#PTonICE Podcast

Latest Episodes:

Episode 1754 - Incorporation: do's & don'ts Jun 21, 2024

Show notes

Alan Fredendall // #LeadershipThursday // www.ptonice.com In today's episode of the PT on ICE Daily Show, ICE Chief Operating Officer Alan Fredendall discusses the importance of incorporation, the difference between various corporate structures, and secondary benefits to incorporation Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PT on ICE Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at signup to receive a one-month free grace period on your new Jane account. ALAN FREDENDALL Good morning, everybody. Welcome to the PT on ICE Daily Show. Happy Thursday morning. Hope your day is off to a great start. My name is Alan, happy to be your host today. Currently have the pleasure of serving as our Chief Operating Officer here at ICE and a faculty member in our Practice Management and Fitness Athlete Divisions. It's Leadership Thursday. We talk all things small business ownership, practice management, tips and tricks, that sort of thing. Leadership Thursday also means it is Gut Check Thursday. So Gut Check Thursday this week comes courtesy of street parking. If you don't know street parking, It is an at-home functional fitness crossfit style program designed for people who are primarily working out in the basement, the garage, the barn, whatever. A bunch of different options, at-home programming designed to do by yourself or maybe with your spouse or your kids or something like that. So this workout was sent to me by our very own Dustin Jones, division leader over in our older adult division. 12 rounds for time, 5 double dumbbell hang power cleans right into 7 double dumbbell front squats and then drop the dumbbells and do 9 box jump overs. Recommended weights, 50's for guys in the hands, 35's for ladies. and then a 24 inch box for guys and a 20 inch box for ladies. So go there, you're trying your best to hold on to a minute per round, maybe faster if you can really cycle those dumbbells really fast and you're light on your feet and springy on that box and definitely trying to get done under the 15 minute mark. So remember, you are rewarded for participating in Gut Check Thursday. Post your time lapse on Instagram. tag us at ice physio hashtag gut check Thursday you'll be entered into a weekly drawing to win a free ice t-shirt that will mail out to you so that is gut check Thursday today we're talking about incorporation do's and don'ts so we start our brick by brick course with this topic. This is a very important topic. I believe this is a very overlooked topic. I think this is an area of practice management where we can think it really doesn't matter. We can get really sloppy with how we incorporate and our incorporation type, if we incorporate at all, and I think it's really fundamental to understand why we incorporate, how we incorporate, and one of those benefits that you may not know that will result in you hopefully paying less tax money each year as a benefit of incorporation. WHY INCORPORATE? Let's start with why do we incorporate? Who cares, Alan? I'm seeing patients at my CrossFit gym or I see a couple people from my run club or whatever. I see them on nights and weekends. What does it really matter? Is it worth paying the $50 to my state to form a corporation? Short answer, yes. We talk a lot in Brick by Brick that becoming a business owner, even if it's not a full-time thing, even if you never plan to grow your practice beyond yourself, the whole idea behind being a business owner is to really look at and evaluate where are those areas that have maybe even a small degree of risk but that has a really simple, easy, low cost, time and or money solution to eliminate that risk. And owning a business, running a practice is really about minimizing that risk as much as possible because why not? Why carry a bunch of risk even if it's a hundred different amounts of really small types of risk? if you don't have to. And incorporation is one of those risks. The cost of forming a corporation is something that you can do in every state on your own. You don't need to hire a lawyer. You don't need to pay $1,000 to LegalZoom. We show you in Brick by Brick that it's a form usually on your state website. It's something you can fill out yourself. It's something that might even be free, especially if you're a small business owner, you're a first-time business owner. Something that you can knock out as simple as a couple minutes. In some cases, have your incorporation documents back instantaneously. So you're thinking, in some states, five minutes and zero dollars to form a company that is going to go a long way to limit your risk. Let's talk about that risk. What is that risk? When you are running a business, if you are not incorporated in the eyes of the law, both the legal law as well as tax law, you and your company are not separate entities. You are what is considered a disregarded entity. You are somebody who has not formed a corporation. You and your company are the same person, the same entity, and that carries a lot of that risk that we were just talking about. If you were to be sued for whatever reason, your business assets can be held liable to cover whatever you might be sued for personally, and vice versa. If someone falls in your parking lot, if a robber tries to break into your clinic and falls through the window and cuts their arm on your window glass and sues you, Your personal assets can be used and seized to pay for the outcome of that lawsuit should you lose. And that is because you have not legally separated yourself, the individual American taxpayer, from your company, your business. And again, that process is very, very, very simple, often quick, often very cheap to do. And so we always, always, always encourage people Even if you are seeing one patient a week, one patient a month, you are just a side hustle, seeing patients five to 10 hours a week, even if you never plan to grow beyond yourself, you plan to just essentially be self-employed, spend the 50 bucks, spend the 100 bucks, spend the 10 minutes, spend the hour, and incorporate so that you create that legal division between yourself and your business. Your personal assets are protected when the business gets in trouble, your business assets are protected when something may happen in your personal life. The last thing you want to do is have your house seized because maybe somebody slipped on the ice in your parking lot which you have no control or responsibility over and yet here you are having your personal assets seized because you have not incorporated. DIFFERENCES IN CORPORATE STRUCTURE So looking at a corporation, what are the two major types that we see with physical therapists? These are going to be state dependent, but you are going to form some type of limited liability corporation. The reason, again, we do this is right in the name of those companies. We are limiting our liability. So we can either form a limited liability company, LLC, or in some states, Physical therapists may be required to form a Professional Limited Liability Corporation, PLLC, or sometimes called Professional Corporation, or PC. What are the differences? They're important and it's important to know them. I'll start with this, you should always form an LLC and not a PLLC if you do not need to form a PLLC. The major difference between these two corporation types is that in an LLC you are protected from malpractice and fraud claims against anybody else in the business including yourself as a personal practicing physical therapist working in your own business. Now in a PLLC, a professional limited liability corporation, what some states have done is said, hey, professional level folks, folks who are licensed professionals, whether they're healthcare professionals, mental health therapists, attorneys, dentists, whoever, anybody that is required to have a professional license in this state must form a professional limited liability corporation or professional corporation. Why? These states are saying, hang on a second, you should not be safe from committing male practice or fraud as an individual licensed provider, even if you are acting within the scope of a corporation. And so the difference between an LLC and a PLLC, primarily, is that you do not have built-in mail practice and fraud protection with that PLLC. At the end of the day, you have to form whatever your state requires, so if you have to form a PLLC or PC, you have to do that. But if you don't, you want to form that LLC. The second difference in a PLLC is there is a big con, and it is that everybody in the company, anybody who will ever have ownership stake in that company, has to be from the exact same profession. So for a while, ICE was a PLLC. We are now a corporation, an inc, if you will, but we were a PLLC, which means that Jeff Moore was our owner. He's a physical therapist and because he formed the PLLC and he was a physical therapist, no one else could have ownership stake in the company that wasn't also a physical therapist. So that's something to keep in mind, especially if you're going into business with a partner, that partner must be a physical therapist. If you are also a physical therapist, if you were to sell the company, you would have to sell it to another physical therapist. If you were to pass it on to your children, or your spouse, or any of those things, everybody would have to be from the same company, or you would have to dissolve and reform the company. If you're dealing at all with any sort of contract insurance or whatever, you want to avoid obviously dissolving your company, losing your business, losing your business name, losing your tax ID, all that sort of thing. So we want to avoid dissolving our company if the company is changing hands under good terms. And so that is the second con of a PLLC. But again, if you have to form it by your state law, you have to form it. So LLC versus PLLC, if you're able to, always choose LLC, but recognize you might have to choose PLLC. TAXATION BENEFITS TO INCORPORATION And now the final benefit, a benefit that's not talked about a lot, is one of the reasons, aside from protecting yourself from legal liability, is that there are a lot of taxation benefits to forming a corporation. This is really hard to understand, but if you have been alive for a while, you recognize that this is naturally true. America is built to service companies. There are a lot of legal benefits. There are a lot of tax benefits to owning a company. Even if you don't own a giant company like Amazon or Tesla or something like that. Even if you own your own small business and you're your own employee. there are a lot of taxation benefits to incorporating as an LLC or a PLLC. The primary benefit is that you can elect something called S-corp taxation. This is a form you fill out with the IRS, form 2553, and this is not a different type of corporation. What this is doing, back in 2016 under President Trump, a law was passed where we can elect to be taxed as an S-corporation. What does that mean? It means we are eligible for pass-through taxation. Instead of paying a 21% flat corporate tax on all of the revenue that our business makes, and then paying it to ourself, paying it to others, and having those folks pay income tax on that money, avoiding that double tax is the result of something called S-corp taxation. And so, your company does not pay tax, it does not report anything to the government, you pass through your revenue and expenses to your personal income tax. What does that do? That provides us with two main avenues for benefits. The first is it lets us enroll 20% of all of the business expenses over to our personal income tax as a deduction. Now that's pretty huge. As you're starting, you may not spend a lot in your business, but if your business grows to multiple people, you will find yourself spending tens of thousands and hundreds of thousands of dollars in expenses. What's nice is that 20% of that can get pulled through to your personal income tax as a tax deduction. And so you get to stack that on top of all the other stuff you write off. As a business owner, you have a lot more leeway now of other stuff you can write off. You can write off anything that you may have spent money on that's a reasonable business expense. And so by having a business, by being incorporated, you're able to write off a lot more things and overall pay a lot less income tax than when you were an unincorporated personal citizen just paying taxes. That is one of the primary benefits of spending the time and money to get yourself incorporated. SUMMARY So incorporation, do's and don'ts. Do please incorporate. If I haven't stressed it enough, it is a relatively cheap, quick process that gives you a lot of legal protection. It also gives you a lot of taxation benefits that should see your tax bill be lower once you own a business and are incorporated than before when you were not incorporated and you were just a private citizen paying taxes normally. So if you have Deeper questions about this, our Brick by Brick course starts again July 2nd. We go really deep into the weeds on topics all like this. We talk about incorporation, we talk about whether or not you should work with insurance, we talk about how to work with Medicare either in network or taking cash. and we get into the nitty gritty about a lot of business topics so that at the end of the eight weeks, you feel really good about starting your practice or at least understanding the steps you need to take to start your practice. So if you're interested, we'd love to have you. Again, the next class starts July 2nd. I hope this was helpful. Have a wonderful Thursday. Good luck with that Gut Check Thursday workout. If you're coming to Michigan this weekend for the Fitness Athlete Live Summit, we'll see you tomorrow. Have a good weekend. Bye, everybody. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinic…

Full show notes at the publisher

Episode 1755 - Programming for performance & profit Jun 21, 2024

Show notes

Dr. Rachel Selina // #FitnessAthleteFriday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Endurance Athlete faculty member Rachel Selina discusses programming and starting to fill more of a coaching role that can be an excellent way to continue to help runners beyond formal clinical care. It can also be a fun way to diversify your revenue streams and supplement your clinic income. Start thinking in 3 tiers for offering either endurance or strength programming (or both!) 1. Generic 2. Semi-custom 3. Fully custom/interactive Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn from our Endurance Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTIONHey everyone, Alan here, Chief Operating Officer here at ICE. Before we get into today's episode, I'd like to introduce our sponsor, Jane, a clinic management software and EMR with a human touch. Whether you're switching your software or going paperless for the first time ever, the Jane team knows that the onboarding process can feel a little overwhelming. That's why with Jane, you don't just get software, you get a whole team. Including in every Jane subscription is their new award-winning customer support available by phone, email, or chat whenever you need it, even on Saturdays. You can also book a free account setup consultation to review your account and ensure that you feel confident about going live with your switch. And if you'd like some extra advice along the way, you can tap into a lovely community of practitioners, clinic owners, and front desk staff through Jane's community Facebook group. If you're interested in making the switch to Jane, head on over to jane.app.switch to book a one-on-one demo with a member of Jane's support team. Don't forget to mention code IcePT1MO at the time of sign up for a one month free grace period on your new Jane account. RACHEL SELINA All right. Good morning, everyone. Welcome back to the PT on ICE Daily Show. My name is Rachel Selina, and I'm happy to be your host this morning. We're here for Fitness Athlete Friday. And with that, we're going to jump into the topic of programming, but not looking at it from like what the programming actually consists of. but more so kind of how do we, how do we market that programming and what is it as a service that we're actually offering? Okay. So we, we talked about this at the sampler this year, um, about starting to find ways to diversify our revenue streams. Um, mostly from the standpoint of like avoiding burnout, but also like it brings you more income, hopefully doing something that you enjoy. Doing that's kind of a change from your normal. I always think it's kind of funny. I'm definitely someone who likes diversification So I end up having like I have like six different Roles or six different jobs and so trying to explain to someone like hey, I thought you were a physical therapist It's like what I am but I also I also do this or I also do this I also offer this and to me that That helps me. I like being able to work with people in lots of different capacities. So as we're talking about our endurance athletes, we're going to look at how do we use programming, kind of both the endurance programming, like our aerobic training and strength training and offer that as a service. And one of them that we'll dive into is like, yes, it can be an additional revenue stream. But I think from a performance standpoint, it's also really helpful for our patients because if we think they're ending formal care and we can send them out and still have a way of being in contact with them, like if we have designed their next training program, right, they're done in the clinic, we're not seeing them on like a regular basis anymore, but they're following a program that we wrote, they're more likely, if something comes up like, hey, my Achilles started bothering me, instead of waiting for it to be like a big deal, Um, I think it's more front of mind if they're following something you designed for them to think like, Oh yeah, I could reach back out to Rachel. Like I could ask her about this. Um, or just being in that more constant contact, but in a non nonclinical standpoint. So I think it, it helps our patients as they're going back into their training, um, to just have that kind of touch point or remembrance, um, that we're here, um, and we can help them with that. So from a performance standpoint, they're going to, be involved with us and be in that more constant communication so things don't go unchecked for such a long time. So that I think is helpful from the performance standpoint, but then there's also lots of ways that we can offer programming and kind of our particular take on it and what good programming could look like. because we have that background, we have that knowledge instead of someone just going, not that there's, you know, not good plans on the internet, but someone just going and getting programming from a random other person or from, you know, someone who's not familiar as much with how to kind of work around injuries or prevent injuries through what our programming is doing. So if we, if we think of that, like our aerobic programming first, okay, like what's the, How many days a week are they running? Are they training for a half marathon or a marathon? I think there's really three levels of programming we can offer and I kind of think of it tiered as how much input it takes on my end. So the first tier would be I write a program and I keep it very general. Like it's not for a specific person. It's I have written a marathon training program and I have available whether it's on my website or Instagram or whatever, however you want to sell it. Like I have available a half marathon and marathon training program that anyone can just buy. Um, or maybe I offer it for free. That's an option too. Um, but someone just buys it and there's no other input from me beyond that. I wrote it. Um, and I think with that, like it's very hands off. Um, here, this is what you're getting. This is what it is. Go do it. Um, I think with that though, like we're in a good spot to be able to do that because we can design a program with all of those good like principles of progression, kind of making sure we're not progressing too much, too fast, keeping pace under control, all of that, but it's not specific, right? This is a very general. I think if you're going to, even if you offer it for free, right? You could still have on that program, right? At the header or something like that. Like you can still have your name, your clinic info, something. to that nature, where again, every time that person looks at that program, they're seeing your name, they're seeing your clinic, and just being that point where you're front of mind, right? They can't get away from you, in a good sense. So that's kind of our first tier, something very general that's just put out there, anyone can buy, there's no other input to it. If we take it a step up, okay, that next step, that next tier, I think is semi-customizable. There's now a person in front of me who has a goal. So this now is Sarah, who's going to run a half marathon. And Sarah wants to run it at whatever pace. She wants to run an eight-minute pace. I can take that program, that general program, and adapt it to what Sarah needs. So I can put specific pace goals in there. I can put… you know, Sarah works late on Tuesday, Wednesday, Thursday, so she needs shorter workouts on those days. Like I can, I can change some aspects of that program so that it is specific to the client or the patient. But then beyond that, it's not, there's not anything else beyond that. I'm not, you know, I'm not in weekly check ins or anything like that. It's here's a program that's Tailored now for you. So semi customizable I think is that mid mid range and then if we were to go one more step Okay, like someone who wants everything I think of fully custom training programs And this is where they're bringing you on a more of like a coaching role. So I've written their programming But I'm also now having regular checkpoints, right? It takes a lot more on my end because I can't just do it and be done. It requires a constant kind of back and forth and checking in on how the training is going. Are they progressing appropriately? How are they tolerating it? And making those kind of week by week changes. And this, I'll think of using this if someone has very specific goals, like it's not just here's the race and here's the pace I want. But if there's a lot of elevation involved, or altitude involved, or multiple disciplines, or just something very, very specific. Or if someone really wants that more constant touch point, this is where we'll start thinking of fully custom programming. And then in terms of, like, you're obviously going to charge different. Like I said, that first tier, if you're just putting a general program out there, you might choose to have that be a free resource for people. because you know they're going to keep seeing your name, and that might be all you get from that, which is perfect. For a semi-customizable one, I usually think of charging per the time it takes me. So if I usually have a set cash rate in my clinic for an hour, and writing a custom training plan takes me an hour and a half, I'm gonna charge an hour and a half of what my usual clinic rate is. So I'm making sure that I'm compensated for it, and it's not taking away from my other my other revenue generation. And then fully custom, I think you have a lot more flexibility here for what what you want to charge, because it's going to depend on how much of your time it's going to take. So that can be I think you can either do it on a month to month basis or think of it as like a training block, which is usually helpful with our endurance athletes because they're usually training in those blocks of like, I have four months of you know, training for this one particular event. So maybe you do a particular like four month payment for whatever you think your time will be for that, that given goal. So that's kind of our that's our aerobic training. I think we can also look at this for strength training. And in a similar sense, like I'm not going to break it down quite as much, but you can have different levels, like you can have just a general program of know two days a week of strength training that someone's going to do and they're going to do the same thing each week as kind of your lowest tier non-customized. But then you can take it up a step or and think of like I'm going to write specific workouts every week for again for Sarah. Sarah is going to get two workouts from me each week that are you know taking into account her strength level her progression and that would be a different a different cost, a different level than just that generic. Or you can also think of doing like a class. Like if you have the space to do a class, maybe you start to offer a strength training for runners class that meets either once a week or twice a week. And you have people commit to that timeframe, right? Because then you can block out that time in your schedule. You have maybe one or two hours during the week that you know are dedicated to that and getting people to sign up for that bigger block of time. But again, they're just they're all different ways to offer something that we have the skill set to do and probably do better than a number of people that are out there doing it just because we can take into account proper progression and loading principles. And if we're doing some version of the custom programming, we know how to monitor tolerance to training load and whether that adaptation is occurring how we want it to. We know how to modify Or work around injury and then if we're constantly involved with that person, right? How much more likely are they to to come to us earlier? Which is the goal like most people don't seek out care for an injury until it really stops them from running So if we can get to people earlier, right? We can hopefully keep them going just like we say we we don't want to like leave the gym when we're injured we we want to use the gym to help us with our injury and We can think of it the same way for running, like we don't want our runners to have to stop running. We want them to be able to work through that and keep running so they're not losing that capacity. And like I said, just determining your cost, like you have to decide what your time is worth and how much time each type of programming is going to take you. But I think it can be a really good way just to be able to think differently, to kind of activate a different part of our brain. Um, and it's really rewarding to be able to help someone meet their specific goal, um, and kind of see them from that whole, that whole longer term process. So just some food for thought, um, different ways you can start to diversify your income working with endurance athletes in a way that benefits you, but also really benefits your patients. Sweet. Um, we have some injured runner courses coming up. So if you are interested in our online course, that one, our next cohort starts July 9th. OK, that's our eight week online course. We meet every Tuesday. And then we have now several options coming up for Injured Runner Live. Our last two for this year will have the beginning of September in Maryland. And then we just added a beginning of November course here in Michigan in Grand Rapids. So we'd love to have you out at one of those if you're looking to dive deeper. into working with your endurance athletes. So that's all I have. I hope you have an excellent Friday. Hey, enjoy your weekend and hopefully get out there and go for a run. All right, bye everyone. OUTRO Hey, thanks for tuning in to the PT on ICE daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Full show notes at the publisher

Episode 1753 - Top tips for HIIT & medical complexity Jun 19, 2024

Show notes

Dr. Dustin Jones // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult division leader Dustin Jones shares tips to make HIIT more objective, being diligent with monitoring vital signs, and underdosing high-intensity with medically complex patients when needed. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everybody, Alan here, Chief Operating Officer at ICE. Thanks for listening to the PT on ICE Daily Show. Before we jump into today's episode, let's give a big shout out to our show sponsor, Jane. in online clinic management software and EMR. The Jane team understands that getting started with new software can be overwhelming, but they want you to know that you're not alone. To ensure the onboarding process goes smoothly, Jane offers free data imports, personalized calls to set up your account, and unlimited phone, email, and chat support. With a transparent monthly subscription, you'll never be locked into a contract with Jane. If you're interested in learning more about Jane or you want to book a personalized demo, head on over to jane.app.switch. And if you do decide to make the switch, don't forget to use our code ICEPT1MO at sign up to receive a one month free grace period on your new Jane account. DUSTIN JONES Alright folks, welcome to the PT on Ice daily show brought to you by the Institute of Clinical Excellence. My name is Dustin Jones, one of the older adult faculty within the MMOA division. Today we are talking about the top tips to apply high-intensity interval training amongst medical complexity. So I think many of us have been there, right? We're working with that individual that has a whole laundry list of different diagnoses, different medications on board, maybe in a more acute setting. And we know that high intensity interval training is helpful for people. We've seen some literature, we've read some of the research, but what does it actually mean to apply this amongst a very complex situation? All right. So we're going to cover, some key takeaways from a super helpful article that was published last year in 2023 in the Cardiopulmonary Physical Therapy Journal titled, Putting It All Together, An Evidence-Based Guide to High-Intensity Interval Exercise Prescription for Patients with Complex Comorbidities. And I really appreciated the team that wrote this article because it is difficult to navigate, right? Like, we will see some of these headlines of high-intensity interval training proven to be effective in the ICU, for example, or HIT being effective with folks that have recently suffered from a stroke. Some of these things we typically wouldn't associate high-intensity interval training with, but it's been shown to be effective. Now, when we go to apply that, it can be rather intimidating, right? I can speak to this mainly from the home health setting where The trend in home health is that people are getting discharged from more acute settings like the hospital a little too soon, right? So you have these very medically complex individuals in their home with very limited monitoring, medical support if something goes awry, and all the negative thoughts and what coulds, right? What could happen starts to creep into your head, and that can dramatically influence our intervention. Let's talk about three, I've got three main tips for y'all, things that I have learned through mainly mistakes in my career, but then also what this article talks about. One is objectify, two is monitor, three is, I'm gonna save that one for last. BE OBJECTIVE WITH HIGH-INTENSITY TRAINING All right, so the first one, we go to apply high intensity interval training. We need to be objective. Here's what can typically happen. You read an article, you maybe hear a PT on Ice daily show podcast, see a social media post like, all right, I'm going to use this with Betty tomorrow. All right, Betty, we're going to do high intensity interval training. And you're already working on gait training, for example. with Betty and so you're going to be like all right Betty I want you to go fast for 30 seconds and then I want you to walk slow for 30 seconds we're going to do that for a total of 10 minutes right great start I love what you're doing there you got a one-to-one work rest ratio it's already a goal that Betty has to improve her ambulation ability, maybe even distance endurance. Awesome. But what typically happens, right? She goes to do her fast walk. What does that actually look like? Is it fast? Or is it just slightly faster than her normal or a slower walking speed? All that I'm saying here is when, say ambulation, when we aren't objectifying it, when we aren't giving people a number to hit, to look to, to get that real-time feedback loop, they will often undershoot their intensity. This is where the ergometers that many of us have access to can be very, very helpful. A lot of these things are, they're collecting a lot of dust in a lot of clinics, to be honest, right? Like the new step. It's either collecting dust or we're throwing people on there for 20 minutes while you finish your notes or they take a nap, right? We got our recumbent bike. Maybe you have a rower, maybe you have an echo bike, maybe you have a ski in your clinic, but these are functionally all ergometers that are measuring work, they're measuring speed, they're measuring distance traveled. Those are objective metrics that we can use for dosage, that we can use to give people that target to try and hit to make sure you're reaching an intensity. Right, RJ, outpatient, has an Echobike. Echobike, you look at that screen, you've got calories, you've got watts, you've got your revolutions, right? You've got your distance. These are all things that we can use to set a goal to achieve appropriate intensity while we're performing our intervals. So RJ, for example, with the Echobike, it may be watts, right? You may say, pick a number of watts that you're trying to hit. during that 30-second interval and then it's going to be 30 seconds easier, 30 seconds rest for maybe like a total of 10 minutes with someone. Giving them that objective thing to look at is going to be so much more effective than just quote-unquote saying go faster, all right? NuSTEP has the same thing, right? Many of you all have already, I shouldn't say wasted the money, the NuSTEP can be helpful with certain patient populations But my gosh, the price per square foot of a NuStep is absolutely ridiculous. But if you already sunk the money and have one, freaking use it, man. That thing has all kinds of data and information that we can use to really redeem the NuStep, redeem that piece of equipment and achieve a higher intensity. All right? That's the first one. We need to objectify what that high intensity actually looks like. Use ergometers. If you don't have the ergometer, maybe use something like a percentage of a heart rate, for example, some other metrics that we can use to objectify. MONITOR VITALS Speaking of heart rate, number two is going to be monitor. Now, this is what really allows us to apply higher intensity intervals with medically complex individuals, is when we are monitoring Vital signs and signs or symptoms. Vital signs are absolutely huge especially in so many acute settings. Hopefully many of you all are getting them at rest initially, hopefully at least bare minimum at the initial evaluation, right? But when you're working with more acute individuals, you have these complex comorbidities. We need to be checking vitals every visit, but then when we're applying these high intensity intervals, it can be very helpful and advantageous for you to check vitals before, during exercise, and then after to gauge their response. Now I'm not saying check every single vital sign, right? But there's gonna be some pertinent ones based on who you're working with, right? So like if I have someone that is constantly cruising, you know, in the 150s over 90s blood pressure, they're pretty hypertensive. It's not managed terribly well. They sometimes have some symptoms, but a lot of times it's asymptomatic. I'm going to be checking blood pressure pretty regularly. I'll also be checking their heart rate as well. And I can do that during, and before, during, and after an interval. That's where these ergometers can be really helpful. Like a new step, for example, when I program that interval, they're working hard, but then they have that rest. That rest is when we check our vitals. I'll support their arm, get a manual blood pressure reading, and you're going to be able to gauge their response and make sure that you're in a safe zone, right? And the way we like to think about these zones is we like to think about them as traffic lights. So there's a red light in terms of things that you may see where we're going to stop exercise and a yellow light where we're going to be cautious but proceed and then green is just full send. We go into those in our Level 2 course, related to resting vitals, exercise vitals, signs and symptoms as well, related to high-intensity interval training. But for our purposes here, we want to monitor during, so you'll have a good idea of how they're responding. Another one is if someone has some type of cardiopulmonary issue, then a pulse ox can be really helpful, looking at oxygen saturation. We can see their response, make sure we're good to go, and we can adjust our dosage based on that. when we're able to monitor those vital signs it's going to give you an objective view of what's actually happening and I don't know about y'all but here's what typically happens with me is I may throw someone on a new step for example a recumbent bike and we're doing high intensity interval training and I know they've got some cardiopulmonary issues on board, some things that I'm somewhat concerned about, and I literally tell them to go hard. I may give them, you know, hit this number of watts during these hard intervals, and I literally am closing my eyes, crossing my fingers, praying to the rehabilitation gods that something bad doesn't happen. But if we're able to monitor and get that objective information, you can rest assured that you're giving that person exactly what they need, and it is safe. UNDERDOSE THE HIGH-INTENSITY FOR MEDICALLY COMPLEX PATIENTS Alright, so first we need to objectify it, second we need to be able to monitor it, and then third and the counterintuitive one, but it's the reality when we're going to apply high-intensity interval training amongst medical complexity, is that we need to underdose. I hate to say it y'all, but we need to underdose. Oftentimes, I'm not gonna say always, but oftentimes these folks are have a lot on board, right? And from the medical side, but then also from the psychological side, you take someone that has been given the diagnosis of heart failure and imagine what that feels like, right? You may have some perspective of what that actually means, a prognosis of that and what people can continue to do with a diagnosis like that. But there's so many individuals that will get these seven syllable medical diagnoses and they literally view it as a death sentence and they're actively falling apart right in front of your eyes. And that is not necessarily the case. There's a lot of psychological damage as well as physical damage along with these medical complexities. And it can be very advantageous when you introduce something novel and new like high intensity interval training to do it in a very approachable manner. This is where I am typically when I'm introducing I may use something like a subjective report, like an RPE, a rating of perceived exertion. That goes against the first thing I said, right? I told you you need to objectify it, but maybe initially, we want them to be a little bit more in the driver's seat and give them that RPE. You may say, I want you to go hard, I want you to go fast, I want you to go at a seven out of 10, RPE of 10 is your all-out effort, right? Initially, I think that is helpful. But we don't want to stay there because most of the time, people's true high intensity doesn't necessarily match up with their perception of high intensity. And that's where we need to be objective to calibrate that. But initially, I think under dosage, self-report can be very, very helpful. We also need to consider what these high-intensity intervals can do to people outside of our session, right? I learned this the hard way way too many times in home health, where we'd have this epic session. We'd be gone for about 20, 25 minutes, high-intensity intervals, you know, doing steps or ambulation, and then we do some transfer training. I'd take them, walk them out to their mailbox and back. They haven't seen the sunshine in weeks. Man, it was an epic session. And then I come back in a few days. What has that person done since that session? Nothing, right? They weren't able to do their laundry. They weren't able to do any tasks around their home. they were laid up because I absolutely gas them. And so we want to be able to leave gas in the tank for many of these individuals to be able to do things that are really important to them like ADLs, like IADLs, maybe a certain social function, right? And so when we start with that under dosage, you will be able to tweak and progress without impacting the rest of their life too much. which is really important. Many of you all may not have experienced that, right? I think many of you all probably did MRF, right? Memorial Day, high volume, you're working real hard for, you know, 40, 50, 60 minutes, maybe more if you're me, right? How'd you feel after that, right? Many of you all, myself included, were absolutely wiped and that's what a 10-minute session can do for some of these individuals. SUMMARY So, We may want to introduce it in an underdosed manner, see how they respond, make it approachable, and then gradually progress it from there. Then we start to objectify it, give them that target for, I want you to hit this many watts, for example, or this many revolutions per minute. And then we continue to monitor their vitals before, during and after those intervals, and you've got a potent cocktail that can really influence people's functional capacity, but then also the disease process that they are suffering from, and most importantly, it can be safe. All right, let me know your thoughts. Let me know any tips that you have from applying high-intensity interval training amongst medical complexity. I would love to hear from the folks in the ICU, in acute care, in skilled nursing facilities, in acute rehab, where you're dealing with a lot of medical complexity. Love to hear from you all. Drop in the chat on this Instagram video, or if you're watching on YouTube, if you're listening on the podcast, we're grateful for y…

Full show notes at the publisher

Episode 1752 - Treating wrist pain at the shoulder Jun 18, 2024

Show notes

Dr. Cody Gingerich // #ClinicalTuesday // www.ptonice.com

In today's episode of the PT on ICE Daily Show, Extremity Division lead faculty Cody Gingerich discusses addressing shoulder mobility in wrist pain patients.

Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog.

If you're looking to learn more about our Extremity Management course or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

EPISODE TRANSCRIPTION

INTRODUCTION Hey everybody, Alan here, Chief Operating Officer at ICE. Thanks for listening to the PT on ICE Daily Show. Before we jump into today's episode, let's give a big shout out to our show sponsor, Jane. in online clinic management software and EMR. The Jane team understands that getting started with new software can be overwhelming, but they want you to know that you're not alone. To ensure the onboarding process goes smoothly, Jane offers free data imports, personalized calls to set up your account, and unlimited phone, email, and chat support. With a transparent monthly subscription, you'll never be locked into a contract with Jane. If you're interested in learning more about Jane or you want to book a personalized demo, head on over to jane.app.switch. And if you do decide to make the switch, don't forget to use our code ICEPT1MO at sign up to receive a one month free grace period on your new Jane account.

CODY GINGERICH Good morning everybody. My name is Cody Gingrich. I'm one of the lead faculty with the extremity division and I am coming with you today on a clinical Tuesday and we're going to be talking about treating wrist pain at the shoulder. All right we're going to be tackling shoulder but treating the wrist. Okay. So wrist pain going after the shoulder to deal with wrist pain. This is a big deal when we're talking specifically about, um, a fitness athletes. Okay. So The reason being, the fitness athletes, people who are lifting in the front rack position, so think our Olympic weightlifters, our crossfitters, people who are just really working a lot of front rack position or overhead movements in general, are going to really benefit from these type of things, okay? So, couple things that I wanna start with and why it is important to look at the shoulder when someone is coming in with wrist pain. In the extremity division we talk about wrist pain a lot of times and most most of the time a lot of different presentations of wrist pain are going to be due to or need more wrist extension. It is going to be a wrist extension intolerance and that is largely going to be the case when we're talking about what we are today as well. With these barbell athletes or overhead athletes that need a good amount of wrist extension to get into good front rack position, or if we were thinking about handstand walking or handstand push-ups or pressing weight overhead, we also need a good amount of wrist extension tolerance to support our body weight overhead. Okay. And a lot of times when these people can come in, we can get pigeonholed into just looking at the wrist and be like, okay, well we're lacking some wrist extension and we need to treat that and we need to calm that down. And we, we stay in our lane right there at the wrist. But what I want to talk about today specifically is going to be really addressing shoulder mobility. in order to free up some space at the wrist. So I have a couple of, uh, I have a PVC that hopefully y'all can see, and we're going to try to show you, um, why in a non-adequate shoulder mobility can end up putting way more stress at the wrist with these athletes, even if they have a pretty good amount of wrist extension. Okay. So when we're talking specifically about the front rack position, I've got a PVC pipe here. So one thing is going to be where we're starting with is going to be if we have a lack of lap mobility, a lack of lap mobility is going to not allow our elbows to come forward and up as much. Okay. And so what that leads to is that barbell then sits way more on our wrist and hand than it does on our shoulders. PVC, I got to kind of tuck my chin down and get it there. But the more that we can drive our elbows up, the more that weight then is supported by our shoulders in that good front rack position. If we don't have the ability to really turn our elbows up high and we keep them low because we don't have that mobility, then most of that weight then comes through our wrists. And even if we have good wrist mobility, that is still a ton of pressure there coming through the wrist joint. The other side of things is we also need shoulder external rotation in that front rack position to distribute the weight that's going through our wrist more evenly. So the other front rack position that I see where if we can't get our wrists and our hands out here, we end up with our wrists right over our shoulders and maybe our elbows even just outside, just like this. And what that does is it forces extension and rotation at the wrist and ends up putting a ton, a ton of stress through that radial side at the wrist. Whereas if we can then open up that shoulder external rotation, that then can distribute the weight more evenly. We can have a flat palm. and a flat wrist into extension. So the other thing when we're talking about getting overhead, I mentioned handstand walking. If we don't have adequate shoulder flexion and we are overhead, that leads us to be here and we still are trying to get our feet up and over our body to walk forward. And that then requires a significantly amount more wrist extension if we don't have all of that shoulder flexion. If we can gain more shoulder flexion then at the top we don't need to roll over our wrist extension quite as much. So a couple different ways and that could also be a lat mobility problem as well. So what I want to encourage you is we have several tests If someone comes in and they're saying they've got pain with these particular movements, right? First, make sure that they have that adequate wrist extension. And the best test we've got for that is really going to be have them place their hand on a table and then see if they can get their elbow beyond 90 degrees at the wrist. Even right at 90, they probably have enough wrist extension to be able to calm those symptoms down, even without gaining wrist extension. So you can still make gains in their pain and treat their wrist pain, even if that wrist extension is a little slower to come. It is typically easier to treat soft tissue mobility restrictions than it is joint restrictions, typically. So a lot of times in our athletes in this population, those shoulder mobility limitations are oftentimes going to be soft tissue related. So we want to then check shoulder mobility. The best test for that, to check lat mobility, is going to be the seated wall test. So if you have the person sit up against the wall, back as flat as they possibly can, PVC pipe then in their hands, palms down, and reach up can they get their knuckles to the wall? If they can, have them then turn those palms up and reach again. And if they come up short of the wall, we can be confident that there is some lap mobility restrictions on board. Okay, that is going to be a situation where treating the shoulder and the lats are going to be a really great way to address the wrist pain, because that will then allow those elbows to come up higher, take stress off of what the wrist is going to have to take on. So if we can decrease stress at the wrist by increasing shoulder mobility, we are doing a good job bumping that wrist pain forward. That's going to address both the elbows high in the front rack position and oftentimes the stacked overhead position when people are going handstand pushups, handstand walking. So we can kind of knock out two birds with one stone by really looking at the lat mobility. Secondarily, we can also look at shoulder external rotation. Okay. Now this could be a mobility issue. This could also be an external rotator strength issue. Okay. But to check the rotation can have them in supine, bring them to this position and then passively rotate and see if they have that mobility to get into that external rotation. If they don't, if they can't access that external rotation in that 90-90 position, we are going to want to start working into that external rotation. That can be with some contract relax. We can do the classic PVC stretch where we work this way and try to warm that up ahead of time before they get into that front rack position. we can also work some like band work in this position working out again contract relax or have the band pulling here stretching out some of those internal rotators and then we can go x internal rotation and then we do eccentrics into external rotation with a band moving that direction that will help to open up some of that external rotation specifically in that front rack position. Okay, so what that will do then is again in that front rack, get us from instead of this position, it will get us more that position and more evenly distribute that weight across the wrist as opposed to it digging into one side or the other. SUMMARY So overall, If someone comes in with wrist pain, and specifically that wrist pain is happening when they're in a front rack position, when they're putting a bunch of weight on their hands from doing handstand walking, handstand pushups, go after and look at the wrist absolutely, but absolutely don't neglect looking up the chain and looking at shoulder mobility, shoulder strength. If they don't have adequate lat mobility to get their elbows through in a front rack position or full shoulder flexion in that position, look first at the lats. See if we can't gain some shoulder mobility from that soft tissue, really be able to get in and through that elbow, take off some of the stress from the wrist. If they have a hard time getting their hands outside of their shoulders and big chest there, start looking at do they have adequate shoulder external rotation, either mobility or strength to be able to maintain that position and again, decrease the stress from the wrist. If you don't hit that and they don't have that ability, you can treat the wrist all day long, but they are going to continue to just keep pissing that off because they don't have any way to overall decrease the stress that that wrist is taking on. Once we can find that root cause of why that wrist is taking on so much weight, then we can start increasing the tolerance to that wrist extension. So we can start mobilizing there, we can start adding back like a plate carry where we're working here, we can spin that in different ways, all of that, and we can then start working at the wrist. But if we don't clear the shoulder first, you're going to be fighting a losing battle overall, because we haven't addressed why that wrist is taking on so much weight and getting irritated in the first place. Okay, so I just want to keep keep y'all's heads involved as far as don't always get tunnel vision onto one joint, right? We always want to look up the chain and seeing if there is something going on that we might be missing. That's all I got for you for today. So again, just as a quick recap, someone coming in with wrist pain, specifically our barbell athletes going overhead, we really want to clear lap mobility and external rotation mobility at the shoulder and make sure that those things are clean so that we can decrease the stress being put on the wrist. If you want to catch extremity man My last minute plans that you can make it to there. Otherwise, we will be in Kent, Washington on July 13th and 14th or Hendersonville, Tennessee on July 20th and 21st. We hope to catch you out there. We have a ton of different, all of those exercises and techniques that I just talked about are in that extremity course and we go into them in much more depth. So we'd love to catch you out on the road. All right. Hope everyone had a great day. Thanks for listening.

OUTROHey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Episode 1751 - HEP for the new mom Jun 17, 2024

Show notes

Dr. Heather Salzer // #ICEPelvic // www.ptonice.com

In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Heather Salzer discusses tips for designing home exercise programs for newly postpartum moms, including removing barriers to movement, being smart with the structure of the HEP, and encouraging habit stacking.

Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog.

If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter!

EPISODE TRANSCRIPTION

INTRODUCTION Hey everyone, Alan here, Chief Operating Officer here at ICE. Before we get into today's episode, I'd like to introduce our sponsor, Jane, a clinic management software and EMR with a human touch. Whether you're switching your software or going paperless for the first time ever, the Jane team knows that the onboarding process can feel a little overwhelming. That's why with Jane, you don't just get software, you get a whole team. Including in every Jane subscription is their new award-winning customer support available by phone, email, or chat whenever you need it, even on Saturdays. You can also book a free account setup consultation to review your account and ensure that you feel confident about going live with your switch. And if you'd like some extra advice along the way, you can tap into a lovely community of practitioners, clinic owners, and front desk staff through Jane's community Facebook group. If you're interested in making the switch to Jane, head on over to jane.app.switch to book a one-on-one demo with a member of Jane's support team. Don't forget to mention code IcePT1MO at the time of sign up for a one month free grace period on your new Jane account.

HEATHER SALZER Good morning, PT on ICE Daily Show. I'm Dr. Heather Salzer and I'm here with the pelvic team at ICE. And today we are going to be talking all things home exercise plan for the new mom. I think this is an area where we can do better as clinicians. Oftentimes I hear, man, my postpartum population just really doesn't do a good job doing the exercises I give them. This is a group where they have a lot going on, right? So oftentimes we just assume, okay, well, they don't have time to add in these extra things. And that's where we're wrong. I think if we meet them where they're at and set them up for success, not only will they have small wins of being able to accomplish, that part of their rehab plan, but also we're going to see better results with our care plan from there. This is a topic that's very near and dear to my heart. In clinic, I treat about 70% pregnant and postpartum individuals, so I've had a lot of time to help these people figure out how can we best increase compliance and set them up for success with their exercises. Additionally, I am about four months postpartum with an adorable little daughter at home, but she certainly takes up a lot of my time. And so in the last few months, I've had some experience using some of these same tips and tricks that I use with my clients for myself to be able to get in some of my rehab as well. So this is a topic that's fresh on the mind for me. We're gonna divide this up into about four different sections of tips today. So we'll be talking about workout structure, removing barriers, habit stacking, and managing expectations and how you can use these areas to help set your clients up for success. Let's dive in.

WORKOUT STRUCTURE So first of all, workout structure. I am a huge fan of using time-based workouts or home exercise plans for this group. And the reason is then they know, man, I only have five minutes, but I can sneak that in right now. And so within that, I like to keep it 10 minutes or less. And if it's somebody who's wanting more, you can give them several segments of five minute or 10 minute things, but that way you at least know like, okay, let's at least try to get these five minutes in. So what does that look like? I will use a lot of remands, so rehab every minute on the minute, and set them up with maybe three exercises, and we'll do that two times through, or three times through, and so that gives them either a six minute or nine minute workout. Another thing in this postpartum population that I'm a big fan of is the Tabata, so 20 seconds on, 10 seconds off. One specific example of something I give people a lot is some variation of that hollow hold and Superman hold. I'll set this up, what this looks like is eight rounds, so four rounds of hollow hold, four rounds of Superman hold, and we'll do that for 20 seconds on, 10 seconds off, and you can scale it up or down. So maybe that hollow hold in the beginning is just lifting one leg and focusing on kind of finding that core tension. Maybe we're progressing it all the way to a hollow rock. Similarly with the Superman, we can lift just the arms, lift just the legs, and then talk them through what are the progressions across this. And then four rounds of each, flip-flop back and forth or do all four hollow, all four Superman, and in less than four minutes, like three minutes and 50 seconds, right, they'll get a really effective both core workout and some blood flow to that posterior chain, which can be both important areas with this group. If you're like, man, I don't know, Heather, I don't know if that's really enough of a workout, I challenge you to try it today and choose a level that feels difficult for you, wherever that may be along that spectrum, I bet by the end of four minutes, you're gonna be like, oh, yeah, okay, I can see how that could work. So using those time-based intervals can be huge in this group to help set them up for success when we're thinking about workout structure.

REMOVE BARRIERS TO MOVEMENT Second, we're gonna be worrying about removing any barriers to set them up for success for getting their workout done. A big piece of this can be equipment or space. So if all of their equipment is in their garage and they have a garage gym set up, but it's hard for them to hear their baby from the garage, they may be avoiding going in and using that space. So can they bring their dumbbells in, maybe just one set of them, program everything with one weight to start, and put them by the couch? Make that more accessible. Maybe we're using baby for weight instead. Little one doesn't want me to put her down. So instead, let's hold her. Let's see what we can do with that baby, using the baby for our weight instead. Another thing, if you're a new parent or have been around new parents at all, I'm sure you've heard the words tummy time. So I love utilizing this time that mom is going to be on the ground with her new baby as a way to get in some of our exercises as well. So we're kind of removing that barrier of like, all right, you're already going to be there. Let's set this up. So what this could look like is maybe we're working on some C-section scar tightness. So while baby's on the ground, working on baby's tummy time, mom can do the same. She can be down there doing some gentle Cobra stretching. Maybe we're taking that opportunity to slow down, take some deep breaths, get into happy baby, child's pose, do some side planks, get creative with it. What does your patient need? But tack it onto that time. And yeah, tummy time is a great opportunity to sneak that in. So really think about what's their setup at home? How can, like ask them, where do you envision yourself getting these things done? what will make space or what will make sense with your space and then work with them with that.

HABIT STACKING Number three is going to be habit stacking. So this ties a little bit into what we were just talking about tummy time, doing their exercises while they're already doing something that they're doing that day. I first kind of heard the term habit stack from James Clear's book, Atomic Habits. And I love this concept where we take something that we are already doing across the day, and then we add our new thing that we want to do on top of that, and it's gonna help increase our ability to get that new thing done because we already have established that other habit. So in the postpartum population, there is a lot of things that happen routinely across the day, and so let's take advantage of that, right? Tummy time was one example. Another example of something that I give a lot in clinic is when we're dealing with like shoulder tension, maybe we're spending a lot of time breast bottle feeding, holding baby, coming forwards, and I want just more blood flow to kind of open things up and get them moving across the day just to get them out of that position. We always say your next posture is your best posture, right? So Can we figure out where they're spending the most of their time nursing or bottle feeding or whatever that looks like? And can we set a heavy resistance band by that? And every time they do that, which is probably gonna be every one to three hours in the beginning, that's a lot of times, can we do some banded pull-aparts just to get increased blood flow to their shoulders, neck? with that. Maybe we're not doing this in the midnight feedings. Maybe we're just encouraging like 50% of them, but that's one example of how we can get that in. Some other things that I like are adding things on with diaper changes, another thing that's going to happen routinely. If you're wanting that person to work on kind of establishing connection with pelvic floor and you think that doing some pelvic floor contraction Kegel work is appropriate, you could time that with a diaper change. So every time you change a diaper, give me 10 to 20 pelvic floor lifts. Another example I'll use is every time you make coffee or go to heat up your coffee in the microwave because it's gotten cold and you are now heating it up for the third time to hopefully drink it, can you do a set of lunges or squats in the kitchen while you're making that coffee or heating it back up? Get creative, ask your clients what are you doing across the day And if I give you this to try to do on top of it, do you think you'll have the time and space for that? Use habit stacking to your advantage. Lastly, and I think most importantly, is managing expectations. These people need wins. They need to feel successful. And they need to know that it's okay if they're not hitting this every day. So I talk a lot with these people in this group about consistency over time. That if you miss a day, if you miss a week, if life gets in the way, let's talk about what happened where we weren't able to get to it, but also let's not worry about it too much. Let's jump back on it. Because in the longterm, over the next few months, if we can be doing this a couple times a week, even for five minutes, three to four times a week, we will see change. So first of all, just setting them up for success, knowing that they do not have to be perfect with it, but then also kind of managing how fast they expect to progress with how much time they're able to put in. Because in reality, if we are doing five minutes a day, four days a week, can we expect really quick progress? Maybe not. Again, I would argue the exercise that we're getting done is always better than the one that's not happening. However, let's talk about what our realistic expectations of what we're kind of what we expect out of it based on what we're putting in. And let's really help these people have these small wins, feel confident with it. And oftentimes what's going to happen is you give them like four or five minutes of something to do. They're able to be consistent with that. They come back feeling great because they were able to do what you asked them to. And maybe they're already starting to notice a little change in their ability to contract the core again or connect with those muscles. And they're gonna come back and they'll be like, okay, I want more. How can we carve out more time? How can we make this maybe a little bit longer? Okay, now I think I'm ready to add a little bit more weight. So get that win, and then you can stack on. Always meet them where they're at. If they want more from the beginning, great, go for it, give it to them. But also, have a conversation, figure out what that looks like, and then from there, really kind of help work with them to figure out what the best plan is. Awesome.

SUMMARY So in summary, we're thinking about our workout structure We are removing barriers to help them get it done. We're gonna give them opportunities to habit stack so that we can take advantage of the things that these moms are doing across their day already. And we're going to help them manage expectations, talking about consistency over time, and really setting them up for success. If you would like to learn more about working with this population, we would love for you to join us in one of our pelvic courses We have our next online cohort for level one starting July 8th. That's filling fast, so if you would like to get in on that, make sure you get grabbed your spot soon. And then we have two opportunities to join us on the road before long here. July 20th we will be in the Cincinnati area in Loveland, so jump on that course. And then we also have an L1 pelvic course or sorry, a live course July 27th in Laramie, Wyoming as well. So would love to see you online or on the road soon. And thank you for joining me here this morning. And I hope you have a lovely rest of your day. Happy Monday.

OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Episode 1750 - Femoral neck BSI Jun 14, 2024

Show notes

Dr. Megan Peach // #FitnessAthleteFriday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Endurance Athlete division leader Megan Peach discusses femoral neck bone stress injuries, including referral for diagnosis, potential treatment options, and rehabilitation & return to running. Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn from our Endurance Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTIONHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PT on ICE Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app slash switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at sign up to receive a one month free grace period on your new Jaina. MEGAN PEACH This is your PT on ICE, the daily show. brought to you by the Institute of Clinical Excellence. My name is Megan Peach. I am one of the lead faculty for Rehabilitation of the Injured Runner online and live. And today I'm gonna talk to you about, no surprises here, bone stress injuries. But specifically I wanna talk to you about femoral neck bone stress injuries and what to do once you expect that your patient has a possibility of even having a femoral neck bone stress injury. because sometimes that decision on what to do might be a little daunting. And so I'm going to present this information in a bit of an algorithm format. And I'm not the biggest fan of algorithms because our patients don't often fit perfectly into the algorithm boxes that we need them to fit in to in order to progress along that algorithm route. But this one I actually think makes a lot of sense and I think it's pretty straightforward so hopefully it will be helpful for you in your clinical decision-making process. So I'm also going to make some assumptions that you have already done your subjective exam, you've already done your objective exam as well, and you are ready to make some decisions and you've decided that your patient has potentially a femoral neck bone stress injury. Now that part is really important because if you are even suspecting a femoral neck bone stress injury, then you need to consider it a femoral neck bone stress injury until it's proven otherwise. And that's important because as physios, we can't tell if that's a high risk or a low risk femoral neck bone stress injury. All we know is that there's potential there and one, they're treated differently, but two, the high risk can progress on to be a more serious injury. And so it's really important that we treat them as femoral neck bone stress injuries until that condition is proven otherwise, or it's proven as a femoral neck bone stress injury, and then we can move on in that treatment algorithm. So once you have made that decision, this person sitting in front of me is potentially a femoral neck bone stress injury or has one. The first thing we're going to do is refer them out to an orthopedist. They need additional imaging. And again, that's because we really need to determine one, if this is a femoral neck bone stress injury, and two, if this is a high risk or low risk, because again, they're treated a little bit differently. And so that referral to the ortho is going to jumpstart that part of the process where they can then get additional imaging. MRI is the gold standard to diagnose bone stress injuries. You could also refer them to their primary care provider. Their primary care provider can certainly refer them for an MRI, but ultimately they're going to go and see an orthopedist. And so it's nice to just take out that middle appointment and you can always communicate this information to their primary care provider, especially if they were the ones that referred them to you in the first place. Okay, so all of the patients are going to start out with their referral to the ortho, and then hopefully go for an MRI. Now the results of the MRI are really important because they're going to dictate at what path in this algorithm they're going to take. So I'm gonna give you three different scenarios based on the results of this initial MRI. The first scenario is that the MRI is positive for only bone marrow edema. It is a femoral neck bone stress injury, but it's only bone marrow edema. There's no fracture line. So this patient is then going to do six weeks of non-weight-bearing. Kind of a bummer, a hard conversation to have, especially if there's no distinct fracture line, but they still need six weeks of non-weight-bearing to prevent further progression of this injury. After the six weeks, whether or not they get a follow-up MRI is really dictated by that orthopedist and their experiences. Typically they don't if it is bone marrow edema only, And so at this point, they would likely begin a weight-bearing progression. And that weight-bearing progression is going to be gradual, likely over the course of a couple of weeks. After they are able to weight-bear normally, they're going to then start into a normal walking program and a formal rehabilitation program. With that being said, during that six-week period of non-weight-bearing, certainly they could do formal physiotherapy, but you could also send them home with exercises they can do on their own to prevent atrophy, to maintain the strength that they do have and the muscle mass that they do have. That, of course, is a conversation between you and the patient and the orthopedist on where they want to spend their time, potentially money, potentially number of visits for physio, because you know they're going to need them once they start that weight-bearing progression. I'm not going to talk a lot about the details of that weight-bearing progression because I want to stick to this clinical decision algorithm, but in that weight-bearing progression, it would then work itself into also a return to sport progression as well, but that's where it starts. Okay, so to summarize that first scenario, you have your patient, You have differentially diagnosed them with a potential femoral neck bone stress injury. You referred them out to an orthopedist. They had an initial MRI, which was positive for bone marrow edema. Then they did six weeks of non-weight bearing, and then they progressed into a loading program to get them to load normally and walk normally, ultimately probably run normally, and get back into the sports and the activities that they want to do. Okay, so the second scenario, we're going back to that first MRI. They come in with their results. Their results say that they now have a stress fracture, okay? And so this is a totally different scenario than the first scenario with bone marrow edema only. Now, the location of a femoral neck stress fracture is really, really important because that's going to determine whether or not this is a high-risk or a low-risk bone stress injury. So if the fracture is on the underside of the femoral neck, it is deemed a compression-type fracture, and it is going to be more low-risk. If the fracture is on the superior aspect of the femoral neck, it is deemed a tension-type injury, and that is going to heal a lot more slowly with a lot more difficulty. It is deemed a high-risk bone stress injury, and it's treated very differently from the low-risk or compression type fracture. So the MRI is going to describe the location of that fracture as well as occasionally the severity. If that person presents with a compression type fracture, so on the underside of that femur, and it is 50% or less of the width of the femoral neck, they are going to then, surprise, do six weeks of non-weight bearing, okay? And so they have a fracture line, but we're still going to treat them conservatively in this scenario. After the six weeks of non-weight bearing, typically they will have a second MRI or follow-up imaging. Occasionally that can be x-ray if they were able to visualize the fracture line on an initial x-ray. So a follow-up image, and based on the results of the follow-up image, they're going to be filtered into basically three different paths again. And so if that follow-up image says that they are making good progress and healing, so maybe we don't see a line anymore, maybe there's callus, maybe there's less bony edema, then we're going to filter them back into that progressive weight-bearing approach. And so the same thing that we use for scenario one, they're going to do a progressive loading program into full weight-bearing and then walking and then running and then return to sport, et cetera. Okay, that is if they were asymptomatic and they demonstrate healing on that follow-up image. If the follow-up image does not show any progress, it doesn't show any regression, it's just kind of stagnant, or the patient is still symptomatic, they're still having symptoms in that hip. Now, granted, they haven't been weight-bearing for six weeks. they're going to restart that six weeks weight-bearing. It is a tough, tough conversation, and nobody likes it. Not you, not the orthopedist, certainly not the patient. They're going to start that process over again, and they're gonna start back at the top of that six weeks non-weight-bearing, and then they'll likely have a repeat image at the end of that second six weeks of non-weight-bearing. I should mention here that I keep saying six weeks non-weight-bearing It's a start and I think it's important to educate our patients on that. It is just a start very often they will go into Longer durations of time non weight-bearing in order to treat this condition Okay, so the third scenario after the second image the follow-up image is that there is a regression and so this is not based on symptoms it is only based on that second image and this now shows a progression in the injury, maybe the fracture line increased, maybe the edema increased, but there's been some basically like regression in the issue. And so, or progression in the injury, however you want to take it. And so with this situation, unfortunately, they've now become a surgical candidate and they will likely stay under the care of that orthopedist. Okay. So to summarize that second scenario, They have come into your clinic, you suspect a femoral neck bone stress injury, you refer them out to an orthopedist, they come back with a positive MRI for a fracture line, but that fracture line is less than 50% of the width of the femoral neck and it is on the compression side or the underside of that femoral neck. They then do six weeks of non-weight bearing. They get a follow-up image. Based on that follow-up image, they will either continue in a progressive loading program in formal rehabilitation, repeat the six weeks non-weight bearing, and then do another follow-up image, or go on to be a surgical candidate, depending on the results of that second image. Okay, our third scenario. They come back with their first MRI, and the results show, again, a fracture line. This fracture line, though, is one of two scenarios. It is either a fracture line on the superior aspect of that femoral neck, which is a high-risk, tension-tight bone stress injury, or that fracture line is on the compression side, or the underside of that femoral neck, and it is greater than 50% of the width of that femoral neck. Either of these two situations, unfortunately, are going to necessitate, likely, a surgical intervention. So an open reduction, internal fixation, to stabilize that fracture and make sure that it doesn't progress into a more severe injury. The type of that ORIF is obviously very dependent on that surgeon as is the weight-bearing status post-operatively. So some will do non-weight-bearing for an additional six weeks, Some will do partial weight-bearing and then some will do full weight-bearing immediately after surgery. It is obviously just up to that orthopedist. And so that third scenario is quite short compared to the others. Your patient came in, you suspect ephemeral neck bone stress injury, you refer them out to the orthopedist, they come back with the MRI results with a positive for either a fracture line on the underside of that femoral neck on the compression side that is greater than 50% of the width of that femoral neck, or they have a fracture line on the tension side, the superior aspect of that femoral neck. Either of those two situations are then going to necessitate some kind of surgical fixation for that injury. Obviously, that is always a discussion between you and that patient and the orthopedist and whatever team they have around them in terms of if surgery is the appropriate intervention for them. Obviously, this is just a basic algorithm and then to help guide some of these clinical decision-making processes. Okay, so the themes in this algorithm that I want to highlight are regardless of what that initial MRI says, basically all roads lead to six weeks non-weight bearing. It's kind of an unfortunate part of this injury is that we definitely don't want this to progress from a low risk to a high risk bone stress injury. That's the worst case scenario because if we can prevent that in any way, even if it means six weeks non-weight bearing, we have to do that. So any roads, maybe with the exception of that third scenario where it just leads to surgery, all of the other paths essentially lead to that six weeks non-weight-bearing. So just know that that might be in their future. The other thing is, is that any progression that we do formally as informal rehabilitation after they've done their six weeks non-weight-bearing and they've been basically released to physiotherapy or released to progress to walking or weight-bearing, all of the progression has to be asymptomatic. Any progression that is symptomatic, creating symptoms in that hip, it must be backtracked. And so if they are initiating weight bearing and they are symptomatic, they're likely going to have to backtrack into a few weeks of non-weight bearing again. Really hard conversation again, but it's necessary in order to really prevent progression of this injury for obvious reasons. So the two themes, six weeks non-wavering and any progression must be asymptomatic. SUMMARY All right, that is the content I have for you today. Just want to make a couple of mentions of our upcoming Rehab of the Injured on our online course. We are currently in the middle of our, our current cohort…

Full show notes at the publisher

Episode 1749 - Technology tip Thursday Jun 13, 2024

Show notes

Alan Fredendall // #LeadershipThursday // www.ptonice.com In today's episode of the PT on ICE Daily Show, ICE Chief Operating Officer Alan Fredendall discusses 5 tips to begin to get more comfortable with technology & improve your productivity Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everybody, Alan here, Chief Operating Officer at ICE. Thanks for listening to the PT on ICE Daily Show. Before we jump into today's episode, let's give a big shout out to our show sponsor, Jane. in online clinic management software and EMR. The Jane team understands that getting started with new software can be overwhelming, but they want you to know that you're not alone. To ensure the onboarding process goes smoothly, Jane offers free data imports, personalized calls to set up your account, and unlimited phone, email, and chat support. With a transparent monthly subscription, you'll never be locked into a contract with Jane. If you're interested in learning more about Jane or you want to book a personalized demo, head on over to jane.app.switch. And if you do decide to make the switch, don't forget to use our code ICEPT1MO at sign up to receive a one month free grace period on your new Jane account. ALAN FREDENDALL Good morning, P10i's Daily Show. Happy Thursday morning. Hope your day is off to a great start. My name is Alan. Happy to be your host today here on the PT on ICE Daily Show. It is Leadership Thursday. We talk all things practice management, small business, ownership, and leadership. Today we're going to be talking about a bunch of technology tips. Today is Thursday, though, which means it is Gut Check Thursday. We've been waiting to post this workout for a while. Our CEO, Jeff Moore, requested this a couple weeks ago. An interval workout every three minutes for five sets. You're gonna complete 50 double-unders, and then you're gonna hit a 400-meter run. Already, those of you that are less cardio-inclined are thinking, ooh, gonna skip that one. So our goal of that workout is obviously to get done before the three-minute mark so that we have some rest. So trying to get those double-unders ideally performed unbroken. and then completing a fast 400 meter run, trying to get done maybe between two to two and a half minutes so that we have 30 seconds to a minute of rest, and then really trying to hang on and be consistent and not let that building fatigue slow us down too much. We have a bunch of different scaling options over on our Instagram page. If you can't do double unders, if you don't have any equipment, a bunch of different options on how to modify that workout. So remember, if you participate in Gut Check Thursday, If you record a time lapse and you post it to your Instagram page and tag us, you are entered into a drawing to win a free lead from the front or be about it ice t-shirt. So don't forget, there's a little something in it for you for participating. So today, we're talking about technology tips. Now, especially for those of you that run your own practice, understanding technology is really important because it's going to let you do a lot of stuff on your own that's going to save you time, hopefully, and also save you money. In our brick by brick course we talk a lot about how important it is that we become as a profession, especially those of you who want to run your own practice and run your own business, become more comfortable with technology. The end goal of technology is that it lets us do more work in less time if we're doing it correctly and we understand the basics of technology and how that technology can help augment our back-end skills and our practice. Unfortunately, I would say as a profession, as a country, as a species, we are not very good at technology. And something to think about is that if you are 52 years of age or younger, you have theoretically had access to a computer your entire life. So very often we see folks say, Oh, I'm, I'm too old. Like I'm too old for technology. And then I find out that that person is like 42 years old and they've, they've been using a computer most of their life. And it's a lot like a car, right? You can understand how to drive a car, but not know how to fix a car, how to optimize driving your car. And it's possible for two truths to be present at the same time that you understand how to drive your car in a legal manner, in a safe manner, but also that you have no idea how your car works, how to fix it, maybe how to become a better driver, that sort of thing. And we see that same comparison with technology. THE IMPORTANCE OF TECHNOLOGY As practice owners, and even as clinicians, and maybe if you never have a goal of owning your own practice, we need to understand the expectations that the average consumer has around technology. 95% of Americans have high-speed internet access. That is almost everybody. 92% of Americans have a smartphone that connects to the internet, and 77% of Americans want to communicate digitally with their healthcare provider. They want to do self-service stuff, book their own appointments, pay their own bill online. They want to text instead of call or talk to you in person. They want to text or email. So understanding where we're at in 2024, we have a consumer base who has a really high expectation that not only are we going to understand technology, that we're going to be able to offer those services through our clinic. That folks can go to our website, book their appointment, text us a question about their homework, and maybe engage with us on an app. And we really, really need to become more technology forward if we're going to meet those expectations of our patients. Some folks are worried about artificial intelligence about robots. We always see these blog posts of our physical therapist going to be replaced by AI or robot. And if I've learned anything over the past 10 years or so, it's that people hate robots. We've certainly gone through our phases here at ice with chat bots and things like that. And overwhelmingly people want to talk to people So I don't think we need to be worried about being replaced as a profession. I do think you need to be worried about how somebody who understands technology better than you having an easier time running their practice with less expenses in a manner that is going to create a gap between you and them competitively. And technology can help you close that gap. So you'll find yourself working harder or paying somebody else to do this stuff for you. if you don't become more comfortable with this stuff. So today, I want to talk about five different tips that are really, I think, going to dramatically change your understanding of technology and really help dig away at that gap that you might be perceiving in productivity of are there programs, are there apps, are there software? that can help me be more organized and be more productive? The short answer is yes. So we're gonna talk about what is a computer, what are the parts of a computer that are important to understand as far as maybe purchasing a new piece of equipment, understanding how and why different pieces of software can help your practice, password keychain, things like Boomerang, which is an extension we'll talk about for your web browser, for your email, and how to do things like bookmark folders. WORK IS ALWAYS FASTER ON A COMPUTER THAN A PHONE So let's start with tip number one. This is tough for us to understand, especially those of you, you might be in your twenties maybe and you've had a smartphone your whole life. Computers, a laptop or desktop computer will always be faster than a cell phone. Not only will it be faster physically, what we call the hardware, it will run smoother, with the software, the pieces of technology, the graphical interface we interact with will be better, but you are able to type faster on a computer and overall be more productive on a computer than a phone. So phones are great for looking up the weather, getting directions to go to dinner, answering a short text message or something like that. But they're not great for a couple things. Number one, writing out long messages. You've all probably found yourself looking at a paper sent to you via Instagram messages or text message or something. You're thinking, gosh, not only is that going to take me forever to read, it's gonna take me forever to respond to on my phone, and you're not alone in that feeling. We've actually studied this, a really cool study, Palin and colleagues from 2019, looking at what is the speed difference between typing on your phone and typing on your computer, and finding that the slowest phone typer is only typing 13 words per minute, and the fastest computer typers are typing over 100 words per minute. that's a 615% speed difference. This paper going on to summarize that the average person is 25% slower trying to work on a phone versus a computer. So sometimes we're out and about, we don't have a computer with us, we don't have a way, even if we have our computer, to maybe get it connected to what we need to do and our phone is our only resort. But this first tip, if you have a computer near you and you're trying to do something on your phone, it's going to be a lot faster for a number of different reasons for you to just get on the computer so when in doubt switch to that computer you'll be amazed at how fast much faster you get relatively simple tasks done like answering a longer email like logging into a website or something like that so keep in mind that all pieces of technology are created first on a computer. They are optimized to work on a computer. Humans type faster on a computer. There are a number of different ways about why you'll be faster and you'll get more work done in less time if you can get on a computer versus trying to do everything on your phone. And that can be a big mindset shift for a lot of people thinking that phone is the best option or maybe the only option when they might literally have a computer within arm's reach. UNDERSTAND YOUR HARDWARE My second tip is understanding what is inside of your computer or phone can go a long way especially if you're making a new purchase to understand what makes a quote-unquote good versus a quote-unquote bad computer. Understanding we have four main components that matter that can change as far as hardware is concerned when you're looking at a new computer or phone. The processors or the central processing unit or CPU is one of them. The RAM, or the random access memory, is another. The video card, or what's sometimes called the graphical processing unit, or GPU. And then your hard drive, where things are actually stored. And so, understanding these components, understanding why usually more is better, is really important in having an actual computer or phone that can do the work you're asking of it. So the central processor, the processing unit of a computer, is running what's called operations per second. This is very similar to our brain. I love the comparison to our brain. The human brain is conducting one exaflop of operations per second. That's one billion billions every second. So a processor in a computer is a lot like nerve conduction velocity in your brain. Now compare that 1 billion billions to a fast modern desktop or laptop computer that's only processing about 36 billion operations per second. So 1 billion billions versus 36 billion. So human brain much faster, desktop computer not so much, but the only thing slower than a desktop or laptop computer is a phone. It's a myth that the phone in your pocket is the supercomputer that is equal to a desktop or laptop computer, and that's simply not true. Why? Size. Your laptop, your desktop can fit more stuff in it, and the stuff that it can fit is things like more processing units. So the iPhone 15 can only run 15 billion operations per second. So the average laptop or desktop computer can process two to two and a half times faster than your phone. So again, another argument to whenever possible switch from your phone to your computer. When you're shopping for a new laptop or desktop computer in 2024 we want to see 8 to 12 processing cores and we want to see each of those cores be able to process at least 3 gigahertz that's operations per second. So that is something you could find when you're looking to purchase a new computer. Often one of the first things you're shown is the brand of the processor, how many processing cores the computer has, and how fast each individual core is. Again, this is the case where more is better. The second most important hardware piece of a computer is the RAM, the random access memory. This is the thing that allows those processing cores to pull up data and begin to do operations on it. So I like the comparison to RAM is your brain's ability to multitask. It is your computer or your phone's ability to multitask. If you're somebody that keeps 700 tabs open in your web browser and you're always complaining about how slow your computer is, it stutters, it's slow, it freezes up, it locks up, it shuts down, it turns off, whatever, that is because you are asking your computer to multitask beyond its RAM's capability. Again, this is a case where more is better. More RAM, more multitask ability. In 2024, we want to see a computer have at least eight gigabytes, eight GBs of RAM or more. A really high-end desktop computer is going to have 32 to 64 gigabytes of RAM. You're going to be able to watch a TV show on one screen, process a video on the other, have a third monitor where you can still do email, and you're not going to really experience a slowdown. Vice versa, if you don't have that much RAM, you're not going to be able to multitask as much. So RAM is really important. The third component is a video card or that graphical processing unit. This is the piece of equipment that generates all those outputs from the processors and the RAMs into what you see on the screen, on your phone screen, on your laptop screen, on your computer monitors at home, on your desktop. Again, here more is better. Graphical processing units or video cards have processors and RAM built in them. Bigger is better. The more processing power your video card has, the quicker you're gonna do things like process and edit videos. So if you are someone that is doing a lot of video or audio editing, you're making content maybe for your clinic's blog or your clinic's social media, you want a computer that has a really nice video card. It's going to make it less work for your computer to do that. It's going to get it done faster. If you've ever tried to maybe render a video on an old computer, it can sometimes take hours. And during that time, it is consuming so much processing power from your computer, you often can't do much with that computer. It's slow, it freezes, whatever. You basically have to set it and leave it alone until the video is done. So if you find yourself doing…

Full show notes at the publisher

Episode 1748 - All the grief you cannot see Jun 12, 2024

Show notes

Dr. Christina Prevett // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult division leader Christina Prevett as she discusses experiencing loss, processing grief, and its impact on being a geriatric clinician. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTIONHey everyone, Alan here, Chief Operating Officer here at ICE. Before we get into today's episode, I'd like to introduce our sponsor, Jane, a clinic management software and EMR with a human touch. Whether you're switching your software or going paperless for the first time ever, the Jane team knows that the onboarding process can feel a little overwhelming. That's why with Jane, you don't just get software, you get a whole team. Including in every Jane subscription is their new award-winning customer support available by phone, email, or chat whenever you need it, even on Saturdays. You can also book a free account setup consultation to review your account and ensure that you feel confident about going live with your switch. And if you'd like some extra advice along the way, you can tap into a lovely community of practitioners, clinic owners, and front desk staff through Jane's community Facebook group. If you're interested in making the switch to Jane, head on over to jane.app.switch to book a one-on-one demo with a member of Jane's support team. Don't forget to mention code IcePT1MO at the time of sign up for a one month free grace period on your new Jane account. CHRISTINA PREVETT Hello everyone and welcome to the PT on ICE Daily Show. My name is Christina Prevett. I am one of the lead faculty within our geriatric division and today I want to talk a little bit about grief. This is kind of a personal conversation, but it's also one that I think is really important when we are working with older adults. So personally, I've kind of been speaking a little bit on my social media. I lost somebody very close to me very recently. So I lost my godmother. She was my aunt. She was in my top 10 list of favorite people and she was somebody who had battled cancer a long time ago. They found out a couple of weeks ago that she had a metastasis in her brain and her first radiation she didn't do very well and she passed away like very very suddenly. And to say that this rocked me, like, I don't know if I'm going to keep it together on this podcast. I'm going to try. But to say that this rocked me was like an understatement of the world. And it was devastating. I'm still not OK. And it made me think a lot about grief. So I am 34 years old. And over the last two and a half years, I have lost three people that are really close to me. I lost an uncle that was my dad's best friend, my aunt who was my mom's best friend, which means that they were around us all the time, and I lost my grandmother who I was really close to. And as I was reflecting on this most recent loss, which my aunt was probably the closest person that I have ever lost, I reflected a lot on the process of grief and I thought a lot about how my older adults must feel. And so it reminded me of a conversation that I had with my grandmother. So my grandmother passed away just shy, a month shy of her 98th birthday. She lived a very long life. Her husband was alive until he was 93. And she was just this incredible role model of successful aging. somebody who was able to keep cognitive capacities, physical capacities in the realm of what she wanted for a very long time. And I was having a heart-to-heart with her one time, and I'm sure many of you have had similar conversations with loved ones that have lived a long life. And I said, you know, Grandma, I want to be like you and live to 100, because at that time I was certain she was going to be a centurion. And she turned to me and she said, you don't really want to live to 100. And I asked her why, and she's like, because everybody around you is dead. And to be somebody at, I'm 34 years old, to have had this feeling of accumulated loss, I'm only starting to potentially scratch the surface of what she could possibly mean and what all of our or so many of our older adults may be experiencing in their life. And so while I feel the acute sting of losing somebody really close to me, what I'm also like really recognizing is that there's also a accumulation effect that weighs heavily on my heart around having multiple people that I've been really close to that have passed away. And if I am feeling that at 34, I can only imagine how many of my older adults are feeling when it comes to, you know, they've lost parents, all parents, both parents, their in-laws' parents. They may have lost siblings or, God forbid, kids. Like there's friends and family, like you know, there's jokes around how our older adults are one of their social calls is going to funerals because they experience loss around them so frequently. And I never truly appreciated, I think, how much of a toll that would take on an individual's soul and their experience in some of their zest for life until I felt like some of the accumulated effects over a relatively short amount of time of experiencing a significant amount of loss. what this got me to think about is the way that we interact with grief with our older adults. And when we, really as a culture, how we interact with grief. And so I had one of our TAs, Rachel Moore, she's one of our lead faculty for Pelvic. We were having conversations about this and she said, you know, it's so interesting because everything else just keeps going and you feel like you're stuck in this loop of, oh my gosh, this person has left. And it's true, right? We are with individuals in that short amount of time where we're doing funeral preparations and all those types of things, but that grief weighs heavily on a person's soul and on a person's mind. And we don't really teach individuals how to deal with grief. And when it comes to older adults, we oftentimes think that this is such a normal part of the aging process that I don't think we ever truly hold space for individuals when they are dealing with grief. And so when I was reading a book called Breaking the Age Code, this really came front of mind. So we talk at an MMOA about the psychosocial considerations of working with older adults, about how it can be so great for us to put a heavy deadlift in their hand or get them getting up off the floor for the first time in a decade. And all of those things are really wonderful. But if there are other buckets that are just leaking because they do not have the financial resources, the mental resources, or the skills in order to help with these big buckets that are truly just hemorrhaging, then we're not really gonna give them the best type of care. And when I was reading a book called Breaking the Age Code, it really came front of mind for me about this. where when we look at mental health disorders, and not to say that grief is not a very healthy expression of sadness, but Becca Levy, who wrote The Code Breaking the Age Code, she's the one that we talk about with all of our ageism literature. She wrote a section in this book, her book on mental health, and she talks a lot about how the knee-jerk reaction with our older adults is to give them anxiolytics and antidepressants, without truly leaning into grief and leaning into talk therapies and conservative cognitive behavioral therapies that can just be so, so beneficial when we're working with our older adults. And she described some literature where she actually said, you know, many of our older adults may do even better with talk therapies than some of our younger individuals do because they're creating that connection so intensely. are craving those skill sets that they need in order to make it through their day because their grief is so heavy and your grief doesn't just last for two weeks. And so I was reading, kind of thinking about all this and the weight of grief and the thoughts around grief and how this relates to our older adults and how personally this is relating to me. I started reading a book called The Collected Regrets of Clover and there was a couple of things that they really talked about that I think is helpful for the way that I'm approaching now or thinking about approaching conversations with some of my older adults that I am working with who are experiencing loss or who have disclosed to me that they have lost a lot of people that are close to them. This book is it's fiction. It is so beautiful. It talks about a woman who is a death doula who basically comes and supports individuals through the end of their life. Similar to how a postpartum doula would help a new baby come into the world or a pregnancy postpartum doula, a death doula helps people end their life and end their life on their terms. And they talk about how when we're thinking about grief, First, it's this large weight that is on their frame. And as time passes, that big backpack turns into a purse. And what she's saying is that your grief is always carried with you, but the weight of it becomes easier to carry with time. It never goes away, but we start to be able to function in some ways with it. And I think that's really such a powerful thing to speak to. And when we are working with our older adults, they may be holding a lot of purses. They may be carrying a lot of bags of loss in the non-literal sense that can create this expression of apathy or a lack of engagement, which can sometimes create this space where it may be hard for individuals to engage with us in rehab. sometimes being able to dig deep into some of those considerations and create resources for them can be one of the best things that we can do. And so in this book, she had this quote and I read it on my Instagram a couple of weeks ago, but I'm going to read it to you now. And then we're going to finish off this podcast with a couple of things that I'm thinking about as a geriatric clinician to recognize that there is a lot of grief with our people that we are working with that we cannot see that are influencing who they are and how they show up in the world. And so in this book, this was literally the fifth page in. So if you're a fiction reader, this is such a beautiful book, but they said the most important thing is never to look away from someone's pain, not just the physical pain of their body shutting down, which we see all the time in rehab, right? But the emotional pain of watching their life end while knowing they could have lived it better. Giving someone the chance to be seen at their most vulnerable is much more healing than any words. And it was my honor to do that, to look them in the eye and acknowledge their hurt, to let it exist undiluted, even when the sadness was overwhelming. And so to put this into the context of rehab, I think there's a couple of things that I can think of as a clinician. And the first is that physical vulnerability and emotional grief, they are challenging to navigate. And we want to recognize that not only are we working with individuals who have low physical reserve, but there is an emotional piece of recognizing the loss of physical capacities and the emotional load of the loss of people that love them and they loved. as they get older. So my dad is 67. He has lost his mom, his brother, his best friend, and another friend from school in the last two years. And he's like, this might be it for me. All these people that I planned my retirement with are no longer with me. And I don't want to go to the golf courses anymore. I don't want to engage in physical activity because the people that I wanted to engage in physical activity with are no longer there. diving deep into some of those conversations, we say at MMOA to get truly curious, but not only physically curious about the things that drive individuals, but emotionally curious about maybe some of the things that are holding them back. And I think that can be a really, really wonderful way to get into some of the barriers and recognize that it's a little bit more complicated than them just not wanting to engage in doing squats with us, right? And so that's kind of number one. Number two is it's heavy for us to be able to listen to things that are really sad, but we can have a very big role in trying to mend and heal some individuals who do not have somebody to talk to. We have a loneliness epidemic in our older adult spaces, really all over our generations, but that is compounded, that loneliness is compounded when the people that you are not lonely with have passed away. And so recognizing trying to create resources, whether that is resources within the community like seniors associations or gyms where individuals can connect and have new kinships, especially in the face of loss when they are ready to. is one way for us to create resources and networks. But additionally, having a person that you can refer that is a psychologist, a talk therapist, a psychiatrist too, but where the knee-jerk reaction isn't just prescribing medications. And I am not anti-medication, do not mishear me, but I think that the addition of, you know, our conservative side, we talk about how we are not anti-surgery, we are conservative management forward. Why are we not applying this same mindset when we are working with our older adults who are dealing with really heavy emotions and maybe have never been taught how to deal with grief? I am a parent who is trying to not hide, but make appropriate the work that, you know, of grief and grief processing with my five-year-old. And I am acutely aware of trying to teach her skills to manage sad emotions. But so many of our older adults don't, they don't have those skills. And so it's important for us to recognize some of those resources. And so where I'm going to challenge you all today is one, to lean into these conversations if you have them with some of your older adults. But two, is to do a quick Google search to see if you can find a talk therapist in your area that you could have in your referral network when these conversations do come up. And inevitably, if you're working in geriatrics, the concept of grief and loss will come up. I recognize that in the United States and in Canada, one of the hardest things is finding someone who's in network or taking Medicare and finding somebody who doesn't have a super long wait list. I totally recognize that. It may require a little bit of digging deeper and that can oftentimes be one of the biggest barriers for individuals seeking care through talk therapy and why our primary care physicians are leaning into med management. But sometimes, you know, the best thing we can do is try and find some providers, find individuals who work with older adults on the regular, and try and create those bridges and those connections when appropriate. All right, I hope you found that helpful. I kept it together pretty good, I think, considering all things considered. If you are looking to get into some of our olde…

Full show notes at the publisher

Episode 1747 - Expectation and tissue healing Jun 11, 2024

Show notes

Dr. Justin Dunaway // #ClinicalTuesday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Spine Management & Pain Division lead faculty Justin Dunaway discusses new research regarding patient expectation & tissue healing. Take a listen or check out our full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our Total Spine Thrust Manipulation or Persistent Pain Management courses, or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTIONHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PT on ICE Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at signup to receive a one-month free grace period on your new Jane account. JUSTIN DUNAWAY All right. Good morning, YouTube. Good morning, Instagram. Looks like the cameras are looking good. Okay, here we go, team. Welcome to PT on Ice, Clinical Tuesday. I am Justin Dunaway, lead faculty with Institute of Clinical Excellence. I teach in our Total Spine Thrust Manipulation courses and our eight-week Persistent Pain Comprehensive Management courses, which the newest cohort began this week. Still plenty of time to jump in if you're interested. Just coming back from a weekend in Bozeman, Montana, teaching Total Thrust at Excel PT with Jason London. Big shout out and thank you to that group for bringing me out. If you've never been to Bozeman, it's an absolutely beautiful town, totally worth your time to get out there and see it. All right, today's topic, expectation and tissue healing. This is an absolutely fascinating, fascinating study that came out in December of last year. I'd been on a bit of a hiatus from PT on ice, and when this study came out, I was super excited for the opportunity to jump back on the stage, and I knew that the first topic had to be talking about this stuff. So, I'm a bit of a nerd in the beliefs and expectations space. I think there's so much really cool evidence, some really cool, really intricate, fascinating studies that have been done. And we know that the way patients believe about their body, about tissue damage, what they know and understand about pain, and the expectations that can come from that can change pain, pain perception, motion, pain pressure threshold, all of that stuff. We know that patients' beliefs around interventions, they believe that this intervention can be helpful or harmful, they expect this intervention to help or hurt, will absolutely change their outcomes with that intervention. We have seen research that shows us that patients' beliefs aside, provider beliefs, If I believe in the intervention I'm about to give a patient, versus if I don't, that will change the outcomes of that intervention as well. We know that beliefs and expectations around exercise, when all things are held constant, when everything about the patients are held constant, when everything about exercise is held constant, we just look at beliefs, we know that beliefs around exercise as it relates to my job, how physical my job is. If I believe that my job is physical enough that it counts as exercise, it can actually have positive effects on blood pressure, resting heart rate, body composition, and weight. We know that when I think about my beliefs around exercise, it relates to my peers. All things being held equal, if I believe I exercise less than my peers, it actually has a negative effect longevity some really interesting cool research from Ellen Langer a handful of years ago but she took older adults put them in this this five-day retreat where where they set up the whole building to be like from 1952, all the shows for a certain month that year, all the pictures and the furniture and the magazines and news articles. And they were only allowed to talk about stuff from that year for five days. And then they had massive changes in all kinds of physiologic stuff. They had massive changes on disability and like six minute walk tests and things like that. And what's fascinating is they took a picture pre and post this five-day retreat and then had independent reviewers look at these pictures. And the independent reviewers rated the five-day post pictures as years younger than what they looked like when they went into the trial. So just incredible, fascinating stuff in the world of how powerful the mind-body connection is. Now there's this interesting new line of research that I just kinda stumbled on recently where the expectation variable that they start to play with is perceived time passage. So time is held constant, but in very creative ways they get patients to believe that more or less time has passed. One really interesting trial is they give subjects, they feed subjects, they measure blood glucose, they hold time constant, And then in some sessions, they make the subjects believe that more time has passed. Some subjects believe that less time has passed. And what you find is that blood glucose levels track better with perceived time passage than actual time passage. Another interesting trial is they took humans and they short sleep them, give them six hours of sleep and measure a bunch of cognitive tasks. And obviously you do worse when you're six hours asleep on cognitive tasks. But then in the second piece of that, they give you six hours of sleep but they make you believe that you got eight hours of sleep and a good night's sleep. And then that mitigates that and they actually do significantly better on those tasks. So that's kind of everything leading up to this point, but this study, and there's so much more, it's such a really cool body of literature in this space, but the study I want to talk about here came out in Nature, super well-respected journal, in December of last year, and it's called Physical Healing as a Function of Perceived Time, from Peter Engel and Ellen Langer. This is going to sound kind of nerdy because it is, but if researchers had baseball cards, I would have an Ellen Langer rookie card framed in my office. Her body of literature in this space over the last, since like 1970 to now, is just absolutely incredible and has really paved the way for everything about beliefs and expectations. So here's the premise of this study. And this study was mind-blowing. What they did is they brought subjects in. And subjects, they had three sessions. Each session was an hour long. Sat the subject down, put a cup on their forearm, just like a standard biofascial decompression therapy cup, put the cup on, gave it five pumps, left it on there pretty tight for 30 seconds, popped the cup off, took a picture immediately, and then had a timer on the wall for 28 minutes. At the end of the 28 minutes, took a second picture. And then during those 28 minutes, they had the subject, specific time intervals, rate their healing. Asked them a handful of questions, but this is basically about how much do you think it's healed, how red is it, how swollen is it, is it painful, blah, blah, blah. And then at the end of the 28 minutes, then they had just a random, unrelated task to kind of fill the rest of the hour. Like they watched TV and rated commercials and played a video game or things like that. So then the trial itself looked like this. When you came in, you were randomized into one of three scenarios. Scenario one, everything I just said, there's a 28-minute timer on the wall, pre and post, and they do the things. Scenario two, they come in, and there is a 14-minute timer on the wall. Now, they're in the room for 28 minutes, but the timer is altered, so it ticks down a bit slower. So even though I'm in here for 28 minutes, I believe I'm only in here for 14 minutes. Scenario three, timer on the wall. The timer is set for 56 minutes. Again, it's only 28 minutes long. It just ticks significantly faster. So at the end of that 28 minutes, I believe that I've spent 56 minutes in the room waiting by healing. Okay, so that's how the trial's set up. Really interesting way that they controlled for this, and they controlled for kind of the after-minute variables. I won't dive into that. But the outcomes, the outcomes are where it really gets neat. So the first piece of this outcome is not gonna be mind-blowing. The patients, or the subjects, when you've looked at their self-report of healing, what they believe happened is they looked at their arm each time, When they were in the 56-minute trial, when the timer ticks 56 minutes, even though it was only 28, they believed that more healing had taken place than when they were in the 28-minute room, and more healing took place in the 28-minute room than in the 14-minute room. I thought I was in the room longer. I feel like more healing occurred. Cool, but that's not mind-blowing. The mind-blowing piece is this. Those pre and post pictures, they sent those off to independent reviewers that didn't know anything about the trial. They just said, hey, take a look at these pairing of pictures and tell us which ones healed more, which ones kind of healed, which ones didn't heal nearly as much. And without a doubt, when looking at the pictures, the pictures that came from the 56-minute room, showed more healing than the pictures that came from the 28-minute rooms, and those showed more healing than the pictures that came from the 14-minute rooms. And again, remember that they were all 28 minutes. Every picture was taken pre and post 28 minutes. The only difference was how much time I perceived had passed. That is fascinating. What the conclusion of the trial was is basically that tissue healing Isn't just a function of time passage tissue healing time. That's still important, but that's not the only piece tissue healing is at least in part a function of Perceived time passage, but it's not really perceived time passage, right? It's it's me believing that more time had passed Really put me in a space where I believe that more healing has occurred and when I believed more healing occurred. I It did. Even though that was such a short trial, even though it was so acute, just believing in that space that my body was healing faster, it did. Now, this has massive implications in my head, from acute injuries through through tissue healing from surgeries. It doesn't matter if we're treating a patient that's got persistent 10-year centrally dominant pain, if I just rolled my ankle, if I was just in a car accident, if I just had an ACL reconstruction or anything along those lines. If tissue healing and tissue health is a piece of the puzzle, then my beliefs around my capacity for my tissues to heal or how quickly they're healing or what's going on in my body since that injury, that is gonna have a direct implication and direct effect on how quickly and how healthy those tissues can heal. I think that's the direction that this line of research is going. So what do we do with this information? What I'm not suggesting is that we start messing with the clocks in our clinic and bring people in for a 30 minute session, but make them feel like it was an hour or things like that. Although that's kind of interesting, right? And I think Dr. Langer, if you're listening, I think a really cool trial would be to take a whole bunch of humans Relatively untrained, you put them on a bike three times a week for the next six weeks at 30 minutes RPE of six, and a third of them believe they're on the bike for 15 minutes, a third believe they're on the bike for 30, a third believe they're on the bike for an hour, and I bet what you find is that the hour group outperforms everybody else. It's pretty fascinating, but… What I think that this means for us from a clinical perspective is that when we think about like patient education, we think about beliefs and expectations and things like that, we tend to focus on, importantly, but we tend to focus on teaching patients about pain. We tend to focus on trying to test, retest so they can show immediate improvements in the clinic. We try to get patients to kind of believe in the interventions that we're doing. But there's a space in the education, there's a space in whatever the patient's mindfulness practice is, there's a space in trying to get patients to really think about their tissue healing, thinking about their rate of tissue healing, thinking about the health of the stuff inside their body, and shifting that in a very positive direction. Because what Ellen showed us is that that is going to affect tissue healing. So at the end of the day, this is just another really cool facet of information in this mind-body connection space. And from a treatment perspective, we need to not just be thinking about having really good clinical reasoning, really good skills, and being able to really match the right intervention with the right hypothesis, with the right patient, things like that. But we've got to be thinking about the context in which our treatments occur. We've got to think a lot about where the patient's beliefs and expectations are about themselves, about their body, and the interactions they're having outside the clinic. The more work we can do to get the patient's mindset in a space that's positive, that's healthy, that is pro-healing, whether it's understanding pain, whether it's believing in the treatments we're about to do, whether it's really just understanding that they have a very, very powerful capacity for their tissues to heal and heal well and heal quickly. Those are the things that are really gonna drive outcomes forward. And I think that the novel piece of this study is that it's more than just about physiology, it's more than just about pain and pain perception. Now the belief piece also will actually affect, speed up, slow down the rate at which our tissues heal. Alright team, so again, absolutely mind-blowing study. Another really great piece of information, this mind-body connection. And thank you all for hanging out for the last 12 minutes. It was awesome to be back on the stage, chatting with you all. Hope to do it again very soon. Have an awesome day in the clinic. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content o…

Full show notes at the publisher

Episode 1746 - Pelvic workshop excellence Jun 10, 2024

Show notes

Dr. Shaelyn Sharbutt // #ICEPelvic // www.ptonice.com

In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Shaelyn Sharbutt makes her debut on the podcast, discussing how to execute a successful pelvic workshop geared toward coaches.

Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog.

Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter!

EPISODE TRANSCRIPTION

SHAELYN SHARBUTT What is up? Good morning and welcome to the PT on Ice daily show. My name is Dr. Shae Sharbutt and I am on faculty for the pelvic division here at ICE. Today we're going to talk a little bit about doing a workshop for local fitness professionals and coaches based around pelvic floor issues. So this is really important because so many of those people's clients will either put their memberships on pause or stop working out completely during this new phase of life. They're trying to navigate it. Maybe it's their first time being pregnant or their first time being postpartum. and they might not have a pelvic floor specialist friend or a good provider telling them that it's okay to do these things. They might have a really good relationship with their coaches and so this is going to be the first person they talk to about these things. CONTACTING THE GYM & PLANNING THE WORKSHOP So typically whenever I first start talking to a gym, I will contact the gym directly, either their gym manager or their gym owner or their head coach about the interest that they might have in a workshop like this. We can DM, we can email, and you might even have a close enough relationship to text these people, but it's really best if you can get a meeting face-to-face and build that relationship. This not only gets that gym owner or that head coach super excited about what you're going to tell them, but it also lets them see the value that you're going to bring the other coaches and their members. So whenever you go to have this sit-down conversation, it's best to be prepared. I always have a PowerPoint or a presentation to give to these coaches when I do these, and I'll bring that along to that meeting with that gym owner or head coach to kind of show them what to expect from this workshop. It helps them feel a little better prepared, know what kind of equipment I'll need before I teach their coaches, and how much space I'm going to take up. It's then important to make sure that they understand that it needs to be during a time when we don't have open gym going on and we don't have class times going on. Maybe see what time of the gym is the least busy and they can block off a schedule and say, hey guys, we're trying to get our coaches the best education we can. Please don't come to the gym from this time to this time this Sunday. Have them kind of plan that ahead for their members. And that way the coaches can focus everything on what you're saying and what you're teaching them. And then they're not distracted by gym members working out or maybe wanting to cue somebody's lift in a corner or what have you. KNOW THE GYM'S PAIN POINTS So whenever you're creating content for this workshop, you really need to think about what these people do. Are you going to a CrossFit gym? Are you working with contact sport athletes like in a martial arts gym or a jiu-jitsu gym? Is there going to be running involved? Are there gymnastics movements being educated? Are there heavy barbells that people are getting under. You really need to understand what these people are doing day in and day out to be able to educate their coaches on progressions and regressions. So this should really be a community that you're involved in and that you understand what they're doing and those coaches are going to respect you even more if you're involved. So from there, we want three main things for our pelvic floor workshops for these coaches. GIVE SOME PELVIC BACKGROUND The first thing is a little bit of background. Most people don't even know that they have a pelvic floor, let alone that they can struggle with issues with this area of their body. So give these coaches a little bit of background. Educate them on these muscles. It doesn't have to be a full-blown anatomy lecture. Nobody wants to sit through that except maybe a nerdy PT student. But make sure that you give them a little bit of background. Maybe you show them a couple photos of what the pelvic floor muscles look like. Maybe you whip out a model. But if you can relate that back to something they're familiar with, like hip structure, hip and glute muscles, core canister, maybe some abdominal muscles, that'll kind of relate it back to things that they cue day in and day out and are way more familiar with. From there you want to give a background also on symptoms that they might have their clients complaining about in the gym. So a lot of CrossFit coaches are going to understand that there are women who leak with double unders and running and lifting, but maybe educate them on some abdominal pain, maybe educate them heaviness in that vaginal region. Really make sure that they understand that these symptoms are not the same for everybody and that points of performance are most important and we'll get to that here in a second. But giving that background and giving some symptoms to look out for can be really helpful. GIVE GOOD DEMONSTRATIONS Part two of the pelvic floor workshop, you want to make sure that you give good demonstrations. So let's say for example, I'm in a CrossFit space and we're talking about pull-up regressions and progressions throughout pregnancy and postpartum. If I'm talking about a banded pull-up, I'm going to take out my band and I'm going to show them different variations of a banded pull-up. I'm going to show them what I like even more, a toe spot pull-up or a low bar pull-up. we're going to go over points of performance, we're going to talk about engaging the lats, we're going to talk about holding that nice hollow body position, and cues that we might give someone who has a baby in their belly, such as hug baby or pull baby close to your spine, and then have the coaches practice that with each other. So, demonstrations are super important. Have them watch you set it up. And from there, you want to have a discussion and get their minds thinking about when they would use these different variations. So, if we're going to stick on this pull-up progression example, let's say that we're talking about a workout being done in class FRAN. That's a great, easy example. So for those of you that don't know, FRAN is a 21-15-9 of thrusters and pull-ups. Let's say I give them an example like someone is five months pregnant. It's their first pregnancy. They're having some uncomfortable stretching on the abdominal region. They don't like it. They are really good at kipping at baseline, but doing that large kip is really bothering them. What kind of scale would you give them? Question these coaches, ask them these questions and get their brains thinking and have them think through some different variations that they would use. It's also important to teach these coaches and have them think about timeline. So you don't want the time domain for this pregnant or postpartum athlete to be vastly different than everybody else in class. So if she can't do strict pull-ups or it would take her forever to do strict pull-ups and this Fran workout is taking people in class five minutes or less, what variation could we give her? What rep scheme could we give her to give her the similar stimulus to the rest of class and make her feel involved? So having the coaches build this discussion with each other and get out of their comfort zone from their typical scaling options can be super fun and helpful. Also lets it be a little bit more active. From there, I typically get a million more questions about specific movements. So, be prepared to answer questions about rowing. Be prepared to answer questions about going upside down. Maybe they'll ask you about bench press. Not only laying on their back, but getting up from that bench press and not being uncomfortable. They're always going to ask about core exercises. So have things ready, have examples ready to go for more demonstrations, but really make it a discussion and that'll be a lot more fun and involved of a seminar. So, that's part two we covered. Part one being give a little bit of background. Part two being some good demonstrations and examples of class workouts. GET COACHES ACTIVE & INVOLVED Part three that you want to make sure you get is the coaches doing these things. Get them involved. Get them moving. We already talked about it a little bit with pull-ups But if we're talking impact progressions make every coach in there get their plate out and they're gonna do toe taps with you Make sure they're coaching each other through different breathing techniques under load and then from there on We're always talking about hashtag be about it here at ICE. Get a group workout going. Have everyone have to choose a variation that they normally wouldn't do, a scaled option that they normally wouldn't do. Some of our coaches are games athletes and they're fantastic coaches and they're fantastic athletes, but they've never had to do a toe spot pull up in their life. Have them practice toe spot pull-ups in a workout. It is hard. Have them practice that form. Have other coaches pick them apart, just like they would any of their other clients. That can be a super fun way for them to practice their coaching skills, but also feel what it's supposed to feel like. And then they can imagine, man, if I had a big old belly with a baby in it, how hard would this movement be? So that can be super fun as well. So lastly, you want to make sure that you feel comfortable being the subject matter expert. Don't be ashamed to refer to yourself as the expert in your field. You want to make sure these coaches have someone to ask, someone to talk to. someone to send their clients to that they don't feel comfortable modifying their workouts or they have more questions that are just out of their scope. It's okay to be the subject matter expert. It's okay to know what you're doing. I think sometimes we apologize for that and we just need to be confident and know that we're the person that they should refer to. We are the fitness forward professional and we are in it with them. We understand what these mamas want to do. So make sure you're cool with being the referral source for these coaches. SUMMARY Guys, thanks for listening. Our next cohort for level one, if you want to learn more from your pelvic crew, that is in July, and then that's selling out really fast. Make sure you also get signed up for level two if you've already done a level one. We're wrapping up a level one right now, so you know those people are going to hop on that level two as soon as they're done. They're all fired up. And then lastly, We have a live course in Cincy, Ohio. Get signed up for that as well. We love the live course. We go over in detail a lot of the variations of progressions and regressions I just discussed. So if you're not comfortable with that, sign up for that Cincy course. We can't wait to see you there. And if you need even more info, get on our pelvic newsletter. It is a blast and it is best practice. So that's sent out every month. We will talk to you guys soon.

Our TOPPODCAST Picks

Follow Us

Stay Connected

Related Podcasts

Links

Stay Connected