. And when I was trying to do it all with this podcast, it was keeping me small. I wasn't able to upcycle this as much as I have with the help of these four women. So I just want to tell all of them and I say it in the podcast as well as that I appreciate them. I think they're amazing and I wouldn't be able to do what I do without them. And I just want them to know that my gratitude for this past year of 2019 is so immense and looking forward into 2020. I'm so excited to see what we all come up with. So I hope you guys really take in this episode because I think it's really special and of course to the audience thank you so much for another great year of listening and interacting with the podcast and being able to meet so many listeners all over the world has been a real joy to me in this past year. So everyone, thank you so much. Have a very, very happy new year and we'll be back with brand new episodes in 2020. Karen Litzy: 00:05:24 Hey Jenna and Julie, welcome to the podcast. Welcome back to the podcast. Since you've both been on several times. The reason being is because we all work together on the podcast to make it what it is. So well, welcome, welcome. So we're wrapping things up for 2019 and I thought, well, what better way to do that then with the people who make this podcast happen every year and who I'm eternally grateful for and appreciate so much for all of your hard work and your dedication and your fun and your being you. So, thank you guys for everything that you do. And now let's talk about 2019. Right? So we have January, 2019 to now. So a lot of things have happened within that year. So Jenna, we'll start with you. What are some highlights for you that's happened over the past year that you can kind of share with all the listeners? Jenna Kantor: 00:06:34 Why hello listeners! Good, good evening and sun salutations. For me, I started my own practice literally on January 1st and we were driving back and I got my first patient that day. So literally my practice started this year. That was a big one for me. I also very quickly left all my PRN for those who don't know, that's working as needed, like a substitute teacher at a bunch of mills and I very quickly left all of them and I have been working for myself and it was the best decision I ever made. I have that musical theater background, which I'm sure listeners are quite familiar with, but if you don't know not, you know, and I was really not meant as a physical therapist to be sitting in one spot from nine to five. I really am not built that way and I love that I can make my own schedule, my own life and not feel like I'm really stuck in a location. It's a very, very big deal for me. That was something that was very concerned about as a performer. So I'm grateful to have made that move for myself. Karen Litzy: 00:07:49 Awesome. And Julie, how about you? So what's happened from January till now? Julie Sias: 00:07:54 So having been kind of mentored by Karen for the past three years, it was nice cause I also actually started my own practice and Karen was helping me along the way and everything. And January 1st yes, had my first patient and everything and it's been going really well, I haven't left my PRN jobs, but I do manage my concierge outpatient practice. And then I also see kiddos as like a consultation kind of gig. And then I work at a skilled nursing facility, PRN right now to supplement all that. But it's been a really exciting year because I finally have had a lot of control over all of my hours and it's been nice being out of school as a new grad. Karen Litzy: 00:08:44 Yeah. And Julie, when did you graduate? What was your graduation? Julie Sias: 00:08:49 So I graduated in the summer last year and then I took the licensing exam in November. Karen Litzy: 00:08:56 Right, cause you had to wait that extra long time to take your licensing exam. Julie Sias: 00:09:01 Yeah, so that was when I was just like a licensed applicant in California and I was working at the skilled nursing facility that I did a clinical rotation at. And then after I finally got my license, I was able to do all the paperwork to get a corporation and everything. Karen Litzy: 00:09:16 Right, right. And Jenna, when did you graduate? Jenna Kantor: 00:09:19 That is so cool, Julie. I graduated in May 2018, took my boards in August and then I had a baby. No idea. I felt like, I think it was the rule of threes and I didn't have a three so I made up one. Karen Litzy: 00:09:48 That's so funny. Can you imagine now people probably be like, Oh my God, if they get like just a little clip. Julie Sias: 00:09:54 That's Jenna's one liner for the episode. We should make a graphic. I had a baby. Karen Litzy: 00:10:06 So great that the two of you were able to have a good idea of what you wanted to do and then we're able to execute on that and take action on that because it's certainly not an easy thing to do, especially when you've just graduated and you're trying to, you know, sort of make your Mark and kind of find your way. So to be able to know that before you even graduated I think is is amazing. And do you have any advice? Let's say there are some new grads listening or some students who are getting ready to graduate on what they can do to get some clarity around maybe where they would want to start their career at. And I'll have either one of you can jump in. Julie, do you want to jump in? Julie Sias: 00:10:56 Yeah, I'm ready to rock. So it was good to have accountability from you Karen because I kept telling you every year that I was going to do this. So then when it finally came to the time I couldn't really back down. So that was good. Cause then I had told everybody so if I ended up backing down that wasn't really going to look very good. And then I was also really clear with how I wanted my life to be. And going this route is definitely more of like a, it's tough, it's been tough kind of cause it's feast or famine sometimes and that's kind of like the ugly side of being an entrepreneur. But I have to like pause and just be grateful when I think about like my day and I just go, you know what, this is actually my ideal day. I got to go for a walk in the morning. Julie Sias: 00:11:54 I saw two patients. Maybe it's not like whether I want to be for like a full time job eventually, but I just have to like take a second and just be grateful. So it's good to have a clear vision about what you want your days to look like and then just know that when you put in the hard work eventually it will pay off. Jenna Kantor: 00:12:41 Yes. Amen, this is Jenna. I could not agree with you more. I think that is such a good point with any new practice owner is to stop and essentially smell the roses because it's easy to be, Oh my God, this is where I'm at. Oh my gosh. You know, living sometimes paycheck by paycheck and yes, you're not going to be rolling in the dough right away. It takes time. It takes patience, it takes persistence, all that stuff. But exactly what you said I think is a great way to approach it. I think a big thing, well there's a lot of big things for somebody. Big things when you graduate and you're trying to find a job, but there really is, from what I have seen, I know there's always an exception to the rule. There…

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469: Dr. Sarah Haag: Pelvic Health for Non Pelvic Health PT Dec 23, 2019

Show notes

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Sarah Haag on the show to discuss pelvic health for the non-pelvic health PT. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women's and men's health. Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span. In this episode, we discuss: -Intake questionnaires to screen the pelvic floor for patients with low back pain -Pelvic health red flags -How to address pelvic floor health with a conservative population -Assessing the pelvic floor muscles without doing an internal exam -And so much more! Resources: Oswestry Low Back Pain Disability Questionnaire: http://www.rehab.msu.edu/_files/_docs/oswestry_low_back_disability.pdf Sarah Haag Twitter Entropy Physio Website Home Health Section Urinary Incontinence Toolkit Rehab Therapy Operational Best Practices Forum For more information on Sarah: Sarah graduated from Marquette University in 2002 with a Master's of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women's and men's health. Over the years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women's Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women's Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women's health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010. Sarah has completed a 200 hour Yoga Instructor Training Program, and is now a Registered Yoga Teacher. Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span. Read the full transcript below: Karen Litzy: 00:01 Sarah, I was going to say doctor Sarah, hey, it just feels weird because we've known each other forever. But Sarah, thank you so much for coming on the podcast to talk about pelvic health for the non-pelvic health PT. So there are a lot of physical therapists who I think are interested in pelvic health, but maybe they don't want to like dive in literally and figuratively. So what we're going to do today is talk about how we as physical therapists can treat people with pelvic conditions, with pelvic issues without necessarily doing internal work. What are the functions of the pelvis, really important for bowel and bladder health, right? Sarah Haag: 00:49 I mean, it is very important for survival, sex, very important for quality of life and propagation of the species. So these are all things that matter. But also when people come in with low back pain, when people come in with hip pain, I always find it very interesting that people say, but I don't do the pelvis. You know, the pelvic floor is only a musculoskeletal structure. We're not trained in most programs to palpate or to touch. It's just skeletal muscle. That's all we're assessing for really as pelvic floor PT's. So I just think it's interesting. It's like a blurry void when you're looking at a body diagram. Oh, there's your knee. So it's really important I think to understand what's there and you don't have to go there, but you have to know what's there and know that some people need help there and help them find the help. Karen Litzy: 01:34 So if someone, let's take this person that has low back pain because that's a diagnosis that we can all agree that we see on a regular basis. So what are a couple of questions you can ask during your initial evaluation? Sarah Haag: So the subjective part of the initial evaluation that perhaps a lot of people are missing or that can take in that pelvic area. There's a couple of ways that you can kind of like cheat your way in where you don't even have to think about what to ask to begin with. If you have a red flag questionnaire, there is a bowel and bladder question on there. So, it's really interesting because people will sometimes circle yes on those and then never discuss it. Like, wait a second, we asked the question, they said yes, it's a thing. Sarah Haag: 02:22 So there's your in, it was like, I noticed you, you marked yes on the bowel and bladder changes. Can you tell me a little bit more about that? Most of the time it is not truly a red flag. Most of the time it is not a sign they need to be referred to a physician. Most of the time it's like no one's ever asked me that. Yeah. Stuff is different. There's your in. And then also if you use the classic Oswestry. So it was modified I think in 2001 or 2002 to take off a sex questionnaire. The second question of the questionnaire and it was revalidated and all of those things, but if you use the original, it's pretty awesome because now they're like, Huh, nobody's asked me about sex. And then you'd be like, ah, I see that this is an issue. Sarah Haag: 03:06 One of my favorite Twitter stories is I get a direct message from someone asking me about a patient who was having pain with intercourse and I was like, thanks for reaching out. Absolutely. Can you tell me more about when they're having trouble and where it hurts? Would you like to know where it hurt their knees in one particular position? And I said, fantastic. You can help with that. So, so it's not always, it might be a sex problem, but it's not necessarily that problem. So we have to not be shy about asking those. Low back pain is the most expensive health care problem we have in terms of multibillion dollar, probably millions and millions worldwide. And so of course addressing back pain, we're still working on the best way to do that. Sarah Haag: 03:52 But there's a high prevalence of urinary incontinence and people who have low back pain. So if you're seeing people who have low back pain and after, if anyone else went to the pregnancy talk this morning, after vaginal deliveries, the prevalence of incontinence goes ways up, goes way up. So if you're seeing someone with back pain, if someone has had babies, all you can eat what you can do. So we were like, well I see this in your history cause that's pertinent history for back pain. Correct. And then it's like, Hey, I noticed this, any issues with this? And here's the reason I'm asking because you can't just go, do you pee your pants? Because people like, do I smell like what happened? Like, so if you're just like, you know, there is a really high prevalence and the nerves in your back go to your pelvis and all of these things. Sarah Haag: 04:32 So I'd be really curious to know are you having any issues in this area? Cause there's help if you are. And then kind of go from there. Karen Litzy: And I want to backtrack for just a second. When you were talking about red flags and said some are truly red flags and some aren't. So just so that we're all on the same page, what would be those truly red flags? Sarah Haag: Truly in the pelvic world or in the entire rest of your body world is any unintentional weight loss or weight gain, 10 or 15 pounds over a short period of time. Also like fever, like temperature issues, loss of appetite when you have those other constitutional symptoms that go along with it. So just having some quirkiness with your bowel and bladder, it's really no reason to panic. But if you have also a fever and also a recent traumatic event, no, no, we want to just make sure everything's okay. Sarah Haag: 05:26 And the cool thing is that if you go to the doctor, it's like you don't have a UTI. Everything else is looking fine. Awesome. Then I can help with that. But the red flags, there's been a couple of great papers that have come out where it's like, it's not like if you have pain at night, freak out. No, no. If you have pain at night but also a sudden bowel and bladder change and also, okay, now we need to check in for it. But don't panic if it's the only one. Karen Litzy: And now let's say you're using these questionnaires and someone puts on bowel, bladder or someone circles sex as something that they're having difficulty with. And I love this question because this was something that was brought up last year at CSM. So there was a physical therapist there who said, well, I live in the south and these are not easy questions to ask because people are more conservative or they don't want to talk openly about their bowel and bladder issues or about sex with their partners. Karen Litzy: 06:28 And so what do you say to those people? Those therapists that, are dealing with a population that's maybe much more conservative and they're not sure how to approach those subject matters. Sarah Haag: I always say just always with kindness and with a good intention and with a good explanation. So you can't not do it because it's awkward for you. You should be asking for a medical reason, right? So quality of life is in our wheelhouse, right? Like we're doing all sorts of quality of life questionnaires. Pee in your pants is a huge detriment for your quality of life in many cases, not being able to have sex can impact your relationship with your partner, your feelings of ability to even have a partner, having babies. All of these things that end up being huge stresses, which is gonna make a lot of other things not as good either. Sarah Haag: 07:28 Just start simple if you're asking questions. So if someone comes in with like straight forward knee pain, I'm like, how sex, no, that's not how, that's not where we go with that. But if someone's coming in with low back or pelvic issues, the way I usually approach it is to bring it up anatomically. So this is the anatomy. This is what we're doing. These are where the muscles go. Most people don't think about them. And when they're, if they're having issues like incontinence or have had babies, those pelvic floor muscles are muscles. Like everything else. We're going to work in PT. So I'm going to ask you some questions and I try to do it in a spot where you have some privacy. I know some PT places you're like in the middle of a gym. Sarah Haag: 08:06 If you can find a quiet corner, do everything you can to put them at ease. But just to be like this is why I'm asking. And if you can see that resistance be like all right, like it's not necessarily the number one priority for this treatment anyway, but if those things happen to be issues there is help, it can get better and you just let me know if you have any questions. Cause not everybody wants to talk about it and it's not my job to convince you to deal with it. It's my job to help you if you want help. Karen Litzy: And if you're a physical therapist that isn't specializing in pelvic health, it's a little bit different. Cause if you're specializing in pelvic health and people are going to you because you specialize in pelvic health it's way easier, you know, these questions are going to come up. But for those of us who don't specialize in pelvic health, then those questions can be a little bit more sensitive. So I just want you to make that distinction there for people. Sarah Haag: 08:48 Yeah. And also if you're going to ask if you're going to take that step and be like, all right, I'm going to ask about the incontinence. I mean cause sometimes you're in situations where it is an obvious issue. Other times it's like, well, based on their history they're actually at risk for it. Then you can talk prevention, which has always been kind of fun. But just if they give you some information, especially if you got up the guts to ask them, then please, please do something with it. Don't just be like, oh yeah, so great incontinence noted in the chart. I'll put it on the diagnosis list, like how the plan and there are some things you can do without doing a pelvic floor exam that can make amazing changes. Karen Litzy: 09:49 How can you evaluate pelvic floor muscles without having to go internally? I think that's a question everybody wants to know. Sarah Haag: Great question. I'll be honest, some people don't want you to touch him there like full stop. And so I will actually give people, I would say it's kind of like a choose your own adventure. So we can actually, we can all check our own pelvic floor muscles right here. And I would basically talk you through it. You would tell me what you felt. I keep an eye on everything else to see what else you were doing. But it would be very honest that my assessment is going to be, I believe you, it seems you're doing it correctly. Right? But I have to believe you, but you can actually palpate externally. As a clinician you can actually do it and you can do it in sidelying. Sarah Haag: 10:33 You can do it in hooklying and some people will do it in prone. I'm not a super big fan cause I can't see their faces. And also it can be kind of a vulnerable position. Basically if you just palpate, if you find the ischial tuberosity, you know about where the anal sphincters are. Okay. There's normal human variation. So I always say move slow and make sure you're asking for feedback. But you know, mid line is where the sphincters are going to be. We're not going midline. So you just kind of find that ischial tuberosity and palpate your way around to the medial part of it. And that's where the pelvic floor attaches. So then you can kind of talk them through, like I'd like you to squeeze and there's a bunch of different cues. Sarah Haag: 11:22 One of the most common cues, especially for the back end, is to like squeeze. Like you don't want to pass gas and that's awesome. But if you're a main problem with urinary incontinence, that's the back side, back side, not the front side. So how do we get it up there? So another cue that has been found to be very helpful, it's only been studied in men, but it is, shorten your penis. But what's interesting is ladies, I know we don't have them, right? Imagine that feeling, right? So like just imagine like pulling in, right? It totally changed where hopefully if this is a class, it would have asked where did you feel it? But like it, it changes it from the back and biases it towards the front of it. So find a cue that gets them to go, oh my God, I felt something. Sarah Haag: 12:07 You're like, awesome. So if you're doing a Kegel and like this happens, you're probably not doing it right. If that's happening, you're probably not doing right. But if like I'm Kegeling now and then I let go, you shouldn't have seen me get taller or tensor or breathe funny. It should be very sneaky. So as you're palpating on the medial side of the ischial tuberosities your feeling for those muscles to contract. So it's kind of like a gentle bulge and you can totally feel this on yourself here if you're comfy or somewhere else. But when you feel it, it's almost like when you're feeling like if…

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468: Dr. Steve Anderson: Do You Need a Coach? Dec 16, 2019

Show notes

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Steve Anderson on the show to discuss leadership coaching. Steve is an Executive Coach with Orange Dot Coaching and the host of the Podcast, Profiles in Leadership. He is a former Board of Trustee for The Foundation for Physical Therapy and was the President of The Private Practice Section of APTA for 6 years between 2002-2008. In this episode, we discuss: -Why you should invest in a coach -The importance of outside perspective when you're pursuing excellence -How to be open-minded and gracefully accept constructive criticism -Redefining your daily operations with purpose and vision -And so much more! Resources: Steve Anderson Twitter Steve Anderson Facebook Steve Anderson LinkedIn Orange Dot Coaching Website Episode 197: The Graham Sessions with Steve Anderson Profiles in Leadership Podcast Optima: A New Health Company A big thank you to Net Health for sponsoring this episode! For more information on Steve: Steve Anderson is the ex-CEO of Therapeutic Associates which is a physical therapy company that consists of 90 outpatient clinics in Washington, Oregon and Idaho and a major hospital contract in Southern California. He currently is an Executive Coach with Orange Dot Coaching and the host of the Podcast, Profiles in Leadership. He is a former Board of Trustee for The Foundation for Physical Therapy and was the President of The Private Practice Section of APTA for 6 years between 2002-2008. He was awarded the most prestigious award the Section gives out annually to a physical therapist, the Robert G. Dicus Service Award in 2010. Steve received the APTA Leadership Advocacy Award in 2006 for his efforts in Washington D.C. and Washington State in the legislative arena. In 2012 Steve received the Distinguished Alumnus Award from Northwestern University Physical Therapy School. In 2016 Steve was awarded Physical Therapist of the Year by PTWA, APTA's Washington State Chapter. Currently Dr. Anderson works with business executives and their teams to improve their leadership skills and coaches them to improve communication skills and working together better as a team. He lives on Hood Canal in Washington state near Seattle with his wife Sharon. Read the full transcript below: Karen Litzy: 00:00 Hey Steve, welcome back to the podcast. I am happy to have you on. So thanks for joining me today. Steve Anderson: 00:07 Well, thank you Karen. I'm very happy to be on and I'm looking forward to our discussion. Karen Litzy: 00:13 Yeah. So last time you were on, we talked about Graham sessions and we'll have a link to that in the show notes to this podcast so people can kind of go back and learn more about that. But today we're going to be talking about the importance of having a coach. And first I'll swing it over to you if you want to kind of describe what you do as a coach and maybe what is your definition of a coach because there's a lot of coaches out there. Steve Anderson: 00:45 Okay. So what I am is I'm an executive coach and so that means that I deal mostly with leadership training and communication skills and things like that. So what I do specifically is I work with people that are running companies, CEO types, and executives that are in leadership roles. And so helping them develop their leadership and communication skills. But then I also like to work with teams. And so I have clients that I work with, the CEO and their executive staff on how they can communicate together and how they can work better as a team when they're trying to run their business and grow their business and so on. So that's pretty much what I do. You know, but the definition of a coach is just somebody to help you, you know, figure out. Steve Anderson: 01:40 I think what happens is we are in a very complex world and in our businesses and so on that they get very complex. I think a coach can help you simplify, look at things and simplified a little bit, help you kind of get out of your overwhelming rut, so to speak, and how you can start to look at things that are the smaller pieces and put that together and then just learn how to communicate with others and grow your business. And in a sense that doesn't seem so overwhelming or overpowering. I see a lot of my clients in that mode of, they're just, they're just overwhelmed and they've just got so much to do and so many things to look at that they don't really know what the next step is. Karen Litzy: 02:27 Yeah, I hear you there. I definitely feel like that on almost a daily basis. Now before we kind of go into a little bit more about coaching, just so the audience gets to kind of understand where you're coming from. So you are a physical therapist and you owned a multisite practice, but let me ask you this. You could have retired and just kind of spent the rest of your retirement hanging out and you know, relaxing. So why make that shift to being a coach? Steve Anderson: 03:04 Sure. So I was a physical therapist and came up through a company called therapeutic associates where I started out as a staff therapist and then I became a clinic director and eventually became the CEO of that company. And it had a very unique ownership structure in the sense that every director of every clinic in that company is an owner in the company. So I was certainly not the only owner in the company. I was one of many owners in the company. And so when I retired, you know, I retired fairly young, I guess when you look at what age people retire these days. And so I thought, well, you know, what do I want to do from here? I don't feel like I'm ready to just do nothing. And so I kinda did the soul search and say, what are things that I really like to do? Steve Anderson: 03:54 And when it comes right down to it, what I really liked to do is I just really liked to grow leaders and work with people as they're going through their journey. And so, I went and got certified in a program called insights discovery, which is a communication system or style and started reaching out to people and I've got some clients and worked with them and learned, you know, how to improve and get better at what I was doing. And so now I do it on, you know, certainly a part time basis. I'm not doing this full time by any means, but it brings me joy. It feels like I have a purpose and it's something that I just really look forward to doing. Karen Litzy: 04:39 I think that's such a great transition from the work you were doing as a physical therapist to the work that you're now doing as a coach. And for me, it gives a lot to think about because oftentimes, especially as a physical therapist, I know I felt this way when I graduated from college was, okay, I'm going to start working for a company and then I'm going to work there until I retire. And then that's it. So oftentimes, you know, it's hard for us to think far ahead, but being able to hear stories like yours I think can inspire a lot of people to say, Hey, wait a second. Like there's more to retirement or there's more to when, maybe whenever it is, you feel like your clinical work as a physical therapist is maybe run its course that you can use your physical therapy degree and you can use information, you can seek out new information in order to start a whole new career, but you're still firmly rooted in the physical therapy world. Steve Anderson: 05:43 Right. I think you bring up a really great point in the sense that, you know, you don't, when you come out of school and you start your profession, start your career, you know, you can't see often that thing that you want to do. In other words, it's hard to visualize what exactly I want to do and what exactly I want to be. And I see new professionals coming out kind of tortured with that a little bit. Like they wanted to do something but they can't see it other than just the day to day. You know, we're working with the patient. So I can just share my journey a little bit in the sense that, you know, I was an orthopedic physical therapist and I worked hard at being good at that skill and then I became a director and I realized that I really liked working with the team and working with people and people don't always, they think I'm just messing with them when I say this, but I was kind of a reluctant leader. I didn't go in thinking that this is what I want to do, this is how it's going to look. And, I just kind of evolved into that leadership role. And then as I took steps going through my career, all of a sudden I was voted to the CEO of a very large company at 41 years old. And to be honest with you, I was scared shitless. Karen Litzy: 07:03 I mean, I would be. Steve Anderson: 07:06 Yeah, I was excited to be in this position, but I'm like, Oh my gosh, I mean, you talk about imposter syndrome and I was like, what do I do now? Everyone thinks I'm going to have the answers. So at that point I didn't really know what coaching was or what coaching services wasn't. As a matter of fact, it was fairly a new concept to have a coach. And so I didn't have an opportunity to reach out to one and I didn't really know what to do. And so when I look back on that time, gosh, I could've really used a good coach. And so what I did was I looked for other ways to try and improve my position or my skills. And so I took a few college level or I mean graduate level MBA courses and they were okay, but they weren't really, you know, just resonating with me too much. Steve Anderson: 08:01 And so then I eventually found this group called Vistage and you may have heard of that, but that's an international group where they have CEOs that work together usually 12 to 15 in a group. They meet on a monthly basis and they basically just learn from each other and help solve each other's problems. And so it's like a group coaching, so set up and I was in that for seven and a half years and really, really learned a lot from that because I had, you know, peers to bounce things off or like could get vulnerable with you. Got to know him really well. And, I think when you can trust somebody and work with someone to get to that level of vulnerability, I think that's where the learning really takes place. Karen Litzy: 08:50 And that group that was multidisciplinary group, that wasn't just specifically for therapists or even just for health care, is that correct? Steve Anderson: 08:58 Exactly. In fact, I was the only CEO in that group from healthcare. And then they make sure that there's no competitors or you're not competing with anybody in that group. And so you start out kind of with people you don't know. And over a period of time you start to know and trust each other. And, and over a longer period of time you can really, you know, really get down to things that you have a tough time talking to most people about because you've really gotten to know these people. So I look at that as kind of a coaching relationship and the fact that my clients that I work with now, once they get to know me and once they trust me, you know, they can tell me the thing that they're afraid of or they can tell me the things that they don't know, without looking weak to the people they lead or without, you know, being their fear of, you know, people thinking maybe they don't really know what they're doing, but they can share that with the coach. And then we can get down to the real nitty gritty of that and what that means and how to work through that. Karen Litzy: 10:08 And it sounds like you were able to take what you learned there and combine it with what you learned through your career and then the extra courses taken after retirement to kind of hone your individual coaching skills in order to better grow your clients. Steve Anderson: 10:30 Right. And I think the emphasis on that scenario you just discussed was the experience. I think the experience you can't buy experience, you can't, you know, like when I look back on mistakes I made when I had less experience, you know, I wish I could go back and do those again cause I think I would do them a lot better. But yet that's how you learn. So hopefully a coach has the experience to help you, say this happened to me and this is how I went through it. And, and this is how I can see you maybe, you know, getting there. I do question or scratch my head sometimes when I see, cause I do see business coaches that have never run a business. Steve Anderson: 11:18 So that always kind of makes me feel like, well, you know, I want somebody who's been in the trenches. I want somebody who has worked through this before and can help me see some ways through it as opposed to someone who's just read a lot of books and knows all the catch phrases and the authors and so on. But I think the experience is the key there. And if we look at it from the clinical side, you know, if on the clinical side as a physical therapist, we probably refer to it more as a mentor, maybe then a coach. But same thing there. You want somebody who has experience and who has seen, you know, tens of thousands of patients and has that experience that you don't have that can help you maybe see through some things from their experience. And to me that's what makes it a really good mentor and a really good coach. Karen Litzy: 12:12 Yeah, I would agree with that. 100%. And you're right, there's nothing worse than seeing coaches advertise their services and they've had a business for less than a year. So, let's talk about pros and cons of having a coach. Let's get practical here. So what are the pros? So if someone's out there looking for a coach and they're on the fence, what are some pros to having a coach? Steve Anderson: 12:43 Well, again, I think I said a little bit earlier, but I think a good coach can help you simplify what you're trying to accomplish. You know, I think a good coach can look at a complex situation and help you make it simpler. You know, coaches can be your external eyes and ears and provide a more accurate picture of your reality and recognize fundamentals that you have and that you can improve on. And then just breaking down some actions that you do to make them more practical. To me, one of the things that I work a lot with my clients with is it seems so simple, but communicating with others is so powerful. And if you really know how you communicate yourself or what motivates you and how you come across, and then you really get to know the people that you're communicating with and what resonates with them, then you construct your language and you construct your behavior in a way that connects with them. Steve Anderson: 13:51 Because I can think that maybe my approach is I totally get it and I totally understand what I'm saying and I can look at the person across from me and they're looking at me like, you know, so I'm not connecting with them. So I have to know how to communicate that. And, you know, as we talk about it here, it seems simple, but I think there's a real skill to that. And I think there's a real ability to kind of craft your message in a way that connects with people. Karen Litzy: 14:26 Yeah. And I think whenever you talk about relationships, whether it be a personal relationship, a business relationship, the thing that tends to break it down more than anything else is lack of clear communication. Right? Steve Anderson: 14:47 I was just going to say, and it's like if you look at your family or you look at your people in your business, I've always believed that you don't treat everybody the same. I mean, you have to be fair, but when we're talking abou…

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467: Ryan Estis: Next Level Leadership Dec 09, 2019

Show notes

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Ryan Estis on the show to discuss excellence in business. Ryan Estis has more than 20 years of experience as a top-performing sales professional and leader. As the former chief strategy officer for the McCann Worldgroup advertising agency, he brings a fresh perspective to business events. As a keynote speaker, Ryan is known for his innovative ideas on leading change, improving sales effectiveness and preparing for the future of work. In this episode, we discuss: -Three actionable tips to constantly reinvent your business -How to stay relevant and achieve excellence with changing customer expectations -Four key practices you should adopt to thrive and avoid stagnation -Why you need to reframe problems in order to produce lifetime customers -And so much more! Resources: Ryan Estis Website Ryan Estis Facebook Ryan Estis LinkedIn Ryan Estis Twitter Ryan Estis Instagram For more information on Ryan: Ryan Estis has more than 20 years of experience as a top-performing sales professional and leader. As the former chief strategy officer for the McCann Worldgroup advertising agency, he brings a fresh perspective to business events. As a keynote speaker, Ryan is known for his innovative ideas on leading change, improving sales effectiveness and preparing for the future of work. He was recently recognized as one of "the best keynote speakers ever heard" by Meetings & Conventions magazine alongside Tony Robbins, Bill Gates, Colin Powell and Mike Ditka. Ryan delivers keynote speeches, courses and online learning with an emphasis on actionable content designed to elevate business performance. His curriculum emphasizes emerging trends influencing leadership effectiveness, sales performance and customer experience. Ryan helps participants prepare to thrive in today's ultra-competitive, hyper-connected business environment. Ryan supports the world's leading brands, including AT&T, Motorola, MasterCard, Adobe, MassMutual, the National Basketball Association, the Mayo Clinic, Honeywell, Thomson Reuters, Ernst & Young, Lowes and Prudential. Ryan and his team publish original research featuring client case studies to expand the live event experience. He is also the author of a popular blog on business performance. His writing has been featured in Inc., Forbes, Entrepreneur, FastCompany, SmartBrief, Business News Network, Crain's Business, and Yahoo Business. Read the full transcript below: Karen Litzy: 00:01 Hi Ryan, welcome to the podcast. I'm excited to have you on. So thank you so much for joining me. Ryan Estis: 00:07 Thanks Karen. It's great to be here. Karen Litzy: 00:09 Yes. And so like I mentioned in the introduction, Ryan was one of the keynote speakers this year at the private practice section annual meeting in Orlando, Florida. And I really loved the keynote, which is why I reached out to you. I took action now like you suggested and we'll get into that as part of my tan plan. We'll get into that a little later. I reached out to you via social media. And so here we are, but I have to say I really enjoyed the keynote and yeah, and it took a really like emotional interesting turn in the middle and I feel like in speaking with other participants that was unexpected and welcomed and really got people to sort of grab onto your words and take it to the end. So well done from a speech blueprint standpoint. Ryan Estis: 01:06 Well I appreciate it, you know, and I think an experience like that a little more emotional resonance is a good thing because I think that helps. Helps the tan plan, which I know we're going to talk about get a lot of attention. So that's always the goal. Karen Litzy: 01:20 Yeah, it was great. So thanks so much for that. But now let's let the listeners who weren't at PPS get a little bit more information from you. A little taste of that keynote. And one of the things that you know we were kind of talking about before we went on the air is at the private practice section. There are a lot of small business owners, a lot of entrepreneurs and a lot of my audience are yes, maybe work in healthcare but are also entrepreneurs. And we were talking about kind of customer expectations and how those expectations has changed over maybe the past couple of years. You probably have better research than I do on this, but can you talk a little bit about customer expectations and how they are kind of changing the small business or entrepreneurial landscape? Ryan Estis: 02:09 Right. Well, customer expectations are skyrocketing. They're changing fast because the world around us is changing so fast. I mean, I'm actually sitting at home right now and you know, when we get off this podcast I can turn to my lap and say, Alexa, paper towels and then an hour paper towels are at my front door. And that experience and experiences like those are elevating my expectations of everything. So as a consumer, I have a whole new set of standards with respect to customization, personalization of efficiency, expertise, sense of urgency and how I spend my time. And for those small business owners and entrepreneurs that are astute, aware of that and have evolving their customer experience to meet customers where they are, the future looks pretty bright. Karen Litzy: 03:03 And let's say, okay, we'll take me as an example. So I'm a small business owner and I really liked the way my business is running. I'm successful, I've been in business for 10 years. If it ain't broke, why fix it? So what kind of advice would you give to me? Ryan Estis: 03:23 I'd have some real thoughts about that. I would say if it ain't broke, it's the perfect time to break it because success breeds complacency. And complacency is the ultimate recipe for disruption. And the reality is for so many small businesses and small business owners, they don't change until there's a crisis, or they're experiencing some significant pain. And so, at that threshold, it's too late and you're on the verge of losing market share and getting commoditized, having your margin squeeze. And I know this from personal experience, if you remember from the keynote, my opening story was about exiting the advertising agency I worked for. And the reality of that situation is we had just deep pockets of resistance to change. You know, we wanted to kind of continue to do what we've always done, follow the playbook. And when the world around you changes and the marketplace changes, that's just such a recipe for disruption. And so having lived through that, I vowed personally, I am never going to experience that pain again. So the mindset of a small business owner today has to be continuous reinvention. Change is no longer an event. It's simply a way of existing. If you want to reign, remain relevant, thrive into the future. Karen Litzy: 04:51 And can you give some examples of maybe what you do with your own business to constantly reinvent? Because I feel like we can say you need to constantly reinvent and I feel listeners out there going, okay, great. Well what does that mean? Ryan Estis: 05:07 Yeah, yeah. So I'll get real, real specifics. Because here's the reality. If things are going pretty well and like the scenario you outlined, I had my business for 10 years, it's going well and I'm just going to continue to do what I'm doing. I don't see a real need or I have an appetite for change. And when things are going well that's true because change is uncomfortable. But, I've forced myself to get uncomfortable because that's where I'm evolving, stretched and growing. So we'll see a few things that I do. Three things, three very specific actionable tips. I am always in my business conducting what I refer to as three little experiments. I could be experimenting with my marketing on partnership, new software and the goal of the experiment isn't necessarily to have wild success. Ryan Estis: 06:03 The goal of the experiment is to learn and iterate forwards. So I'm trying new things that I think could help our business. And a part of that is it puts me in a position where I'm expanding my knowledge, acquiring new skills, getting education feedback, and then pantsing the business forward. So I would say some successes iterative, but you want to get out of your comfort zone and into the learning lane. So we have three very specific experiments that we're running in our business right now and there are tasks and we're getting feedback and evolving as a result. So that's one thing that I do. A second thing that I just really encourage or recommend is that in addition to working in your business, like you do, like probably a lot of your listeners do, and I do as a practitioner and a small business owner, you have to make time to work on yourself and on your business. Ryan Estis: 06:59 So for me, we just came out of a two and a half day meeting that I refer to as our 2020 growth summit. So this is literally shutting down emails, shutting down the phones, two and a half days with my team and some of our partners. There were eight of us attending in a room for two days with a very buttoned up agenda talking about the future of our organization. And you know, we're tearing apart the business and challenging ourselves to think about growth into the future. What are our priorities, budget assessment, looking back, looking forward recommendations, competitive intelligence, I mean all of it. So you know, that type of time kind of out of the business to working on that I think is imperative to having kind of a good solid plan and direction ahead. So that's a second recommendation is make you know, take time out to strategically work on your business. Ryan Estis: 08:03 Well, the third recommendation I have, and this is something I may have talked about it in the keynote, but I'm a big fan for small business owners of having what I refer to as a personal board of directors. And I have eight people that I've invited formerly this, that on my board of directors. And I invited people that I had a relationship with. I have a lot of trust and respect for their opinion or what they were doing say in their specific area of expertise. And the invitations were fairly informal, but what it's done is it's given me access to these eight people who have competency and skills perhaps to shore up some of my gaps. And I am able at inflection points when facing a critical decision or a juncture or I'm considering making an investment. Ryan Estis: 08:58 I had a group of people that, you know, I can reach out to and schedule a time with to use as a sounding board. And I think entrepreneurship at times can be very isolating. And you know, you feel you can get to a point where you feel like you're making decisions in a vacuum. And having an advisory board is moonshine option and valuable part of my growth, particularly over the course of the last couple of years. So those are three very kind of tactical things that I think everybody listening to can think about as it relates to their own business. Karen Litzy: 09:29 And, all of those three examples are things that are pretty doable for everyone. You know, it's not like there are things that are so outrageous. Like when you say three little experiments, you mean small, not like I'm going to restructure my entire business, but you know, you constantly throughout the year are doing this. Do you say I'm gonna do three little experiments a year or is it like every quarter or six months? Ryan Estis: 10:00 No, these are good questions. I would say I'm always running three experiments simultaneously. So let's say we're working on a marketing project that's a bit of an outlier, an experiment, something we wanted to do, try it. Sponsorship around some of our content branded content. And I'm not sure where this is going to go or if it's realistic. And so what we're testing this, I've reserved a little bit of budget, a little bit of investment, a little bit of capital. We're going to go down this path and then evaluate it. But through this process we'll learn things, we'll uncover things, we'll get customer feedback. We're working with, you know, our marketing partner. And so it's those, they're small tasks that, you know, if there's traction and the evaluation is, yeah, this is beneficial and we could build it then, you know, that we may expand an experiment. Ryan Estis: 10:57 So, that's the idea. They're small because I'm a big believer in that. Success is iiterative, you know, you want to be doing little things. There's been a thought about that. It's like the minimum viable effort. There's BJ Fogg, he wrote a book about tiny habits and small changes and his ideas that to create these, he's a professor at Stanford. And his idea is that you create a new habit, you need to simplify the behavior and then make the change so tiny, so little, so ridiculous that it's just something that's easy to do. So no, you don't want to and you want to take calculated risks, you know, not something that's going to jeopardize your core business. So that's when I think of three little experiments and then you build on those things based on your expanded knowledge, experience, exposure, you know, you can start to iterate your business forward. Karen Litzy: 11:59 Yeah, that makes a lot of sense. So like in my world, in the physical therapy world, for me, I can think of changes that I made over the last year. And we're joking before going on air, like I went into these changes with like white knuckles. Like I did not want to let go of the things that I was doing because like you said, it's very uncomfortable so that it works. So for me in the healthcare world, something that was, it was just simply switching my electronic medical records from one company to another and it was very uncomfortable. But now that I've been doing it for, I don't know, eight months or so or nine months, I think to myself, this is so much better. What was I thinking before? Things are better. My patients are getting reminders that they have appointments, the platform's easy, or I can do it on my phone. I don't need a computer. So you know, that's an example of something small and at least in the healthcare world that you can do. And like you said, I was getting feedback from my patients and they were like, I love this new system. This is great. I love getting these reminders. I love that I can pay through the system. So it worked. Ryan Estis: 13:14 It works. But I also think it illustrates a very, very relevant point to our conversation that, you know, it's the psychology of change, right? So our brains are wired for safety and survival, not innovation and change, the mechanism in our psychology is trying to keep us safe and alerting us when danger is near. And that's trying to keep us away from these unknown elements. And that was pretty useful in times where there were reptiles running around trying to meet us. But in the modern day society, when you're running a small business, you have to condition yourself to navigate those feelings. So the discomfort, the uncertainty, the trepidation, the anxiousness that you felt upon making this change, that's a sign that you're in the learning lane, that you're expanding, you're growing, you need to kind of learn to welcome a little bit of that tension because that discomfort means you're on the cusp of a breakthrough and you broke through in an area of your business that elevated the client experience that's…

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466: Dr. Elaine Lonnemann: Degenerative Disc Disease?? Dec 02, 2019

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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Elaine Lonnemann on the show to discuss the impacts of being diagnosed with degenerative disc disease. Elaine Lonnemann has served the public clinically as a Physical Therapist for over 30 years practicing in a variety of settings in Tennessee, Florida, Kentucky and Indiana. Her early clinical interests in treating patients with low back pain evolved into a clinical academic career with a focus on best practice in orthopaedics, teaching and leadership. She lives in Southern Indiana and is the mother of four boys with her partner and husband Paul Lonnemann who is also a Physical Therapist. In this episode, we discuss: -The American Academy of Orthopedic Manual Physical Therapists position on the opioid crisis -Patient health outcomes following the diagnosis of degenerative disc disease -The use of Clinical Practice Guidelines for low back pain in physical therapy practice -Pain science education and the treatment of low back pain -And so much more! Resources: Email: elonnemann@usa.edu Elaine Lonnemann Twitter AAOMPT Website AAOMPT Position Statements Battie et al. 2019: Degenerative Disc Disease: What is in a Name? JOSPT CPG: Low back pain For more information on Elaine: Dr. Elaine Lonnemann received a BS degree in PT from the University of Louisville in 1989, a MSPT from the University of St. Augustine (1996) and DPT (2004). She is the program director of the transitional Doctor of Physical Therapy program for the University of St. Augustine. She has served in several positions for the University of St. Augustine for Health Sciences since joining in 1998 including teaching in the online and continuing professional education divisions. Her responsibilities include oversight of the transitional DPT program as well as the orthopaedic and manual physical therapy residency and fellowship. She is a board-certified clinical specialist in Orthopedics, Certified Manual Physical Therapist and a Fellow of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). Her clinical experience have been in private practice, home health, outpatient practice, and as Chief PT of outpatient services in a level II trauma center at a university hospital. Dr. Lonnemann was an associate professor for Bellarmine University in Louisville KY and taught in the first professional program for fifteen years. She has presented nationally and internationally on the topics of spinal thrust manipulation, low back pain guidelines and leadership. She authored textbook chapters in orthopaedic physical therapy and has published in the areas of spine morphology and joint manipulation. She is passionate about leadership, postprofessional physical therapy education, manual physical therapy and integrating pain and movement sciences in the clinical management of clients. She is the current President of AAOMPT and has served two terms as Secretary and Chair of the AAOMPT International Federation of Manual Physical Therapists Educational Standards and International Monitoring Committee, member of the OMPT Description of Advanced Specialty Practice Task Force and committee member and author for the 2018 revision of the Manipulation Education Manual. She received the AAOMPT Mennell Service Award and the 2017 President Joseph and Maureen McGowan Prize for Faculty Development from Bellarmine University which provided the opportunity to study the history of manual therapy at Oxford University. Read the full transcript below: Karen Litzy: 00:01 Hello, Dr. Elaine Lonnemann, welcome to the podcast. I'm happy to have you on. Elaine Lonnemann: 00:06 Thanks. I appreciate being here. Karen Litzy: 00:08 Okay, so today we're going to be talking about degenerative disc disease. But first I would love for you to talk about what it is, why it exists and what do all those letters in AAOMPT stand for? Elaine Lonnemann: 00:27 Absolutely. So AAOMPT stands for the American Academy of orthopedic manual physical therapists and it's an organization, it's an association that started in 1991 basically because some individuals felt like we needed a group that could present scholarly works that could meet, have conferences and also test clinicians based on international manual therapy standards. And so that group, several individuals got together and that's how it started in Michigan actually. So that now we have representing 3000 physical therapists. Karen Litzy: 01:12 That's a lot of therapists. And how long have you been part of the organization? Elaine Lonnemann: 01:19 I've been a member since actually 1994. So quite a lot of time. I was a resident and fellow in training and became a member of really when it was beginning. So I've been involved as a member and more recently as an officer. Karen Litzy: 01:37 Awesome. That's great. So now let's talk about AAOMPT position on DDD or degenerative disc disease, which is something that I think is a very commonly diagnosed. I think it makes people nervous when they hear it because they hear the word disease. So can you talk a little bit about degenerative disc disease and the position AAOMPT has on that? Elaine Lonnemann: 02:03 Yeah, so our position is we just oppose the use of that term. It's commonly used as you said, and it's really used to diagnose an age related condition. And that age-related condition shouldn't be considered a disease. It shouldn't be considered degenerative. So it happens whenever on imaging you see changes in the shape or the size of the disks in the spinal column. So that's how it's identified. And, you know, we know several things that nearly everyone's discs change over time. And the interesting thing about that is that not everyone feels pain even when they have those changes in their discs. So, that's why we oppose it or one of the reasons. Karen Litzy: 02:52 And you know, like we said, it is so highly diagnosed and when people hear that disease, they think of something that like cancer is a disease or Parkinson's is a disease or a syndrome. But I think it's kind of scary terminology and words matter. So what does AAOMPT feel should be a better descriptor? Elaine Lonnemann: 03:19 Well, you know, I don't know that we have a descriptor in terms of a substitute, but I think, you know, patients really have the right to accurate healthcare information. And when, like you said, when they are given that diagnosis, you know, not only disease, disease puts a lot of fear in their mind, but degenerative, I mean they start to lose hope because they degenerative just sounds like, you know, they're gone down a pathway, you know, if it is just described as mechanical back pain or radiating back pain, you know, and our healthcare system really looks at trying to find a tissue or a pathoanatomic cause for low back pain. And the research clearly indicates that and has over time that it's very difficult to find a specific cause for low back pain. So we really need to move away from that model. Elaine Lonnemann: 04:16 And, you know, the other part of that is the patients lose fear, they lose hope. And they also began to believe they can't manage their own pain. So they lose self efficacy. And we know how important that is for our patients. And I think that's the one thing I love about our profession is that we really help patients manage and control their symptoms, their condition, and improve their function. And, whenever they're given that label, it really it can misguide them, you know, because they lose hope. And then they might start choosing, you know, riskier treatment options. Karen Litzy: 04:53 Surgeries, medications, even less invasive procedures, things like that that maybe may not be necessary. But like you said, if you're the patient getting this diagnosis of degenerative disc disease, it can maybe feel like you're at the end of your rope and you don't have much more to go. Elaine Lonnemann: 05:16 That's right. And patients need to know that their situation is real, that the findings that they have, because most people are diagnosed after they've had imaging. And so I think it's really important that we emphasize, yes, those findings are real, but this isn't a disease and this can be managed. And you know, the other thing is that oftentimes those imaging findings stay, but their pain goes away after they're treated. So, you know, that helps to give them some hope. I recently had a student who was 26 years old who came up to me and said, you know, I'm really concerned. I went to see a healthcare provider and because I was having some back pain and they diagnosed me with degenerative disc disease, what am I going to do? And then she just went in, almost fell apart because she said, you know, I love to run. Elaine Lonnemann: 06:06 I don't, you know, I don't know what I should do. Can I continue to exercise? And I'm thinking about getting an epidural injections because I don't want this to progress. And so I had to kind of step back for a minute and say, okay, it just explained to me why you went, you know, tell me about your pain cause you're not going to, she told me, I'm not even in pain now. She said she had had pain for a week and then went in. Because her sister had structural scoliosis, so she was fearful even though that was at 16, she was fearful that she might have a condition that would be a problem. And now she's fearful because she's been labeled as having degenerative disc disease. So, you know, it really took a while to counsel her and you know, to again, affirm these findings are real, there are changes in our discs but these are normal changes that occur with aging and they shouldn't be considered degenerative. The studies indicate that, you know, there's oftentimes when those findings are present, they don't correlate with the exact clinical presentation of the patient. And that's what we want to get. That's the message we want to get up. Karen Litzy: 07:16 And as physical therapists we can certainly relay that message to our patients. But if the patient hears that from the physician first, it makes it a little bit more difficult. Our job becomes a little bit more difficult because now it makes it seem like we're giving two different diagnoses. Maybe it starts with us as individuals, but how can we as the physical therapist who is maybe seeing this patient after they were given that diagnosis from the doctor communicate to the physicians or you know, cause this is a medical system wide use of terminology and it really needs to change from top to bottom. And I feel like sometimes yeah we're that point of entry but oftentimes where people are coming to see us after they get that diagnosis. So how do we as a profession advocate for this change to the greater health care system? Elaine Lonnemann: 08:22 Well I think we definitely need to partner with our medical colleagues with APTA and we are already partners but definitely get the word out that you know, this type of diagnosis really does misinformed patients. There is research and AAOMPT has developed a white paper that explains the research related to how this misinformation can potentially guide their treatment or lead them to choose, like you said, riskier treatment options. And you know, one of those, obviously the opioid epidemic is something that we have to think about. And not to say that it's going to lead them directly into that path, but it does. There has been some research that indicates that, you know, the healthcare costs are driven because we aren't following the practice clinical practice guidelines for back pain. So I think the biggest message that needs to come out is we need to follow those clinical practice guidelines. Elaine Lonnemann: 09:22 And I just heard Tony Toledo, do you have his keynote presentation at the interprofessional collaborative spine conference? And there were physical therapists and physicians and chiropractors all together in a room and you know, it was a great opportunity to meet, you know, as partners with them and you know, what can we do for the greater good of our patients? And I think the biggest, yeah, and he actually presented some of the challenges and what can we do from here forward really to improve this situation. And you know, he was talking to all of this. It wasn't just physical therapists, but one of the things that he did address was the continuity of care. And he said it's really important that patients don't wait, that we get them in early and not that every patient would and I don't want to, I don't, I want to make sure this is clear. Elaine Lonnemann: 10:12 Not every patient who has low back pain needs to be seen by a healthcare provider, whether it be a physical therapist or other conservative type of clinician. Sometimes that pain will go away, but if it's very intense and if it doesn't go away, then they should seek care and it should be early. So talking about the continuity of care, you know, in terms of who sees the patient first and whoever does it should follow the clinical practice guidelines that recognize, you know, with some time with some activity, with some coaching, a reassurance and a comprehensive medical exam that really does rule out a systemic cause or something more sinister because that's the other thing. Patients are fearful. My 26 year old student was fearful that this was something sinister. So I think that is a really important message to get out that comprehensive physical exam can really help to rule out some of the medical disorders that, you know, are uncommon in low back pain, but that our patients are concerned about. Elaine Lonnemann: 11:21 So, continuity of care was one thing he mentioned. Oh, and the other thing he mentioned is variation in care. Of course, you know, it's a big problem because you know, whatever healthcare provider you see with low back pain, there's a ton of variation in how the providers performing interventions. So, you know, he highlighted that and I couldn't agree more but one of the things that he mentioned and you know, of course president of the Academy of orthopedic manual therapy, you know, so one would think I'm going to mention manual therapy, but really it's because that is part of the clinic, one of the recommendations of the clinical practice guidelines, is manual therapy for back pain. And again, not every patient needs it, but he mentioned, you know, manipulation, mobilization, those are forms of manual therapy along with exercise. And so I think that following the clinical practice guidelines, trying to reduce our variation in care and also recognizing that, you know, as physical therapists, we need to refer on or we need to know when not to treat and when we do need to treat consistently and follow those guidelines. Elaine Lonnemann: 12:36 So that's probably a long answer to your question, but as far as the message that needs to get out, I really just think highlighting those things are important. Karen Litzy: 12:45 No, and I don't think that was a long answer at all. I think that was a very good comprehensive answer. And you know, we're talking about clinical practice guidelines. Where can people find these clinical practice guidelines? I know the orthopedic section of the APTA has clinical practice guidelines on their website. Are there other places where people can search for these guidelines? Because oftentimes we talk about clinical practice guidelines, but people are like, I don't have any idea where to find them. I don't know where to look. Elaine Lonnemann: 13:21 Well, so that's a good, good point. In terms of looking at websites, you know, I think the orthopedic…

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