#PTonICE Podcast

Latest Episodes:

Episode 1664 - The fitness forward discharge Feb 14, 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 as he discusses what it looks like to discharge as a fitness-forward clinician. In this episode, we'll cover the do's & don'ts to discharging and even challenge the whole notion of discharge itself. 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 DUSTIN JONESWelcome y'all to the PT on Ice daily show. My name is Dustin Jones, one of the lead faculty within the older adult division. And today we are gonna be talking about the fitness forward discharge, the fitness forward discharge, how we can set our patients up for that fitness forward lifestyle once they leave our doors, all right? So before we dive into this conversation, I wanna start by really saying that the whole concept or notion of the discharge as we know it, traditionally, really needs to be challenged, right? The whole concept of, I'm gonna see this person for six to eight weeks, and then I'm gonna have no contact with that person whatsoever, and then cross my fingers and hope that that person will hopefully come back if they do have issues down the road, right? Hopefully, we see some of the issues with that. Hopefully, we can see the problem with bragging about how few visits it takes for you to get particular results, right? It's like we've created this badge of honor for how little that we're seeing people. And if you spend any time around the Institute of Clinical Excellence at any of our courses, you start to see what you have to offer people. Why in the world would someone like you, a fitness-forward trained clinician, want to be around someone less. You have so many valuable skills. You have such an amazing influence. Your be a valid approach, this fitness for lifestyle that you lead and can ultimately give to your patients. Why would you not want to rub shoulders with these folks that you can absolutely change their lives, right? So the whole notion of discharge, I really want to challenge. I think the Onward Physical Therapy crew is doing such a good job with this with their Restore and Perform program where they will have patients and they will transition to more of a maintenance type situation. I know many of you all watching have similar services where they may come off of quote-unquote physical therapy but you're still getting those touch points to change their lives. That is really, really good. What I want to speak to today in terms of the Fitness Forward Challenge is for many folks that are working with individuals and patients that do not partake in fitness, that these folks are not a part of a fitness community and you're going to work with this person and we need to set them up for success after your course of care. How do we handle those situations? I know for The vast majority of you all watching and listening, that is the case. I can say that for myself, definitely in the context of home health where I've spent most of my time. clinically, but now I'm on the other end of the equation where I am mainly in the fitness space at Stronger Life Fitness in Lexington, Kentucky. So I've really enjoyed experiencing what it's like to get people into our fitness community from different clinicians and what clinicians have done really well to set them up for success, but also what they've done really poorly that's made our job really difficult. And I think about all the folks that even come into our doors because of something that happened in that course of care. All right, so the fitness forward discharge for you clinicians that are working with folks that do not partake in fitness right now. We're gonna dive into some practical things. I want you to think of this in three steps. All right, number one is that we start with the end in mind. Number two is we prepare for what's ahead. And number three, we test the plan. All right, I'm gonna dive into some specifics. within those three chunks. START WITH THE END IN MIND So number one, starting with the end in mind. Many of us will hear this saying all the time, especially when you are in a more acute setting like acute care clinicians, right? As soon as they do their eval, they're planning their discharge, right? That is For many of them, the goal is that, all right, what's the discharge disposition so we can get this person to a place where they can receive care? And I think that's a good mindset for us to have across the continuum of healthcare. Discharge planning starts day one. Where is this person headed? where are we taking this individual? Now, for you all, the fitness forward clinician, the question that we often ask ourselves, but ultimately ask the patient or the client, is how fit will you let me get you, right? Betty comes to you for her back, her back pain, and we're gonna take care of that back pain for sure, but ultimately we don't wanna stop there, right? We change lives, not just pain. We're gonna see how fit we can get Betty ultimately in her one rep max living and help her live the fullest life that she can imagine right that goes beyond pain reduction techniques right so how fit will you let me get you now what is really important when we start thinking about the next step after our course of care when we're discharge planning and starting on day one we need to consider what this person is going to be willing to start and but then also sustain in terms of a fitness routine. What they're willing to start and then sustain. And I would say the latter is more important. It's easy to start something, it's tough to sustain it for months, years on end. So this is where we really need to spend a lot of time understanding this person's goals, their desires, their deep desires of what they want to be able to do. What keeps them up the night? What would they want to be doing if they had no pain whatsoever? And then match the fitness regimen that could ultimately make that happen, right? And with that, we have to consider so many factors, like personal preferences. past experiences, their perceptions of certain communities or fitness modalities. What's their financial situation? What do they have available to them to help offset some of the financial barriers? If someone is on Medicare or have a Medicare Advantage plan, there's lots of things available to help reduce the cost of fitness services. Where are they located, right? Location is such a huge variable in the adherence and consistency of an exercise program when someone is leaving their home to partake in fitness. It's a lot easier for someone to go around the corner as opposed to driving across town, right? And what social support, what resources does this person have? We need to take all of these into consideration and that is going to form our recommendation of where we are headed and we can set that out very early on in the process. So for the outpatient clinician, many of you all watching, many of you all are probably a part of some type of CrossFit community or CrossFit box, right? And you may be treating some patients in the outpatient setting where that transition may make a lot of sense. They may be familiar with it. They may not have a lot of baggage associated with that brand or that gym, that CrossFit box. And that transition can be relatively easy for you. And that's a no-brainer for many of you all. But for a lot of folks watching and listening, they have patients that are likely never going to step foot in a CrossFit gym. And I would go as far to say that CrossFit gym is not the best place to serve some folks, right? I know that's blasphemous on this podcast, but the local CrossFit box may not be suitable for every single person that you're working with as a physical therapist. So we need to understand, are there communities out there that can meet this person where they're at and help them make this a sustainable long-term fitness routine? and for the home health clinicians watching. Is there something that could be done for someone that is currently a homebound status? Is there some type of online community? Is there some type of online service or some type of YouTube channel, for example, that someone could partake in and consume that's going to be suitable for their situation? You cannot make these recommendations without truly understanding the person sitting in front of you. So we have to dig in. What are they willing to start and then what are they willing to sustain? Now, this is going to require some work, right? You need to know the communities out in your area, of the differences of them, of how some may be more suitable or welcoming to other groups of people. there's gonna be big differences there. You need to understand what services are available online to folks that may not be able to get out, what services are available that are willing to accept some of these Medicare Advantage plans or Silver Sneakers or Renew Active if they're on United Advantage, for example. So we need to do some work so you can make some of those recommendations. If you're like, what in the hell is he talking about? Hit me up or join the MMoA community where we have a lot of these discussions and we have a really helpful resource of where clinicians threw in some of their favorite YouTube channels, for example, and different resources that they help encourage that fitness-forward lifestyle beyond discharge. But there's options out there. We can do the hard work for you. Hit me up, DM me, and I'd love to share some of those resources. So that's the first one. Start with the end in mind. PREPARE FOR WHAT'S AHEAD Two, we prepare for what's ahead. So we start with the end in mind and then we prepare for what's ahead. When we start with the end in mind, we get a good idea of maybe what type of fitness regimen, what type of fitness community is gonna be good for this person so they can sustain and continue their health journey, right? If we understand what that community and that regimen is about, we can prepare that person for said regimen in our course of care. And I view this kind of like graded exposure. or gradual exposure, where we're gradually exposing people to elements of that fitness community or fitness regimen. Let's take CrossFit, for example. Let's say you have a patient that has never done CrossFit and they have agreed, yeah, I'm going to join that community down the street once we're done. That's really interesting to me. You can do that person a solid by exposing them to some of the CrossFit movements, of some of the movements that you're commonly going to see in the programming. getting a barbell in their hand, teaching them some of the basics of a squat, a deadlift, a press, and then maybe even getting to Olympic lifting. Expose them to those movements to reduce that new member suck, right? We've all experienced it. There are some benefits to the suckiness of being new and not knowing a lot about what's going on in the community. I do want to acknowledge that, but man, it's really nice if you come into a community having a little bit of familiarity with some of these movements and jargon and so on and so forth. So we want to gradually expose them to the movements that are going to be coming down the pike. We also want to expose them to the intensity that they're going to see. This can also be new for a lot of individuals, particularly going into something like a CrossFit gym or some high intensity interval training bootcamps type fitness community, that if these folks have not experienced true intensity, we can do that in the course of our care and expose them to that so they're not blindsided when they join this fitness community. We would also argue within the MOA division that you want to do that regardless to get better outcomes, keep in mind. But when we also think about that fitness forward discharge, this is really, really helpful to do. So gradual exposure to that intensity that they're likely going to experience and then gradual exposure to the movements that they're likely going to see. The beautiful thing about this is it reduces that new member suck when you're partaking of something for the first time. But for a lot of our folks, it often gives them trust in their bodies, that they can trust their body again. Think of what so many of these folks have been through, especially the older adult population that I particularly work with. We're talking decades of different healthcare interactions, maybe a dozen courses of care in the context of physical therapy, who knows how many surgeries, who knows how many diagnoses that were given without context, who knows how many damaging words have been said to this person where they believe that they are weak, fragile, slow, that they are broken pieces. We have the opportunity to show them that is not the case. That is not the case whatsoever. You can trust your body again and you can push your body again and your body can improve and get better and you can do things that you thought were absolutely impossible. You can show people that through this gradual exposure. So that's how we wanna prepare, that gradual exposure to intensity and movements. Number two, we also want to give people a plan to troubleshoot the difficult scenarios that are going to come up, right? Jeff Moore always says this, and I love this, where he will talk about the path to fitness is always gonna run through some musculoskeletal issues, right? And this is where we are such a huge service for individuals, that we, throughout our course of care, can give people a plan to be able to troubleshoot what is ahead, what is common, the question of hurt versus harm. When am I doing damage versus when a little bit of discomfort is okay? Maybe giving them something like the traffic light analogy where, you know, that zero to three out of 10 is kind of that green light. Still send it, you're good. But if that lingers on to, you know, that four, five, six range, that's kind of in the yellow. We need to start thinking about modifying. We're still moving, right? And then, you know, that seven, eight, nine, 10, where we're in kind of that red light, where we're thinking, still need to keep moving but I may need to go come back and see you physical therapist or PTA or whoever you are so that strategy of if this than that so they understand the difference between hurt versus harm and when they need to come back to see you can be very very helpful another one particularly in a population that's not used to exercising is DOMPS. For many of you all you don't even remember what it was like the first time you felt delayed onset muscle soreness if you've been exercising regularly but for someone new it's a very frightening thing when they do something that they perceive is going to be beneficial and helpful for them and then they try to get out of bed the next day or the day after and they're absolutely miserable. a lot of things can go in your head of what may not be helpful or be…

Full show notes at the publisher

Episode 1663 - Using palpation for differential diagnosis Feb 13, 2024

Show notes

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

In today's episode of the PT on ICE Daily Show, Extremity lead faculty Cody Gingerich discusses the importance of thorough palpation to rule in or out differential diagnosis during an objective exam.

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

CODY GINGERICH All right, good morning everybody and welcome to the PT on Ice daily show. My name is Cody Gingrich. I'm one of the lead faculty in the extremity division coming to you on a clinical Tuesday. So getting into it, what I want to talk about today is talking about palpation and using a good palpation exam in your objective exam for doing some differential diagnosis. We're going to talk about the upper extremity and the lower extremity and why doing a really solid palpation job in those areas, specifically when you're dealing with extremity management. is going to be super, super important when you're trying to differentiate, is this something that might be more of an extremity issue or is this potentially something that's coming more from the spine, okay? We're going to talk about different things that you might see from a subjective standpoint that might lead you to figuring out, not having a super clear picture on which of those two things it might be. UPPER EXTREMITY PALPATION So we're going to start in the upper extremity, okay? So things that you might see or hear, I guess, from your patient when you're doing your subjective exam. right? Numbness and tingling that comes down the arm that comes down lower than the, um, than the clavicle elbow, potentially even all the way into the hand. Okay. Anything noticing tingling. A lot of times when we hear numbness, tingling, we're immediately clued into, Oh, that might be a nervous system problem. That can be a cervical radiculopathy, all of those types of things. but then some of their other aggravating factors are going to be, right? Potentially sitting at a desk, if it's a more of a fitness athlete, pressing overhead, all of those type of things might bring out their symptoms. So if they're sitting, if they're driving, where they could be stressing the actual cervical spine, but they could also be very much stressing that posterior shoulder, okay? Another thing that I see all the time is anterior shoulder pain. Okay, anterior shoulder pain with a lot of pressing type of movements and a lot of times if you know someone's sleeping on that shoulder or whatever else, we need to figure out is that coming from that anterior shoulder, but also we get a lot of referral from the posterior shoulder that pings right to that anterior shoulder. Okay, so I want to talk about how then your palpation job is going to be most efficient in bringing out some of those symptoms. The number one thing is you have to have a system. You have to have a system to know when you're going, where you're going to be and how you get back to that spot every time and how you touch each and every muscle area on what you're trying to palpate. In the extremities, specifically posterior shoulder and posterior hip when we get to it, posterior lateral hip, you can actually hit all of those structures and feel good about where you are palpating is touching what you want to touch. In the spine and areas like that, there are so many layers of tissue, you can't really always say, like, I know what I'm on, but specifically in the back of the shoulder, you can say, I'm on infraspinatus, I'm on supraspinatus, I'm touching teres. All of those things can be very confident that you're hitting that. So where do you want to start? Inferior angle of the scapula. Then you work laterally. You know then when you work laterally and you come back to that inferior angle, you go thumb, thumb, and then you start here and then you work away again. Come back, thumb, thumb, thumb. Now you're three thumb widths up. Each time you're touching your thumb, like working and doing your palpation every time. Now the key with this is if you find a spot and your patient says, Ooh yeah, that's tender. You can't just say, oh great, and move on. You need to spend some time in that area and hold and sustain that pressure. If in this objective they said, well it takes sometimes half of the day in order to bring out my symptoms where I start to get that tingling, then four seconds of you palpating that area on the back of their shoulder is not going to be enough to bring out those symptoms. Maybe 30 seconds, maybe 40 seconds of you really sustaining pressure there is going to be necessary before maybe they start saying, Oh, you know what? It's not just tender there anymore. It's actually starting to creep a little bit here. That's when you can say, Oh, well, maybe that extremity management or that extremities focus is going to be where we need to be. And it's not as much in the cervical spine, right? So that's where you want to really pay attention to what you're doing. You don't always have to get symptoms all the way down the arm, because that may take a very long time for them to get those symptoms all the way down. But if it starts to creep, down the arm like this, you can be pretty confident. There's definitely something coming from that shoulder, that posterior shoulder, where it is relevant as opposed to the cervical spine. Same exact conversation. We're talking about anterior shoulder pain. We are really thinking a lot of times when someone says, Hey, yeah, it hurts right here. First clue might be like, Oh, that might be some biceps, uh, tendonitis, tendinopathy, something like that. But If you, and most people are going to be tender when you palpate right on that anterior shoulder. Note that, but also make sure you do that really solid palpation job on the backside of the shoulder and sustain some pressure. If they find some, if you find something that's tender, sustain that pressure very often. They're going to say, Oh, you know what? I actually do feel that in the front of the shoulder. Okay. Now we need to be hitting the back of the shoulder to treat the front of the shoulder. Okay. And that's where our differential diagnosis, that hypothesis list that we generate from the subjective exam pressing, right? You're like, Oh, okay. That's an anterior shoulder. Definitely a lot of heavy work for the anterior shoulder. But if we're pressing, if we're really working our elbows into that front rack or something like that, that post to your shoulder and that rotator cuff in the back is also getting a lot of work to get that hand on top of your elbow. Okay, so both things are relevant there. Those are going to be the two main things in the upper extremity that you're wanting to change that hypothesis list. Cervical spine, we're getting a lot of just numbness, tingling symptoms down the arm. Okay. If the cervical spine is not blipping a bunch of that stuff, check posterior cuff. Same thing with anterior shoulder. If they're saying anterior shoulder, I get that when I'm benching, when I'm pressing, when I'm whatever, palpate the back of the shoulder, make sure you're doing a good job sustaining pressure. This position right here is occluding blood flow to the back of the shoulder where we sit almost all day, just like this. We are now no longer giving the back of our shoulder a really good environment to allow blood flow and healing. Okay? And so if they're just tugging on those structures all day long, now all of a sudden sitting at a desk can bring out some of those symptoms. LOWER EXTREMITY PALPATION Shifting gears to the posterior lateral hip, very similar conversation. In extremity management, palpation can matter. You can be confident in what you are palpating to know that you're on the structures that you are trying to hit. Again, you want to have a system. There are two ways that you can really create your system. If you want to start at the greater trochanter and work your way superiorly, you can do that. And then each time, you know, I went immediately superior from this greater trochanter, we're hitting glute med, and then we are working and fanning away from the iliac crest. and we can work away that way to the posterior hip. So that way we can know we've hit glute med, we've hit glute min, we've hit glute max. You can also start from the PSIS and work your way more anteriorly and then down to the greater trochanter. Very similar in that you will probably need to sustain pressure. There are people that are going to be mostly tender there. If you find tender spots, sustain some pressure. if you have not sustained pressure for upwards of 30 to 45 seconds to at least see if symptoms have changed at all. And the question is, are you still feeling that right under my thumbs or has that started to creep anywhere? you'll get symptoms all the way down the leg. If we're trying to differentiate between lumbar radiculopathy, symptoms down the leg, into the calf, all the way into the foot, can be symptom generators coming from glute med, glute med. They can also be symptom generators of the spine. Okay, you have to get on those structures and see, is there anything creeping? Do you feel changes in your foot in your calf when I'm sustaining pressure on the muscle tissue? If you are on the muscle tissue, you can be pretty confident that that is not a back thing anymore, at least not fully. And you need to then have a good understanding of where am I? Can I then treat that out? We need to pump some blood to it. If we need to do dry needling, if we need to do some soft tissue and then work some strength, some blood perfusion type of exercises there. Okay. Also, hamstring type of things where people are not sure did I tweak a do I have like a high hamstring injury? Do I have more of a low back injury? That's another differential. When you're here and subjectively right sitting prolonged sitting is going to bring on these symptoms. Well, prolonged SIM sitting is stressing the lumbar spine, you are sitting in some lumbar flexion when you're sitting. The other thing that you're doing is you are occluding blood flow to that posterolateral hip at the same time. Okay, so both things can happen and then that can create irritation to the tissue. Very similar to this posture, any prolonged sitting can bring on that posterolateral occluding blood to that aorta and bring on tissue dysfunction. And that can create symptoms down the leg, again, hamstring, calf, foot, ankle, anything like that. COMBINING SUBJECTIVE & OBJECTIVE EXAMS Okay. So the big takeaways here are subjectively, these things are going to feel, you're going to have your hypothesis list, but you may not be like, they might be pretty equal when we're talking about the hypothesis list before you touch the objective exam. Then, same thing, when you're going through your objective exam, if you just do range of motion, if you do lumbar flexion range of motion, and that comes out, potentially you have stress lumbar flexion, yes, you are also tugging on your posterior lateral hip when you bend forward into flexion. Okay, so don't forget to make sure that you are ruling out that palpation and that lat posterior lateral hip in the hip, or that posterior shoulder when you're in the upper extremity, because those things might still be relevant. And you need to do a good job in palpating to make sure that you are clearing those areas and creating a really solid differential. because subjectively your hypothesis list is going to be very equal going into objective exam and not always with functional movements or range of motion. Are you going to really be able to bump one of those things up or down? But if you get into that palpation and say, you know, I've hit these areas and it wasn't maybe it was tender, but I sustained that pressure and I made sure I hit every single section because I was efficient and I was clean with where I was going each time and nothing really came out. then you can be pretty confident. Maybe it's not those tissues in the posterior shoulder or the posterolateral hip. Maybe we are looking more at the spine, okay? So that's really what I wanted to come on here and talk about today. In the extremity management division, we touch on that briefly when we're going through our objective exam, but I wanted to give a little bit more clarity today on what exactly you're looking for subjectively, and then how can you make a really clean objective palpation exam when you're trying to differentially diagnose. So that's what I wanted to come on here and touch on today. If you want to catch Extremity Management on the road here in the next couple weeks, we've got Lindsey on the road out in Carson City this weekend, so if you want to catch Mark or myself, both of us are on the road March 16th and 17th. I will be in Aiken, South Carolina. Mark will be in Spring, Texas. So we pretty much have West Coast to East Coast covered here over the next month or so. So jump into one of those courses. We'd love to see you out. And hopefully we will catch you all tomorrow on the iShow.

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 1662 - Breaking down the brace Feb 12, 2024

Show notes

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com

In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses the ins and outs of bracing and how to engage in conversations with fitness professionals to make sure we are all speaking the same language.

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, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today.

RACHEL MOORE Good morning, PT on ICE Daily Show. What is up? It is Monday morning. My name is Dr. Rachel Moore. I am here representing our pelvic division, hanging out today to chat with you guys about bracing. So really breaking down the brace, understanding this concept a little bit more, understanding maybe where some pitfalls are in our communication with our fitness professionals that we are working with. So diving into that, let's just get started. IS ALL BRACING INSTRUCTION THE SAME?The brace as a term is kind of like poorly defined. There's really an understanding maybe in the PT world of what the brace is and then maybe in the strength world of what the brace is. And oftentimes what we're seeing or what we're getting feedback from is maybe there's a disconnect between what we're teaching as PTs or being taught as PTs and what the fitness professionals in our communities are being taught. And we wanted to kind of break down where this comes from. So for one, a lot of times fitness professionals aren't necessarily ever truly like taught how to do a brace. The most common cue we hear in like the fitness professional space is brace like somebody is going to punch you in the belly or like somebody is going to hit you in the stomach. And a lot of times that kind of brings about, or people think that this means this push out and this push out. on the PT side of things is actually what we're trying to avoid. And so we get some feedback from students in our courses and that's actually kind of what inspired the topic today is we got an email from one of the students who had taken our courses who said that she was kind of hearing from fitness professionals in her community that the way she was teaching the brace wasn't correct. So what do we do with that conversation? How do we navigate that conversation with those fitness professionals? And how do we kind of get across that we're probably saying the same thing, but it's not coming across the same way. WHAT DOES IT MEAN TO BRACE? So first thing I want to do is really define what the brace is. And in order to define what the brace is, we have to define the component pieces of the core canister, which is what's involved in the brace. So when we're talking about our core canister, we're talking about a 360 degree canister that has a top and a bottom. The top of that is going to be our diaphragm. The bottom of that is going to be our pelvic floor. The front insides are our anterior abdominal wall. A lot of times people just say, oh, that's the transverse abdominal muscles. But in reality, we have to understand that that is more than just the transverse abs. That's actually all of the layers of the abdominal wall. and then the back is the spine and the muscles of the spine. When we talk about this brace, we want the canister to have equal pressure distributed around it and dissipate forces in an equalized manner, rather than maybe one side of the canister getting too much force, which then causes a leakage of pressure into a different direction. So when we're explaining the brace, or we're teaching the brace, We oftentimes teach it as tense your abs, or think about pulling your pelvic bones together. A cue that we use a ton over in the pelvic division with our pregnant athletes is if you have a baby, hug your baby, or if you can remember what it felt like to recently be pregnant, hug baby, that pull together of the abs. We are never queuing a push out because if we think about this canister, a push outwards is going to cause a mismatch of pressure within the inside of that canister. That's then going to come downwards through the pelvic floor. And oftentimes in the pelvic space can elicit pelvic floor symptoms like leakage, heaviness, or farting in the bottom of a squat or when we're lifting. so we expect that the pelvic floor is going to match the degree of abdominal brace we don't necessarily cue an intentional pelvic floor contraction when we're saying brace we might in our populations that are having issues with symptoms cue almost like an over correction because especially if there's somebody that's actually bearing down or pushing when they're bracing and not understanding that they're lengthening their pelvic floor rather than either staying at the same level or allowing their pelvic floor to match the demand of everything that's on top of it. So when we're cuing our brace, it is tense your abs, pelvic floor either stays the same or we slightly lift pelvic floor to match that pressure. That's how we teach that brace. THE CONFUSING NATURE OF THE WEIGHTLIFTING BELT The confusion I think comes in especially when we start talking about layering in a belt. So oftentimes in the strength training world, we see athletes busting out a belt and maybe they're using it all the time for every However, whatever the weight is on the bar, it's not necessarily just that they're heavier lifts or maybe they're reserving it for their heavier lifts. The key thing with the belt is that when we layer in the belt, the brace doesn't change. And that's something that I think we need to make sure our athletes and our coaches are understanding is that the belt is there to give us this extra support and really proprioceptive input to allow that increase in spinal stiffness to happen, but it is not a mechanism to push into. and I have my husband's belt. I left mine at the gym, so this isn't gonna fit me exactly right, but I wanna walk through the fit of the belt and where I think this confusion maybe comes from when we start talking about fitness professionals queuing a push-out. So with the belt, when we're talking about using a weightlifting belt, we want to think about, if you have YouTube or Instagram live up, I've got the belt here, and I'm just gonna kinda walk through the fit of the belt and what we're looking for. So when we are putting a weightlifting belt on, we're looking to fill that space in between our pelvis and our ribcage. If there's a little bit of overlap, that's totally fine, but we're kind of going like the top of the pelvis and that's my marker for where this belt is going to go. When I put my belt on, I'm going to put my belt on and as I tighten it, I want to fully exhale. I'm not like sucking in and shrinking and shriveling up as tiny as I can. I'm just doing a comfortable exhale. And then from there, I'm tightening. And in this tightening, I can breathe. I can talk. I can put a finger in between me and my belt, and I'm not uncomfortable. It's not squeezing me. If we have the fit of the belt correct, then that approximation that comes from inhaling i think is maybe what the confusion is coming from so if i have my belt on right i tightened it on my exhale as i do an inhale and i think about inhaling into my belly and into my spine that good solid 360 breath i feel my tissues push into that belt that is different than me intentionally pushing into the belt, that push your belly out sensation. If you're watching this live or listening to this later, put your hands on your belly and feel what happens when you push your stomach out. What do you feel at your pelvic floor? More than likely, it's a dropdown. If we think about tensing our core, Usually we don't feel much there. Maybe we feel a slight lift. And if we do feel a drop down, then we over correct and think about going up towards the basement to mitigate that. But the key here is the fit of the belt and understanding how to do that brace. So where does the confusion come in? When we're talking about our fitness professionals or maybe people who have never been trained in how to use a belt, the thought is to push out into the belt to create that contact with the belt. But if we have the belt fitting correctly, we don't need to do that push up. That's the biggest thing that I want you guys to understand and take away is it all comes back to the fit and making sure that we're using that belt correctly. Even without the belt, our brace stays the same, right? We're thinking inhale into belly, tense abs. It's never push out as if we're pushing our abdominal wall away. WORKING ALONGSIDE FITNESS PROFESSIONALS So when we're having these conversations with Fitness professionals or other coaches in our community who are maybe pushing back and saying like that's not how we teach our brace Really breaking this down and explaining to them where we're coming from and why. I think a lot of the time like we assume that everybody is just saying the opposite just for the sake of saying the opposite or maybe like they're just digging their heels in and there's no sense in educating them. But in reality like we have a lot of opportunity here to create bridges with these fitness professionals and create positive relationships. And we're not gonna do that by saying, well, you're wrong, or telling the athletes, well, your coach is wrong, just do it how I teach you. So using this as an opportunity to get in front of those coaches and those fitness professionals, and as a way to kind of bridge this relationship of, hey, you guys are coaching, I'm teaching your athletes, I would love to get on the same page, this is how I teach a brace, this is why. The goal here is to create equalized pressure across this core canister, If we push out in one direction or another, we put ourselves at risk of potentially having pressure leakage, quote unquote, out through that wall. It's also just not as strong. And at the end of the day, all of us are here to help people get stronger and move better. So if we think about this and conceptualize all of these walls of this castle being strong rather than one being broken or pushed out, then we can kind of understand that that applies into better, more efficient bracing mechanic, which then leads into better lifting and higher strength with our sets that we're working on, increasing our strength and capacity there. If this is confusing to you, I've got another podcast episode, episode 1577 of PT on Ice Daily Show that's all about the Valsalva, kind of breaks down a little bit more of the specifics of the Valsalva, which is that breath hold with the brace. The Valsalva can also have the belt, so we can have this spectrum of breathing. SUMMARY We really break down the spectrum of breathing in our live courses. Our live course is coming up in March. There are so many opportunities to catch the live course out on the road in March, y'all. March 2nd and 3rd in California, 9th and 10th in North Dakota, 23rd and 24th in South Carolina. So holy cow, so many opportunities to come hang out with us. Be on the lookout. Christina Prevett and I also did a clinical commentary that will be coming out in the spring 2024 edition. of the Journal of Pelvic Obstetric and Gynecologic Physiotherapy, so that should be coming out here pretty soon. We'll be blasting that all over the place when it does come out, but be on the lookout. Sign up for our pelvic newsletter, because that's gonna be one of the first places that drops, as well as on our hump day hustling. Thanks for joining me this morning, guys. I hope that cleared up some confusion. If you have any questions about bracing, or you're not sure how to explain it, or anything along those lines, please reach out, shoot me a message. I'm happy to chat with you more.

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 1661 - Long run: do's and dont's Feb 09, 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 how to help your athletes develop a healthy mindset around their longer runs, including progressing them gradually, running them intentionally slow, using them to practice for race day, and how they can translate to the race.

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

INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today.

RACHEL ELINA All right. Good morning, everyone. And welcome back to the PT on Ice Daily Show. My name is Rachel Salina, and I'm a TA with our Endurance Athlete Division. So I'm happy to be here on a Fitness Athlete Friday. to be able to talk to you about a running topic. So that's where we're going today. We're going to talk about the long run and specifically a couple do's and don'ts about that long run. And the reason I'm bringing this up is that in working with a lot of running groups and with running clients, there seems to be just this like, perception of the long run, right, that like long training run each week as just this like super utmost important, like the only important thing of a training cycle. And so I want to do this topic today to just kind of help us and help us help our patients and clients to kind of reshape their mindset. about the long run to have a healthy mindset of what it actually is and what it's not and how that can be utilized. So I'm going to keep it really simple. We've got two do's and we've got two don'ts. DO: USE LONG RUNS TO TEST YOUR RACE DAY PLANS Our first do is do use the long run to test your race day plan. All right, it gives us an opportunity to test out everything we want to actually use race day, whether that's clothing or food. And this is kind of where that advice, I guess, if you're a runner, you've probably heard this, or you maybe have said it to people, don't try anything new on race day. This is kind of speaking to that. There's value in that advice. So think about if you have your favorite pair of shorts and tank top that feels super comfortable for a one hour run, and you're planning to wear that on race day, but you've never worn it for longer than whatever, an hour and a half. Right? Maybe that same combination does not feel comfortable once it's like two hours saturated in sweat. And maybe it starts to chafe, but you wouldn't have known that if you didn't test it. Right? So you use the long run to test your clothing. That way, you know, either you need to change your clothing to something different or know how to like use body glide or something like that to prevent chafing. But it also gives your runners a chance to test their hydration and their nutrition strategy. So using that long run when the body's going to be working longer to see how do they feel with taking goos and chews and gels, like that kind of thing, like kind of fake food. Does their stomach and their gut tolerate that? If you haven't tested that before going into race day, like you can set yourself up for a not great situation with just not knowing how your body will respond. So can you, you know, have Can you test the fuel that you plan to use on race day? Can you test the clothing that you plan to use on race day? Are you comfortable carrying your water? Do you know what the aid stations at this race will have so that you can start to practice with what those products are? So do use the long run as a test for race day. DO: GRADUALLY PROGRESS LONG RUNS Our second do is do progress that long run gradually over a training cycle. So just like we have the 10% rule for kind of our overall progression of running volume, we can kind of think of the long run itself, like that one longer distance run in the week, following a similar pattern. And it doesn't necessarily have to be like stick to only 10% or always 10%, but just the idea that it should, as overall running volume is progressing, that's when that long run volume should also progress. So it wouldn't make sense if someone maybe starts out and one of the weeks they're doing a 10 mile long run because that's what they have time for. But the next week, like maybe they have vacation from work or they're on vacation, something like that. They have more time and they decide they're gonna go do 16 that week just because they can fit it in. We're not setting the body up in a great way to tolerate that longer stimulus if we haven't gradually built up to it. So what the actual number for the long run is will obviously depend on what distance of a race you're doing and what the experience of that runner is. But just using that concept of progressing it gradually as the training cycle is also progressing. DON'T: COUNT ON THE LONG RUN TO BE MAGIC For our first don't, don't count on the long run to be magic. And I think this is where a lot of the mind like kind of the unhealthy mindset is. We get it in our mind that like that's the only important run of a cycle of that week. Right. If nothing else, I need to get that long run in because that's what's going to make me more fit and better prepared for my race. But really the mileage there is the same importance as our mileage through the rest of the week. There's nothing different about it. Like it's still just mileage and time on the feet and giving the body time to make those adaptations to become a better runner. So we can get in a really sticky spot if, again, this is a situation like I know I've been in, I've heard from other people that when they're struggling with this, like think of the person that gets really busy during the week, okay? They're supposed to maybe have three or four like shorter or middle distance runs during the week. The week gets really busy, maybe kids were sick, there was an issue at work, like whatever combination of things that build up a lot, like, and make that person decide to not hit those kind of less important, um, weekday runs. And then, but the thought is they're like, Oh, well, it's okay. Like that stuff doesn't matter as much. I just have to hit this long run on the weekend and I'll be good. Like that's, what's going to get me prepared. But then we have this big gap rate of, well, even if you hit 15 miles over the weekend, but we missed. 10 miles during the week, like we're still not building and progressing in a way that's going to best prepare our bodies for that, that event. Um, just because we hit the long run mileage and we actually can set up for just a not great situation if all of our mileage is happening on like one specific day. So don't count on that long run to be magic, right? Or other runs or other volume are just as important. DON'T: RUN YOUR LONG RUNS TOO FAST And then our second, don't, right? Don't run the long run too fast. It's supposed to be longer, slower training, building those physiological adaptations, right? Our long run is not our race. If we race pace every single long run during training, right? We're not training, we're just racing those days. So keep long run, cases, moderate, conservative, right? You can work in some shorter intervals into a long run or maybe do some pickups as a strategy to test that pace when you are fatigued or encouraging your runners to do that. But in general, we wanna keep our faster running, our fast paces, interval work, tempo work on days separate from that long run stimulus, right? Keep each day distinct. Know what the intention is for that day. Explain to your patients what you want from that run, right? And leave the speed work, the fast work to a day when you can fully capitalize on that intention and on that work. Kind of a, maybe like a quick way to think of, is my long run too intense? Would be if you can get back to running again in within two days. If you do such a long distance run or it's so intense that you are just trash, like I cannot run again, I'm so sore, I'm so tired, I can't run for three days, right? Again, we're setting either ourselves up or our patients are setting themselves up to not hit the rest of their weekly volume because they're needing those extra recovery days because they push the long run too much. So keep it conservative. It should be something you can recover from and be back to running again within one to two days. So that's it. Super simple, right? Two do's. Do use the long run to test your race day plan. Do progress that run, that long run volume gradually over the training cycle. Don't count on the long run to be magic. Know what it can do and what it can't do. and then don't run that long run too fast. So that's it. Like I said, I hope you can use this personally or to help your clients kind of develop a better mindset about the long run and kind of how they view their whole training. SUMMARY If you are interested in working with runners or you already do and you wanna expand your knowledge, we have our next cohort of Rehabilitation of the Injured Runner Online is coming up March 5th. So registration is open for that on PTUNICE.com. You can jump in. And then our first live course will not be until June. It's June 1st and 2nd, just outside of Milwaukee. So we'd love to have you either online, live, both, either one. Feel free to jump into one of those. Otherwise, take advantage of the super warm weather we're having. It's odd, it's 60 degrees in Michigan right now. So go outside, get a run in, and have a great weekend. Thanks.

Episode 1660 - Cash, insurance, or hybrid: where's the magic? Feb 08, 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 current state of the insurance-based healthcare systems, alternative practice styles, and the "magic" behind building a sustainable practice. 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 everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. ALAN FREDENDALL All right, good morning, PT On ICE Daily Show. Happy Thursday morning, I hope your day is off to a great start. My name is Alan, I'm happy to be your host today. Currently have the pleasure of serving as our Chief Operating Officer here at Ice, and the Division Leader in our Fitness Athlete Division. It is Thursday, it is Leadership Thursday, that means it is also Gut Check Thursday. This week's Gut Check Thursday is another qualifier workout, so it's on the more aggressive end. So we have every four minutes for four sets. You're basically going to go through one workout of the Hero Workout DT. You're going to do 12 deadlifts. You're going to go 9 hang cleans. The caveat this week is that they're hang squat cleans. So they're going to take longer to cycle and they're definitely going to take more out of your legs than the traditional power clean we find in DT. Then you're going to finish with six shoulder to overhead. So for most folks, that's going to be a push jerk. The weight there is 155-105 on the barbell. Ideally, we're finishing one round of that complex in about two minutes. And then in any remaining time in that four-minute window, we're doing as many wall balls as we can. Guys are going to throw a 20-pound ball to a 10-foot target. Ladies, a 14-pound ball to a 9-foot target. The goal of that workout is to get through the barbell and get to the wall balls and accrue some wall balls. Great scores are going to be really anything above 50 reps. Exceeding 100, making your way towards 150 is definitely going to be an exceptional score. Modify the weight on that barbell, modify the reps if you need to make sure that you get off the barbell in about two minutes and that you have time for wall balls. There is no rest between sets, so keep that in mind as well. You probably don't want to be doing wall balls right until the whistle and need to turn and pick up that barbell without a break. You're probably going to want to allow yourself maybe 15 to 20 seconds of rest on the last set of wall balls and then go and pick up that barbell when the clock beeps. So have fun with that one. That's from a qualifier workout for a really awesome competition we have here in Michigan out on the west coast of Michigan out near Grand Rapids called Fresh Coast Fit Fest. Really fun CrossFit workout two day event on the beach. So some of our teams here from our gym at CrossFit and Fenton are going to be doing that. So have fun with that qualifier workout. THE CURRENT STATE OF THE PT INDUSTRY Today what are we talking about? We are talking about cash-based practice, insurance-based practice, or maybe in between what we call a hybrid-based practice, where is the magic? So today I want to make a couple points. I want to really have a candid discussion on insurance and really the physical therapy profession in general. I want to talk about what it means to open a sustainable and ethical practice. I want to talk about the down-low with payment methods and payment amounts as far as how much we get paid. and I want to talk about the concept that I call the golden rule of private practice. So let's start with that discussion on insurance. So Kaiser Foundation back in 2022 published that about 95% of Americans have health insurance. Why do I bring that up? I bring that up because if you only get information from social media, which unfortunately many folks now do, you might have this perception that cash-based therapy, cash-based medicine in general, concierge medicine, has taken off and that if you still accept insurance, you are somehow maybe 100 years behind what's currently happening. and it could not be further from the truth. Most Americans, most consumers have insurance. Again, 95% of people. So certainly while folks are getting more used to maybe their high deductible plan and that they do probably need to pay out of pocket for some or maybe all of their health care, Certainly that's not the case for everybody. In this idea, this mantra on social media that Americans have just rebelled against health insurance and none of them have it anymore and everybody is totally willing to pay cash for everything and you can charge whatever you want is the name of the game could not be further from the truth. In fact, 33% of Americans have Blue Cross Blue Shield PPO insurance which means they carry pretty nice insurance that they probably pay a lot of money for. So I say all that to say this, we need to be realistic that most of us will probably come and go from this profession before we really see a significant shift in how patients interact with the healthcare system, most notably from how they pay for their healthcare. Why does that matter? And why is that unlikely to change? I think looking at the state of the economy in general, again, if you get a lot of your news from social media, you may believe that the economy is on the edge of being destroyed at any minute. But again, that could not be further from the truth. We dodged the depression that was forecasted. The economy is at an all-time high. And that is shown if we look at insurance company profits. So let's go down this list. I love to look at data like this. Blue Cross Blue Shield last year, $457 billion. Almost half a trillion dollars. UnitedHealthcare right behind them, $414 billion. Anthem Blue Cross Blue Shield, so kind of a conglomerate of a bunch of different state Blue Cross Blue Shield associations, $109 billion. Cigna, that's a private commercial insurance, $76 billion. Humana is another private insurer, $55 billion. If we look at just the five largest health insurance providers in the country, they comprise 5% of the country's total GDP. All of the money that we essentially generate and spend across the span of a year. We also need to recognize as we've talked on here before that by 2030, 70% of Americans will be Medicare eligible. So if anything, what we see over time is that more people are carrying insurance, more people have nicer insurance, whether they're paying for that themselves or whether they're just being provided nicer insurance through their employer and that more and more Americans are also going to be carrying Medicare insurance as they turn 65 or whatever that age becomes over the next couple years. So why are we unlikely to see a significant shift in payment methodology in physical therapy or in health care in general? Look at all of that money, right? If we include all the other health insurers, we're looking about one-tenth of all of our money coming and being generated by health insurance providers. If we include what's being spent on health care, both through insurance and through private pay, that is beginning to comprise almost a quarter of our economy. What does that translate to practically? What can we glean from that? It really says that the chief product that the United States produces is sick, injured people in pain, and that our primary export is dealing with the subsequent secondary issues that come with a sedentary lifestyle that produces really sick people. So I think we're really unlikely to see things shift because a lot of people are making a lot of money either being on the health insurance side of the equation or being on the health care system side of the equation. And I think we are living in denial if we don't think that those giant companies that are making half a trillion dollars a year aren't making sure that some of that money goes to lobbying members of Congress to make sure that there are laws that require health insurance to make sure that we build brand new headquarters buildings that employ a lot of people where case adjusters and claims adjusters and all these folks that run a health insurance company can work and that that company can say to the government, look how many jobs we're creating. And when you really see that these companies are starting to take in nearing a trillion dollars, you recognize how much money is truly in this system. INSURANCE IS WEIRD & NEEDS TO CHANGE That being said, we need to be honest that insurance is totally weird. Health insurance is so weird. It is the most inefficient, weird thing that we probably do, right? We're used to having auto insurance. If you've ever had to make an auto insurance claim, you would probably say that by comparison to health insurance, it was a pretty easy process, right? If you've ever wrecked your car, somebody came out and probably said, Oh dude, that car is wrecked. Yeah, we're going to get you a new car. So we'll do some paperwork. And then you'll get a check and you can go get a new car, right? I just had a windshield crack. It was really cold here in Michigan. It was negative 20 degrees. Made a call. Somebody came out and said, yep, dude, your windshield is indeed cracked to the point where it's probably dangerous for you to be driving. Drop your car off here and in an hour somebody will fix your windshield. We don't see that smooth process with healthcare. We see a really weird process filled with a lot of paperwork, a lot of limitations on access to service, and otherwise, the health insurance company trying to hold on to the money that they're getting from patients. It would be totally weird to have insurance in a lot of the other things we do, right? Imagine you need to get your hair cut. I need to get my hair cut really bad. Imagine I go to get a haircut and they tell me, hey, your haircut insurance will only pay to cut half of your head today. You'll have to wait six months, and they'll cut the other half of your head. How impractical would that be? Yet, that's how healthcare insurance functions. So we need to acknowledge the dichotomy here. There's a lot of money in this system. It's probably not changing anytime soon. That being said, it's very weird and inefficient, and it's not working for a lot of people. So that being said, if this is the current state of our healthcare system, and our industry is physical therapists, how do we navigate this? NAME THE ENEMY We navigate this by naming the enemy, right? Corporate physical therapy with hundreds or thousands of locations, employing thousands or tens of thousands of therapists, overbilling patients, seeing multiple patients an hour, driving up that revenue for both their businesses and the health insurance companies, and really delivering low-quality care. We will never win against those folks one-on-one. We'll never be able to go toe-to-toe with them. If you missed Virtual Ice on Tuesday with Jeff Moore, our CEO, you missed a really good discussion on effortless clinical practice. And he really touched on the idea of the solution to high volume, low quality is not to try even more volume with even less quality. That is a losing game. We can certainly try the same strategy to win. What's probably going to happen is that It's not going to last very long, you're probably going to burn yourself out, and you're just going to become another clinic that gets bought up by one of those big chains. So we need to name that enemy, we need to recognize what's being provided, and we need to begin to chip away at them. We need to hit them where it counts, which is to take their patients away from them. How do we do that? We need to fundamentally understand and recognize and be comfortable with what an hour of our time is worth. WHAT IS AN HOUR OF YOUR TIME WORTH? This is something I heard many, many years now, almost a decade ago now from Zach Long, of no matter what you're doing, you should know what an hour of your time is worth and you should be trying to get that. It doesn't matter if you're treating a patient, it doesn't matter if you're doing back-end work, It doesn't matter if you're doing marketing for your clinic, you should be getting relatively the same amount per hour, and you should have a really good understanding of what an hour of your time is worth. Building upon that is how we build a successful, sustainable practice. We just crossed the halfway point in our most recent cohort of Brick by Brick, our practice management course, and this is something I really hammer on people with how to establish your practice, that before you launch, before you start seeing patients, Now is the time to make sure that you set your practice up so that you have a successful, sustainable practice because that is the only way that we're going to chip away at all of these high volume, low quality establishments in a way that we might actually turn this ship around. What's not going to work is doing the same thing of seeing and taking insurance that does not pay well, seeing two, three, four people an hour and getting stuck in the same volume trap that all of these clinics are already stuck in. $40 a visit is profitable if you see four of those visits per hour, right? We can't get caught up trying to fight fire with fire here. We need to go a different route. We need five high-quality, independent, private practices around every chain clinic to provide really quality service to take those patients away over time from the chain clinic and drive them out. And we need to replicate that across the country. The worst possible outcome of fighting fire with fire is that after a couple years, you decide that you're done and you sell your practice to one of those corporate chains, right? You become the enemy. you turn your practice into another version of something that already exists, the volume goes up, the quality goes down, you just become another cog in the machine. That is the worst possible outcome if you do not think about starting your practice sustainably. How do we do that? PAYMENT METHOD: THE PATIENT'S PROBLEM My third point is that it comes down to payment method. We need to understand and recognize that Some people want to use our insurance, but that some insurance simply doesn'…

Full show notes at the publisher

Episode 1659 - Taking the first step to change your Geri practice Feb 07, 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 discusses how it can feel very overwhelming when your practice looks very different then what you are exposed to in a course like Modern Management of the Older Adult. You don't need to change drastically overnight (though you can!) but we encourage you to take the first step. In today's episode, Christina takes you through 4 steps you can take TODAY, to level up 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 everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. CHRISTINA PREVETT Hello everybody 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 wanted to talk to you about something that we see a lot as we talk to clinicians across the country, across North America, sometimes internationally, about some of the barriers to implementing some of these exercise interventions that we know are so, so relevant and helpful to get our older adults as strong as possible, to give them as much reserve as possible. So when we go into different live courses, we have our two-day online, or we have our eight-week online course, we have our two-day live course. We talk to clinicians in the geriatric space who are in a lot of different practice settings, right? It's really great and really unique that one, we oftentimes have a multidisciplinary group. So we're seeing OTs, PTs, CODAs, PTAs. But then we also have a lot of people in the room who are in different practice settings. So in any course, we can have some people who are in acute care, in home health, in skilled nursing facilities, long-term care facilities, outpatient clinics, fitness. We kind of see this spectrum, right? And we know that with our older adults, that there is a spectrum. And in our courses, we try to speak to that spectrum. So we try to speak to the clinician who is working with really sick folks in the hospital, to the, person who's in fitness and is keeping older adults who are doing fairly well as active as they can into hopefully their 90s and 100s. But sometimes there can be these barriers that are maybe not to do with the client that you're seeing, but the clinician and the space at which the clinician is at in order for it to feel like an overwhelming barrier to get individuals to or to see some of the changes we know are going to lead to better outcomes. And this is not to cast any blame on the clinician, but to acknowledge that it is not just you working with the client, it's you working with the client within the system that is medicine and the system that is your employer. And it's something that we want to acknowledge. So I was at a course recently and I had a person come up to me and I just, I loved the vulnerability, but she said to me, you know, I am a worse clinician than I was five years ago. And she was, she's about five, six years out. And you know, I'm going to talk about what you can do today, but I want to acknowledge this first. And she said, I'm just so tired. And she wasn't saying it for, you know, sympathy. She was just wanting an acknowledgement that she knew that all of the things that we were talking about in this course were exactly what she needed to be doing. And yet all of the other stuff around the system that she was experiencing was making it so that she was exhausted and it made it hard to do the better thing, right? Because Seated Therax is not as cognitively demanding on us as clinicians. The safety profile is oftentimes a lot lower, is a lot lower, even if the returns are not as good. And I first, before we start talking about ways that we can start leveling up our therapy practice, like what is the next step that we can take? If this story is resonating with you, what I want you to do is know that we see you. We see how hard clinicians are working. We see how hard it can be to push back against a narrative that has been, you know, kind of placed into our system that makes it so that there are barriers that are systems and administrative barriers that make, you know, leveling up in geriatrics be difficult to do. It is especially difficult if you are the one trying to push against this and everybody else in your practice is not. And so I first want to just acknowledge you and say, you know, I'm going to start trying to give some practical tips around ways that you can take that next step. But if your biggest barrier is where you are at from a headspace perspective or where you are at from a cultural perspective, just know that I acknowledge that where you are. and maybe some of that reflection will help work towards, you know, I don't know what that next step is for you to try and help get you out of that burnout or out of that exhaustion state, but it may be your biggest hurdle when it comes to leveling up in the geriatric space. So I wanted to acknowledge that first. "WHERE DO I START?" Okay, so the next step is I have no idea where to start. and I have no idea what to do. And so where I want all of you to start, and this is gonna be my challenge for you for the rest of the week, is do one thing different. level up in one thing. So when people come and take our course, they think, okay, now everything that I do has to be different. And that would be like taking you and you eat fast food six times a day or six times a week and you don't exercise at all and you're not sleeping and you're over caffeinated and you don't know what water is. And then you say, okay, I'm going to go and I'm going to eat super clean. I'm never going to have any fast food ever again. I'm just going to drink water. I'm going to kick out caffeine and I'm going to exercise 150 minutes. of aerobic and two times a week of strength training. I love that goal for you, but we wanna make it so that it makes what seems impossible possible. And we're gonna start taking these little steps, right? So we talk a lot in MMA about graded exposure and acknowledging that process when it comes to our patients, but we acknowledge that that practice change also takes time. And if this is not an area where you are focusing with respect to intensity, and this is particularly true in the resistance training space, just know that we don't need to drastically change. LAYER IN STANDING EXERCISES We need to take the next step. And so what can that be? Let's go through three examples of what that can look like. So you have a patient who is coming in and you have been doing predominantly seated exercise. and this is no shame at all. This is where you are at with this person. They are tired, their joints are irritable, and you know that you're gonna have to do a lot of pressing to get that session to be mostly in standing. Great. I want you to get them standing for one. If that's one exercise, that's one set. If you are doing long arc quad, change that to a standing terminal knee extension with a band around the rig or around a doorknob or around the high-low table that allows them to do that exercise in standing. So the one next step can be is to choose one person on your caseload where the easier choice was to do the seated option, but you're going to get them to do the standing option. So that's taking the step Here, that was number one. START USING AMRAP SETS Number two, if you are a person who has had trouble finding a quantifiable baseline assessment of strength. And this is so many people in our profession, like we ask all the time, like how many people take a kind of estimated strength measurement before they prescribe strength exercise? And most people are saying, well, shoot, I don't really do that. And it was a big growth area for me too. So the first opportunity for leveling up, today in your geriatric practice is to get a person who you would have chose a seated option, but you're going to try and get them into standing for at least one set. The second one is going to be to pick one exercise for one person and do an AMRAP set. So we talk about using estimated 100 maxes. So an AMRAP set is as many repetitions as possible. We can use it for a quantifiable baseline amount of strength, You're going to choose a weight that you think individuals can do for 10 repetitions or less because there's a cardiovascular component if we're over 10, if you've ever lifted heavy weights for more than 10 reps, you know what I'm talking about. And I want you to put an AMRAP set in today. So that's number two. Number three is you take one person's session and you get an objective measure for every set. So this is my number three. So one is get a person in standing if we want to have them sitting even though we know they can stand. Number two is getting an AMRAP set to try and find a quantifiable baseline amount of strength. BEGIN TO OBJECTIVELY QUANTITY EFFORT WITH RPE And three is to find a rate using a rating of perceived exertion, an RPE, for each exercise. and try and get individuals in that moderate sweet spot between five and seven. Hey, if you want to push them up to 10, I'm here for it. But if we are trying to take the first step to level up, what we want to make sure is that we are asking our patients, how hard do you think this is? And some people are going to say it's hard because they're tired. Some people are going to say it's hard because of pain. or some people are going to say it's hard because it's effortful, and effort is the name of the game, right? Effort when we're bumping up against pain can be that we're kind of toggling in this wiggle room between this increase in pain and how long it takes for their pain to come down to baseline. It can be exertional effort, but effort is the currency that we are looking at when it comes to all of our rehab interventions. And so the step that I want you all to take is to take a rate of perceived exertion for every exercise. So if they are doing clams, if they are doing bed mobility, I wanna say how hard do you think that was on a scale of one to 10? Or was it easy, medium, or hard? And you want them at least in the medium. There are so many times where I think that I am hitting the right mark when it comes to intensity for my older adults, and then I ask them, and they're like, oh, it's like a three. And I was like, well, dang. Linda, I'm going to switch this weight for you." And we end up taking the weight and putting it higher. Of course, your clients learn that and they'll look at you and you'll ask and they'll say, eight. And I was like, I don't believe you. That's not an eight. And you switch that exercise out. But giving you a rating of perceived exertion, one, that's something that you can document to make sure that you're getting that intensity, is a great way for you to be able to level up your Jerry game today. Okay, I know I said three, but I'm gonna give you four. BEGIN TO MEASURE REST INTERVALS The fourth one that you can do, and then I'll kind of go through all of them again, is to record your rest. Oftentimes we do our sets and then we kind of wait and we wave a little bit and we think, oh, well, I'm getting bored or they're getting bored or they're finished with the story. Okay, we'll start the next set. And we have no idea what that intensity looks like if they are resting for 30 seconds versus 90. If you are working with an individual with a high enough amount of load, they should need that full minute to recover. And so if we don't Check how much rest they're getting it can be really difficult for us to know if we're hitting the mark again with intensity So I gave you a bonus one So I'll do three plus bonus that I didn't lie to you at the beginning of this session About or this podcast about what our ways for us to level up our Jerry game So let's bring this around full circle the first thing is I want to acknowledge you if the hardest part about leveling up your Jerry game is because of the mental state that you are in right now if that is because of your job if that is because of family stress if that has become because of work culture expectations that make it difficult. I want to first acknowledge that and where you are. And know that sometimes if you are sitting at a 40% baseline, your cognitive reserve, and you're giving 40%, then you're giving 100% of the effort that you have available right now. And I want that acknowledged. And I know that it's not just simple as like, let's just change these one things for individuals who are kind of in the throes of some of those difficulties. If you are able to get through and try one thing different today, I gave four options, right? So doing that AMRAP set, getting a person doing an exercise in standing that we probably would have biased towards sitting, taking a rating of perceived exertion for every exercise in a session, or measuring rest, putting a clock on in the background and having it roll up and just kind of getting an idea of how much rest individuals are taking. You'd be surprised how much of our exercises, our interventions are gone because of us taking longer rest intervals than are probably necessary. SUMMARY All right, if you want to learn more of these level up steps, you can hit us up at MMOA Live. In two weeks on the 17th, 18th, I'm in Oklahoma City, Oklahoma with Sam. It's going to be such a fun course. On the 23rd, 24th, We are in Gales Ferry, Connecticut. We actually also have a sold out course right now in Rochester on that same weekend, which is super exciting. I love when we see these big crowds. But Alex is going to be in Gales Ferry. And then March 2nd and 3rd, we are in Rome, Georgia and Sparks Glencoe, Maryland. So if you are looking to find us on the road, if you want to figure out all these level up techniques, That is the place to do it. It is two days. It is so fun. You get to hang out with us and our crew. Maybe we can give you that little boost of motivation that you need to take that first step forward. And we would love to be that little bit of a motivation boost and a culture for you if you are struggling right now with different aspects that are outside of…

Full show notes at the publisher

Episode 1658 - How to market dry needling Feb 06, 2024

Show notes

Dr. Paul Killoren // #ClinicalTuesday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Dry Needling division leader Paul Killoren takes a deep dive into how dry needling has been traditionally marketed and offers some tips to improve your marketing via your website & social media to demystify dry needling in a manner that results in more patients choosing your clinic for treatment. 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 our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling. EPISODE TRANSCRIPTIONINTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. PAUL KILLOREN Good morning team. This is the PT on Ice daily show and I am broadcasting worldwide from my hometown of Appleton, Wisconsin. My name is Paul Killoren. I'm the current division lead for dry needling for ice. We just wrapped up a banger, an awesome group in Milwaukee last weekend. I am from Wisconsin, so wife, kiddo came with me and we drove up to Appleton, which is my hometown. So I am broadcasting from Appleton from my father's office. The childhood nostalgic vibes are strong. I've been in Wisconsin for a week, so you might hear some accent come out of me like, oh, you know, here we are in Wisconsin but wanted to grab this PT on ICE slot to jump on today and discuss how to market dry needling and even kind of how to market dry needling 2.0 maybe even differently than the other dry needling out there. DRY NEEDLING MARKETING 1.0 So I'm gonna be quick this morning, but picture with me, and this shouldn't be hard to picture because almost any website, almost any social media post, if it's a clinic, state to state across the country, here's our list of services, manual therapy, BFR, dry needling, when you click on that dry needling tab, it jumps you to a page, what is dry needling? And that's the page I wanna discuss this morning. Because here is what 90% of those pages start with and look like. Dry needling is a technique that uses a monofilament needle. And from there, I mean, first of all, from there, most narratives, most websites, most explanations of dry needling still kind of go into trigger point-ish theories. So I'm going to give a few tips today. One of them is, is not to go down there, but, and if you've taken a course from us, you get that, that influence that we have better explanations, better narratives to how we do the technique, but what the benefits of dry needling are. But first I want you to picture that snapshot of you've jumped over that dry dealing page on a website. Before I get into the actual explanation, the content of the page, let's just talk how that page should be designed. Because we are in the social media, the Google web page realm where we're trying to get a three second impression to that patient. Everything we know now is that that patient is not necessarily going to spend two to five minutes reading one, two, three paragraphs about dry needling. So really we have above that scroll line, above that page to capture their attention, I mean make it visually appealing, but also give them enough info that either we answered their general question or intrigued them enough to keep scrolling down. MAKE DRY NEEDLING MORE VISUALLY APPEALING So what is dry needling? Before I get into the content, this page. should be visually appealing. I mean, it should fit your website for sure. But here, when I say visually appealing, we have that main homepage. I think a good half or third of it, so large enough to be visible, central, and appealing, should be a video or a picture of dry needling. And here's where I'll say 90% of the webpages out there have a pretty generic stock photo of, you know, maybe a hand, maybe a hand without a glove, gently placing a needle. And I get it, we're using Canva, we're pulling from Shutterstock, we're using generic stock photo libraries for this. First, I think we could admit the stock photo libraries are getting better. So if you created your webpage years ago, there are more dry needling specific images out there to use for this webpage. So if you're not going to have photography of yourself, which first of all I think is a nice touch to have you with a patient doing the technique, but if we're gonna use a substantial portion of this above the scroll line presence on the what is dry needling page, make it a nice looking photo and make it dry needling looking versus acupuncture looking. I know from a still photo there's arguments that you can't tell, but find an image of a clinician using a glove. Find an image of, you know, a more assertive tissue grasp where it looks like the dry needling technique that we're going to do in the clinic. If you use electrical stimulation, find a nice image of a needle with the clip attached, or you the clinician or a clinician using e-stim with dry needling. So make it visually appealing and make that image or video informative. Again, if we only have this small footprint on a webpage or three seconds to grab someone's attention, or really answer their questions. Like, oh yeah, I've kind of heard about dry needling. They click over to your what is dry needling page. That image, that video should immediately answer lots of questions. SIMPLIFY YOUR DRY NEEDLING EXPLANATION Part of why I think that visual is so important is now let's go to the text block. Now let's go to the content, the written information. I would say you have two good sentences that a patient is actually gonna read. Or to be even more extreme, I'll say, if your definition of dry needling says, dry needling is a technique done by physical therapists using a monofilament needle, I think you've already lost your audience. I mean, at this point, I think as soon as we say filiform needle, monofilament needle, they're like, I have no idea what a monofilament needle is, I'm out. We're not talking to colleagues here, we're talking to patients. So again, back to I think that image, that video or that image on the page is intentional. It shows a monofilament needle. They get it. They can see it's not a hypodermic syringe. It's not a blood draw or injection. we immediately answered one of their questions, which is, man, what does this needle look like? What does it feel like is what they're asking, but really they're saying, what does this needle look like? That's what the image is for. Don't waste half or a full sentence in your initial description of what is dry needling to say monofilament needle, which no one in the public has any idea what a monofilament or filiform needle is. So let's not start with that. Again, what we see a lot of over here is dry needling is a technique performed by PTs with a monofilament needle. From there it typically goes into to deactivate trigger points, improve tissue health, all of these things. I think we can refine this first sentence a little bit. And whether I'm saying that this is now how all of us as rehab professionals should market dry needling, or if I'm really just talking to this, to our ICE dry needling 2.0 crowd, I would say dry needling is an intramuscular technique with electrical stimulation. And from there we can say two, improve tissue health, decrease pain, improve muscle responsiveness, improve performance, evacuate fluid. So that would be my first sentence. From that first sentence, I removed that monofilament, filiform, that distracting word that patients don't know anyways. I did that with my picture. And I explained intramuscular. I mean, maybe that might lose some patience, but what we're trying to say in a word or two is this needle's going into a muscle, deeper into a muscle. Again, I think a video or an image showing that should be helpful. Use of electrical stimulation, that is key. And I'll take that point a step further in a moment. But we have an intramuscular with electrical stimulation and then why? And I think that why is just the generic. Patients are saying, why would I consider this? And if they're considering it to decrease pain, improve muscle function, maybe rehab a specific injury, improve muscle responsiveness, tissue health, all those things. That would be my first sentence. I'm not saying from that first sentence we've answered all of the patient questions, but we're starting to frame dry needling in a context that either they're going to form more questions, and I guess if I haven't said it already, the intent of this first paragraph, this first what is dry needling above the scroll line block is not to answer all of their questions. If you think we can answer all of their questions about what does it feel like? Is it acupuncture? Does it hurt? Is this the same as a blood draw or injection? If we think we can answer all those questions in one paragraph, I think that's going to be unsuccessful and to some degree is going to be a little scattered and chaotic. We have our webpage, we have an appealing picture that fits how we treat with dry needling. We started it with an explanation, ideally explaining that it is inside of a muscle using E-Stim and what the goals are. And we removed the words monofilament or filiform needle and removed the narrative and the explanation of trigger points. DRY NEEDLING MARKETING 2.0 So big picture, let's say you were just trained or let's say you were trained years ago I'd love you to go back to your webpage, go back to maybe your most recent patient-specific or informative social media post for patients and look it over. And I mean, be that naive patient and say, take a look at that page for three seconds and say, man, how was that interaction? Could I update this picture? Could I invest in taking my own photos or maybe making a 15 to 20 second video post? If you do that, it should be you, your voice explaining the procedure, but also have the procedure there. Again, the visual of dry needling answers many questions. Everything from the size of the needle, what does it look like? to your specific application of, are we just placing needles like acupuncture? Are we pistoning a little bit? Are we using e-stim? Is it one needle? Is it 20 needles? That little snapshot, actual snapshot of an image or 15 to 20 second video is very helpful for patients. So from there, I think that might be a slightly updated version of preparing for this podcast. I really just went typed in dry needling and a few specific cities. So that the main hits weren't like Wikipedia and all that. It was actually like physical therapy clinics. There are some good looking websites out there. So I love that. But the what is dry needling page, I think needs to be better across the board. I think we need to be more succinct in our explanation and narrative of what dry needling is a little more contemporary, which again, is not just that sterile definition of a monofilament needle. One more thing I'll add is that we are now living in a world, depending on which state you're in, but really if dry needling has been more and more mainstream, really starting in the 90s, early 2000s, a decade, a decade. So let's say we're at least 20 to 30 years removed to where Dry needling has been a part of physical therapy practice in the public sector for a while now. What that brings is either confusion or patients with previous needling experience. More and more patients are saying, I've had dry needling. And whether they loved it or whether they did not love it, we now have to explain how we specifically, you specifically, are going to use dry needling. So if you are ice trained, I'm speaking to you all to say, how do you market dry needling 2.0, the training you all have had, how do you market that as slightly different than just other forms of dry needling out there? First of all, you all know, you should know, and you should be marketing pretty strongly, the use of e-stim. And really, if that patient comes in and says, You're talking about dry needling, I saw your poster, I saw it on your website, like, I really don't wanna do dry needling. Patient's always in charge for sure, but I have more questions first. I'm like, okay, respect that. Where did you have dry needling before? Was it a PT? Was it a chiropractor? Was it an acupuncturist that is just going to call it dry needling? What was it like? Did they piston? Did they just place needles fairly superficially, not very deep? Did they use e-stim? How many needles did they do? These are all questions that we kind of need answers to. If the patient is saying, I had dry needling and I hated it. I was sore for two days. I'm not sure if it helped. Okay. Was the needle dose, the mechanical pistoning, a little too aggressive? Did they not use e-stim? Did they not reinforce it well after the treatment? Or, I had dry needling, you know, I don't care about the needle, but I just, I didn't feel like it did much. That patient is like, well, okay, how did they use the needle? Did they displace it? All the same questions. So we kind of have to frame the patient's previous experience. And that's easy with a patient in front of us where we can do a quick Q and A. But let's say it is just general patients coming. Maybe you have a pretty good grasp of your competition, I guess I'll say, or people in your community who are marketing dry needling, maybe you already have a pretty good awareness of how they're doing it versus how we do it differently. we need to have that on our webpage as well. We need to market that actively as well. And at this point, it's my own sample size. It's previously not using as much e-stim to now I use e-stim almost exclusively. It is worth marketing that our e-stim or our needling, sorry, our needling with e-stim is a little different than maybe the dry needling that our patient has had at this other clinic or other types of dry needling. So I'd put that on the page, and I'd put that high on the page of, at DPT with Needles Physical Therapy, we do dry needling a little differently. We really believe on a little less tissue trauma, that's less pistoning, and using E-Stim. E-Stim allows us to be a little more deliberate, a little more tactical for pain relief, neuromuscular changes, moving fluid. However you need to market that, but I would market that. The E-Stim, The e-stim across the board might be novel and unique to your patient, but having the ability to decrease that post-treatment soreness and be more effective or be more intentional and tactical is worth marketing for the patient. And again, I think that has to be a pretty succinct written webpage, text block explanation, but there's value in having a really nice looking image…

Full show notes at the publisher

Episode 1657 - Non-exercise topics for early post-op care Feb 05, 2024

Show notes

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan discusses the essential, yet often overlooked as aspect of early postoperative care. Alexis explores the wide range of concerns and adjustments individuals face postoperatively beyond the usual need for return to exercise. From emotional and mental health needs to navigating the logistics of daily life, we share valuable insights on how to care for individuals early postoperatively. Save this podcast and share it with your communities to educate them, and let them know what an early postop visit with you might would look like too! 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, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan discusses the essential, yet often overlooked as aspect of early postoperative care. Alexis explores the wide range of concerns and adjustments individuals face postoperatively beyond the usual need for return to exercise. From emotional and mental health needs to navigating the logistics of daily life, we share valuable insights on how to care for individuals early postoperatively. Save this podcast and share it with your communities to educate them, and let them know what an early postop visit with you might would look like too! 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, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today.ALEXIS MORGAN Good morning, YouTube. Get Instagram going here. Good morning. Welcome to the PT on Ice Daily Show. Happy Monday. My name is Dr. Alexis Morgan, and I am one of the faculty with Ice Pelvic. In our pelvic division, we enjoy talking about all things around exercise. And, you know, if you are part of ICE, you know that and understand that. But sometimes our reputation scares people. It might scare our community like, oh, that's the exercise person. They're definitely going to make me exercise immediately. Today's topic is surrounding non-exercise topics for that early post-op care. non-exercise topics for the early post-op care. This is incredibly important, maybe because of the reputation that you have in your community, which if you have that, great, so do I. Awesome reputation to have. However, we need our potential patients, we need our clients, we need them to understand a lot of the things that we can do early post-operatively that don't necessarily involve exercise. And that's not just to get them in the door, but that's also because there's a huge role that we play in early post-op management. Now I'm discussing this with the lens of early post-op post C-section or post-op post hysterectomy or any of these post hernia surgery, any kind of core and or pelvic floor, pelvis type of surgery. That's the lens that I'm going to be discussing this in. However, I will say this is going to be in many of these cases pertaining to really post-op, any surgeries. And we've had a couple of great podcasts on this topic. And Lindsey Hughey has one that comes right to mind on things that we can do to educate to reduce inflammation postoperatively. But I'm going to add a couple other things to that list. So let's go ahead and jump right into those. ASSESSING VITAL SIGNS So number one, we need to be assessing vital signs. This is incredibly important in the postpartum period as maternal death rates are actually increasing in America. And for black women, maternal death rates are three times the rate as white women. Many of these are because of some type of cardiovascular event. We have got to check blood pressures. And in many cases, we as the conservative care providers, those physical therapists or rehab providers, we're some of the only ones that are checking postpartum. Or we might be able to catch something very soon before they might have a six or eight or 12 week follow-up postpartum. we've got to be checking their vital signs and assessing and making certain calls when necessary. That is absolutely important and definitely not exercise related at all. We can get them in and get their blood pressures checked. OWNING SCAR MANAGEMENT Additionally, we, we assess sutures or incision sites or whatever whether that was an abdominoplasty where they have an incision from ASIS to ASIS, whether that is a C-section incision, a little bit smaller, more midline, or that might be smaller little incisions all throughout the belly from some type of laparoscopic surgery. Whatever the case, We, as their rehab providers, assess that incision. We're gonna look for signs of infection and we're also educating about those signs of infection. We're assessing to see how the patient feels about it. Maybe we need to set some expectations surrounding what the C-section scar or what any of these scars are going to look like in a month and in six months. And with that, we can go ahead and begin some scar mobilizations. Now, very early postpartum, we're still in the proliferation phase, inflammation, then proliferation, and then maturation. We're still in that proliferation phase, so we're not gonna be doing scar mobilization on the actual scar, but we can come inches above and below and surrounding. We can teach them how to pull on their skin and press on their skin well away from the scar to go ahead and begin that desensitization. That is incredibly valuable. And just going ahead and painting the picture of what that scar rehab is going to look like over the next three to four months. Many individuals have a lot of fear and concerns surrounding the scar. And we are the best people to be giving them home exercise program, these interventions and helping them understand what it's going to look like. We know we're the rehab providers that have seen this all along the way in several other of our patients. So we can help them understand what to expect and If there's concerns where we need to refer to a mental health provider, then we're absolutely going to do that. That is completely within our realm to assess that and to refer out. And what a great opportunity to help someone. Body image is rather difficult. It always has been, but with social media and the way the world that we live in right now, It is incredibly difficult. And so we need a lot of times mental health providers to help us navigate that. So first we talked about vital signs. Now talking about sutures, we can absolutely discuss fueling. That's the podcast I mentioned with Lindsay Huey, so I won't jump into that necessarily. ASSESSING DAILY FUNCTION But next is ADLs. I was just looking through my messages, some screenshots that I've saved from various, um, various people who have messaged me about, um, pelvic floor related topics. And what I saw was this message from someone who said, I just went to my, uh, follow-up and they told me not to lift any weight. And the person asked, can I lift my baby? And they said, no. Now, obviously this is hopefully a one-off. Hopefully that word is not being said. And who actually, I don't know if the doctor actually said that, but the point is, is that this individual did think that that's what the doctor said. We are here to help them understand how can they be safe? How can they hold their baby? How can they get out of bed? How can they bend over and get the clothes out of the dryer, out of the washer? We can help them navigate these things. This is a great opportunity for occupational therapists as well. We can lean into their expertise here. Helping individuals with these ADLs can be really valuable for these individuals and can help them feel more confident in their body in that early postpartum period. Sometimes they just need to share their story. I think a lot of times we as rehab providers really feel this urge to do, do, do, put hands on, give home exercise program. I need you to do all three of these. We feel like so rushed in order to provide and sometimes The best thing that we can provide is a listening ear, is someone to be someone who can just ask questions about their surgery, about how they felt, about how they felt going into that and how they felt coming out of it. That can be incredibly helpful. ASSESSING READINESS TO EXERCISE While we're talking about non-exercise plans, I said that we wouldn't be doing exercise, but I didn't say that we wouldn't be talking about it. So when we have someone early postpartum, they might be an exerciser and they might be saying, oh, I'm not ready for exercise just yet. Well, that's okay. Let's talk about what does exercise mean to you? What does readiness look like to you? What do you want and what are your timeline expectations? And do they match up with what we have seen or what we expect? Having a conversation about an exercise plan and exercise expectations can be incredibly helpful. Some people may not understand that they can go ahead and start to move now. and they think exercise is any type of movement, and we can kind of break that down. We can discuss different exercises that individuals can do or that this person in front of us can do in this early time, like walking or some basic hip exercises or arm exercises. A lot of times there's several restrictions surrounding surgeries. But just because there's restrictions doesn't mean that there has to be zero exercise. So we can discuss that plan and kind of help them understand what that overarching picture of exercise and health looks like. I already mentioned one referral, but there are several other referrals that we can also make. So in the postpartum realm, referring back to their provider, their OB or their midwife. We can refer to a lactation consultant, to mental health providers. Postpartum doulas are another great referral source, particularly for people who are postpartum and maybe don't have a lot of family nearby. There are so many ways in which we can help people and We don't hold the keys to everything. I can't help with mental health. I can listen, but I don't have all of the tools, but I can absolutely refer to somebody who does. And together we can work to get this person in front of us feeling really good. SUMMARY So vital signs, checking the sutures or those incision sites, discussing fueling, helping them with their activities of daily living, their ADLs, listening to them, listening to their story, figuring out an exercise plan and referring out. The last thing I'll just mention here with pelvic floor and particularly with postpartum, we're gonna discuss with them expectations surrounding those. That's a whole nother podcast for another day, but discussing the expectations surrounding bleeding postpartum, leaking heaviness and pain and giving them what to listen to when we say, listen to your body, giving them a key to understanding what that exactly means. That way, once again, they can be successful. So that's just a little sneak peek into a whole lot of what you're going to learn if you take our online level one course. Our next cohort for our online level one starts March 5 so upcoming in one month at the beginning of March. It is going to sell out, just like this current cohort did so if you're on the fence about it, I recommend going ahead and purchasing that ticket because. If you wait too long, you're not going to get a seat. And we are very strict on keeping our student to faculty ratio at an appropriate level. That way you get your questions answered and you get the care that you need as you're learning from us in the course. So sign up for that. And we also have our first online level two course coming up at the very end of April. And so you're not going to miss that. Once again, that is definitely going to sell out. We are still months away from that, but only a few few seats remain for that. We're going to shut that one down pretty soon. So if you're on the fence about the online level to go ahead and sign up for that one. We are all over the place in twenty twenty four. Our next upcoming cohorts. for our live course. We're going to be in California, North Dakota, South Carolina, and Colorado. Those are our upcoming next courses, all in March and April. So be sure to check us out on the road. And remember, when you do all three of these courses, you are eligible for the ICE certification certified in pelvic. We are here to change the game when it comes to pelvic floor health and pelvic floor rehab. And we need more of you. So please consider hopping on the train, coming to our courses. We know you're going to have a great time. Thanks for being here this morning and listening with me. Have a great rest of your day and we'll…

Full show notes at the publisher

Episode 1656 - Youth fitness athlete programs Feb 02, 2024

Show notes

Dr. Mitch Babcock // #FitnessAthleteFriday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Fitness Athlete lead faculty member Mitch Babcock discusses developing youth strength & conditioning programs, including optimal timing & frequency, age groups, and training progressions. Take a listen to the episode or check out the show notes at www.ptonice.com/blog If you're looking to learn from our Clinical Management of the Fitness 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 INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. MITCH BABCOCKAnd good morning. Welcome to the PT on ICE Daily Show. It is Friday, that means it is Fitness Athlete Friday. We are excited you are here. If you're on YouTube, thanks for watching when you're catching this recording back. And if you're on Instagram, thank you so much for being here as well. Thank you to our listeners who are loyal and downloading this podcast on Spotify and Apple Podcasts and anywhere else that you get your podcasts from. If I am talking to you on your morning commute, I wish you a great day in the clinic. And if you're on your way home or anywhere else, I wish you a great day as well. So I am Mitch. I am your host of this Fitness Athlete Friday. I'm a lead faculty in the fitness athlete division. And I want to talk today about youth sport, youth fitness athlete programs and what you can be doing as a fitness forward clinic to really be reducing those injury risks that we all talk so much about in the youth athletes. Before we jump into that, I just want to draw your attention to two main fitness athlete courses that we have coming up for the month of February that we're in now. On Super Bowl Sunday weekend, I will be in Richmond, Virginia. I was getting a little worried. My Detroit Lions making a once-in-a-lifetime run at the Super Bowl. I was getting a little nervous that maybe I did some scheduling error there. fortunate or unfortunate as it may be, they won't be in the Super Bowl. So Super Bowl weekend, I will be in Richmond, Virginia. And I know what you're thinking, I don't want to take a course on Super Bowl Sunday. We're going to get out in plenty of time early enough for you to go make it to your Super Bowl party and enjoy the rest of the weekend with your friends and watch the game. So if you're in the Richmond area, join me there on February 10th and 11th. And then at the end of the month, February 24th and 25th, you can catch Zach, the Barbell Physio. He's going to be at his home gym in Charlotte, North Carolina. for a fitness athlete course as well. And we just kicked off our next cohort of our Level 1 Essential Foundations course online, and so I wanna make a special hello to all of you that are starting the process of the CMFA certification online with us. We're excited to do the next eight weeks together. We've got a lot of learning that we're gonna engage in, so I'm stoked for that. YOUTH INJURY REDUCTION STRENGTH TRAINING & CONDITIONING PROGRAMS So without further ado, let's get into our podcast today. Youth Injury Reduction Strength Training Conditioning Programs. Here's what we know about injury risk reduction. The screening tools that we have been given, the systems that were promised to help identify and reduce risk of injuries, they're no good. They don't mesh out in the data. We have enough long-term studies now to be very conclusive that these movement screen systems that we think that we're putting kids through to help reduce their risk of injury are in fact doing nothing to help actually reduce their risk of injury, and they're no better than a coin toss oftentimes of being able to identify kids that are at risk. What we know conclusively in the evidence, and then we're looking at now in adolescent athletes and also collegiate level athletes, is that the more that they're engaged in a strength and conditioning program, that the stronger their legs are, the stronger their core is, many of these programs focusing on those two elements primarily, that the better they do at reducing actual risk of injury and the more prepared these athletes are for the demands of their sport, whatever that sport may be. And so when you think about the constraints that the youth athlete is under, oftentimes, and we know this problem exists, where these kids are involved in a one singular sport for 9, 10, or even 12 months out of the year, they're hyper specialized into that one athletic arena. They're going from practice to speed and agility camps to to sport positional specific camps. They're constantly engaged in the demands and the domains of their sport and they're doing way too much in that arena and they're not doing enough either other sports or general physical preparedness. The GPP work that we know is the foundation for all athletic endeavors to be built upon. DEVELOP GENERAL PHYSICAL PREPAREDNESS So our pitch, our recommendation for our fitness forward clinics out there, and there are so many now that are branding themselves as being fitness forward, when you're going out and you want to reach this next population, you want to get ahead of these injuries. You want to do something for that youth athlete. You treat their parents already in the clinic. You know that their son or daughter is engaged in travel volleyball, travel baseball, their competitive wrestler, football, whatever that may be. You know their kids, you know their families, and you want to put a program together that gets as many of those kids as possible in your clinic, in your gym, and really helps to teach the fundamentals of strength training. Right? Because if we can get these kids in and start to help educate their motor control patterns, help to instruct them on strength training, under the supervision of a doctor of PT who's trained in the barbell, who's trained in the dumbbell, in the strength and conditioning community like many of you are, and taking our courses now, there is no better instructor to take these kids under your wing and really lead them to where they need to go, which is learning the fundamentals of how to move their body in space, how to get stronger, and therefore how to be more protective against injury. Stronger athletes get hurt less on the field. And if we can start teaching these movement patterns at a younger age, that gives us such a better upslide for being able to instruct and progressively overload these movements over time. So what we need to be doing as Fitness Forward clinicians is setting up some sort of camp, setting up some sort of program. Maybe you have the resources to do it year long, that's great. Maybe you don't. Maybe you can just divide six or eight weeks of your schedule out to fitting in these youth sport performance camps. And you can do them at various times throughout the year. What we have found to be successful is doing a camp in the summer because they're about to lead into whatever their fall sport is. That could be volleyball, that could be Football, I'm not even sure what sports going at that time if I'm being honest, but but getting them into that late summer Is a great time to run some sort of eight-week camp where you teach the fundamentals of strength and conditioning Keep it very simple. OPTIMAL CLASS LENGTH My first point here is to keep it brief 30 to 60 minute classes are gonna be perfect 30 minute class if you're just looking to instruct the strength component closer to a 60 minute class if you're looking to do strength and conditioning together and Okay, so your choice 30-minute class is about what you're gonna need if you're wanting to instruct at least a strength movement Maybe a 60-minute window if you're looking to add some conditioning in there, okay? Keep these programs at two to three days per week Keep in mind how much these kids are already training right how many times they're already doing their sport specific work their speed and agility work there and They're engaged in a lot of things already. If you can keep your program very precise during days of the week, maybe a Tuesday, Thursday, or we have tried like a Monday, Wednesday, Friday, whatever works for you and your schedule, two to three days per week, 30 to 60 minutes is gonna be ideal for these kids, okay? GROUPING BY AGE Now, what age groups? You can't just, we have had not great success by throwing kids anywhere from six to 14 in the same room together, right? The development of those athletes at various milestones throughout their development is so wide and so different that you're not gonna have a successful class with that many different types of athletes. What I would recommend doing is grabbing kids from the nine to 12 group When they hit about eight, nine years old, they're really development enough, they're cognizant enough, they're engaged in the sport, they like what's going on. So if you can grab a group of nine to 12 year olds, and then maybe have another segment of like 13 to 16 year olds. I think those are two really good spaces where you're getting kids at various ends of development, and you're teaching them very different things. At the nine to 12, our strength work for them is really motor control. The stronger they get is really just more repetitions they've had doing that movement. And so we don't really need progressive overload for that group, we don't need barbell training precisely, but really bodyweight and dumbbell or kettlebell loads are going to be perfect for them. and use the load as the reward. So the key here is that, good job, Timmy. Your air squat is looking really good. Because it's looking really good, I want to give you this dumbbell. Hold this at your chest. You're one of the leaders in the class right now. Hold this dumbbell. Keep your squats looking good. So you're rewarding good movement mechanics with load. In that 9-12 year old range, using dumbbells, using kettlebells to instruct your major fundamental movements, your hinge like a deadlift, your squat like a goblet squat, and a press, a dumbbell push press, overhead press, PVC pipe if they need a lighter load. You're instructing that overhead full lockout position, you're instructing a squat pattern, you're instructing a hinge pattern. And for your older kids, your 13 to 16, if they have been with you and they've shown you some good movement patterns now, now we can start to add the barbell in here. Now we can say, good job on your air squat. Let's go barbell front squat. Let's go barbell back squat. Let's go barbell deadlift. Let's go barbell overhead press, strict, or push press. Team, if you don't feel confident teaching those movements, please take a class with us this year. In two days, Saturday, Sunday, eight to five on Saturday, eight to five on Sunday, you're gonna walk away being very confident in your ability to walk right back into the clinic, whether that's with one person or 10 people, and instruct these movements that need coaching. Okay, so if you feel like that's a gap in your game, it is so easy to sure it up. Just join me in a class, join Zach, join Joe, find one of the fitness athlete courses that's in your area, and we'll help you close that gap very quickly, okay? So that's kind of your range of strength movements that you want to focus your energy on. If you've only got a class that's two days a week, do one day squatting, one day hinging, or one day squatting, one day pressing, and just kind of flip-flop your order that you're programming those in. For the younger kids, using load as the reward. And the last thing that I would, well, excuse me, I got two more things. TEACH THE FUNDAMENTALS OF BODY WEIGHT MOVEMENT Teach the fundamentals of body weight movement. You've got to have these kids doing more push-ups. You've got to have these kids doing bodyweight lunging. You've got to have these kids doing some form of a pull-up. And that can be in the form of a ring roll if they're not strong enough, or an assisted vertical pull. But these kids need to develop upper body strength and core strength, do more planks, do more lunging, do more push-ups, do more pull-ups. do a lot of them. It is so easy to teach them really well and give them to them for homework. Like not enough kids are doing that. And I run into this problem year after year with my teens program is that their ability to do a really sound pushup is lacking. And we can have the debate on generation after generation of how bad that's gotten year after year. Ultimately, I don't care. I don't care to engage in that debate. What I care to engage is that what are we going to do with it now? And right now I'm seeing kids that can't do a pushup. So add the push-up, add the pull-up, add a bodyweight lunge, a bodyweight plank. We need to develop some core strength and some solid bodyweight resisted movements. So keep them as a really good accessory movement to the foundational movement that you're teaching that day. ADD CARDIOVASCULAR FATIGUE TO MAKE LIGHT LOADS CHALLENGING And then the last thing, here we go, is adding your conditioning to make the lighter loads you're using more challenging. If all you're giving little Timmy is a light dumbbell or a PVC pipe, by the time I get them done with a 100 meter sprint and then they go back and do this movement, you're going to see some more variability in their movement. By adding that little bit of conditioning, that little bit of metabolic or heart rate duress to the system, you're going to start to see some changes in movement pattern that allows you to coach and improve. Which, guess what team, you can argue this all you want, but that's exactly what they're doing in their sport too. They're getting their heart rate up, they're running around, they're crashing into their friends on the field or on the sport. Their heart rate is going to be elevated and we still need them to move well. So that's what we're doing in the gym as well. Get them on the rower, have them bang out a 30 second sprint on the rower and then get off and do their squats. Send them on a 100 meter sprint, come back in, let's do some deadlifting now. right? Utilize that assault bike. Hammer out 10 calories as fast as you can. Get off. Let me see your vertical overhead press now. Utilizing the conditioning component first to make the load and th…

Full show notes at the publisher

Episode 1655 - Cupping for acute back spasms Feb 01, 2024

Show notes

Dr. Zac Morgan // #TechniqueThursday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Spine Division leader Zac Morgan discusses how to subjectively & objectively identify patients presenting with acute back spasms, how to treat spasm, and how to follow-up treatment with appropriate homework. 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 Lumbar Spine Management course, our Cervical Spine 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 everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. ZAC MORGAN Alright, good morning PT on Ice Daily Show. I'm Dr. Zac Morgan, lead faculty in the cervical and lumbar division, here to bring you a Technique Thursday talking about myofascial decompression or cupping for an acute back spasm. For those of you all who work with acute back pain, so this is something that early in my career I did not see an awful lot of, but as I have kind of entered the market of seeing more and more acute low back pain, you will see these people walk through the door that are clearly in a spasm. And I want to talk today about why cupping has kind of become the treatment of choice here for that exact presentation. ACUTE BACK SPASM PRESENTATION And let's just kind of narrow in on why we're focusing on back spasms to start. And the real thing is, this is one of those diagnoses you don't read a ton about in the literature, but it's one of those things that you know it when you see it. So it's fairly empirical. So every so often, people kind of walk through the door, and they're kind of in that shape of a question mark. They're really off to the side, and you can tell as they walk through the door that the severity of their situation is really, really high. Even just watching them move about the world, their activities of daily living are extremely challenging when they're experiencing a back spasm. They're not able to freely move through space and move that spine around because their erector or QL or some of that posterior musculature is in a full spasm. So this is something you will see if you're seeing people day of within a couple of days of a back pain episode. So it's certainly one of those acute low back pain scenarios. Now the issue is, you'll see a lot within our profession of people sort of argue about, well this is just going to regress to the mean. And I don't disagree. A back spasm is going to go away on its own, for the most part. So generally speaking, untreated, in my experience watching these things happen around the gym, having some of them myself, a lot of times people have some movement limitations for ten days or so, seven to ten days, maybe a week, maybe a little bit longer, but then they're usually back to normal life after that point. So it's not one of those conditions that sticks around for months the way like a radiculopathy would. It's just something that's acute, but while it's present, it's very severe. I think it's important for us to say We know it regresses to the mean. It will get better on its own. WHAT IF REHAB CAN BEAT REGRESSION TO THE MEAN? Here's the thing. With early treatment, what I'm about to show you all, I think we can take several days off of the episode. And I think that because of empirical data here in the clinic. So I'll watch people walk in in that situation that we just described. Very put off to the side, huge spasm in that erector. You can almost see it through their shirt. and they're unable to do much, and we treat them with some cupping, we treat them with some relaxation techniques that we're going to unpack here in a moment, and often that person feels tremendously better, tremendously quickly, so within a couple of days, maybe three max, versus that seven to ten. Now that's a difference, right? That's almost a week of time different that that person is going to end up walking around with pain or not walking around with pain. Why does that matter? When you think about how influential this spasm is to their activities of daily living, they can't do much. Now deconditioning is going to set in, even on healthy people. If healthy people move around the world for a full week without really flexing their back, without allowing it to move, they're going to have some deconditioning on board. And if we could have gotten rid of that a week earlier, we've given them more of an opportunity to maintain or even gain fitness during this period of time that they have some acute pain. So I think it's really important that we focus in on this because while it's not a usually a long-term disabling diagnosis, it is a short-term disabling diagnosis. And when people are in that disabled period, they're looking for short-term help. And I think we can be helpful with that. IDENTIFYING CANDIDATES FOR CUPPING So let's talk a little bit about identifying these before we actually get into the treatment. And from an identifying standpoint, you want to start with that body chart. So if you've been to cervical and lumbar management, you know we always start out with quantifying where are the symptoms on this person's body. When someone's in an acute back spasm, it'll be a little complicated to find the exact spot of symptoms. They don't usually point to one thing. They often kind of talk about that whole erector side. They might even point to that whole area of their low back and say it just feels locked up. I've certainly had plenty of clients who reported just like local pain sort of at the waistline, like right where the waist of your pants are. I've had unilateral, bilateral, it bounces around a little bit on the body chart, but typically whatever muscle is in spasm is where the pain is. And often the person has a hard time describing it because of the severity. They just say my whole back is out, my whole back's out of whack. So it's not one of those focal diagnoses on the body chart. Subjectively, you're going to see some common aggravating factors. The biggest one's flexion. The person probably won't even allow their back to flex. And when you look at that from the active range of motion standpoint, you see it's just hip flexion. The lumbar spine is not actually actively flexing. The person's just kind of absorbing into hip flexion. Any quick movements are often painful subjectively. So they talk about transfers, they talk about when they've been lying down to get up. Really anything where they have to move quickly will often be an aggravating factor. And then things like bending, sneezing can also be pretty painful for these folks. In their history, they'll usually tell you about some sort of fatigue-based activity that onset this. So this won't usually be like a one rep max deadlift. That makes me more think of a strain. Where this presents itself is in a workout with a bunch of deadlifts. So when somebody's, you know, several sets in and their back is already tired and then it just fully locks up and kind of worsens throughout the evening or worsens throughout the day, that's more of the spasm presentation. It's not just in weightlifters or competitive athletes. You'll see this really with any human who has exceeded their capacity. So I've definitely had plenty of folks that were gardening all day or mulching all day and just using their back a bunch and then it wound up in spasm. So it's really whatever over challenges that musculature tends to create the spasm. So subjectively, you'll see those common ags and then you'll also see that history where the person was either fatigued entering an activity or did an activity so much that it created enough fatigue that eventually created a spasm. Objectively, again, their lumbar spine, it's not going to reverse. When they flex, it's going to stay very flat. You're going to see a lot of guarded movement. The person's probably going to be very hesitant to move, and you'll notice that quite a bit through this active range of motion exam. You will even often see cervical flexion. bother that person's symptoms because the erectors, they attach all the way up in the neck, in the suboccipital spine. So you will see cervical flexion be bothersome, but then it's not like a sensitization thing from a neurodynamics exam because the ankle won't make any difference. So, when you see that cervical component create a lot of discomfort in that acute pain scenario, and then you dorsiflex and plantarflex the person's ankle, and it doesn't make any difference, that's ruling spasm higher on my list. So, objectively, that'll often be how it presents, and then a lot of it's just observation. You'll just look at this person's back, and like I said in the beginning, they'll be twisted off to one side. They may even be kind of in the shape of a question mark. Like you can see that that erector on that side has just shortened in the area of the lumbar spine. And so the person is fairly obviously uncomfortable. A lot of times the erector itself is swollen or hypertonic or larger, whatever you want to call that. And it'll be tender to the touch. So just palpating that region, a person is going to report most of their symptoms. So like I said, a fairly obvious diagnosis. And again, it's one that I didn't see a lot of until I got that really acute back pain person in the clinic. So that's sort of how they present. TREATING BACK SPASMS Let's talk about treatment. There are a lot of things that jump into my head that I would like to do. Like if you have acute non-radicular low back pain, the first thing that jumps into my mind is spinal manipulation. But often moving these people's backs through space is just not a realistic possibility for you on day one. Team, over the last couple of years I've spent a lot more time learning about cupping and doing a lot of cupping with clients and this is the one thing that whenever you see this presentation show up, whenever we drop the cups on that region, get it nice and relaxed and it doesn't even have to be all that vigorous. The person often gets off the table stunned at how much better they feel. So cupping has definitely become the treatment of choice and I like to just keep it really really simple. Now the biggest issue from a treatment standpoint when someone's in spasm is it's really challenging for you to get that person comfortable most of the time. They don't like laying in supine, they often don't like laying in prone, and then on one side or the other they're often really uncomfortable. If you can get them in side-lying, which is typically the most successful for me, you want the erector that is in spasm up. So I have Caitlin here behind me, and you can imagine in this situation, her left erector would be the one that would be in spasm. So that's the one that I'm going to target with treatment, and that side's up. You also want to prop a pillow between the person's knees just so that hip doesn't adduct and create even more tension on that lower back region. Instead, let's keep those hips nice and neutral and get this person in a relatively comfortable position. This will often be the position they've told you in the subjective exam that they like the most. So we're going to go right to that position and then treat in that position. So I'm going to move to the other side of the table, show you sort of where I put the cups, some of the verbal cueing alongside of that, and then we'll wrap this thing up. and summarize at the end. So anytime you're doing cupping you always want to use a little bit of cream. It's just a lot easier to glide the cup around and it's a lot more comfortable for your client. So make sure you add a little bit of cream to that region that you intend to cup just so that that way it's more comfortable for your client. You're then going to grab your first cup and localize it to the region that you think is in spasm. It doesn't have to be directly over it. Reminder, these muscles are literally all the way across the spine. So if the person's too pressure sensitive, you could certainly move away from it. But you want to be in that basic region. And then you're just going to get these things on. with a little bit of tension. So a couple of pumps to start is plenty. So I don't have this thing cinched all the way down where she's in a ton of a stretch feel. Instead, I just have a little bit of air out of the cup and a little bit of domed tissue within that cup. this gives you that nice decompressive feel if you're the client a lot of times they'll be a bit uncomfortable when you first do this but they're uncomfortable anyway they've been in spasm for a few days and so it's no major deal to them these cups are probably only like 30 to 40% pulled out. So typically if I'm being more aggressive with cups, I get it a little closer to that full capacity of vacuum. But for this, I've got a very severe patient in front of me, they're very fear avoidant, they're not moving all that much, and I've just got a little bit of tension in those cups. I start out just like this, like you all are seeing. So the person just kind of gets comfortable, relaxes, feels that pull. But after they've sat here for a couple of minutes, I'm going to start to try to cue that person to do a bit of a posterior pelvic tilt. The point of that posterior pelvic tilt is just to access a little bit of their lumbar flexion while they're in this nice, friendly, non-weight-bearing position. Anytime they're in weight-bearing, that erector tends to want to be in spasm. So I'm going to get them to just relax things a little bit here in sideline in a nice comfortable position. So I might have them move through 10-20 reps here, maybe even cueing some deep breathing in between if they're very severe. So 4-7-8 breathing pattern is often a helpful one, that physiological sigh. Either one of those are typical go-to's while we're in this position and the person's nice and relaxed. Now, for those of you all who treat human beings, you know a lot of times our female clientele is a little tougher than our male clientele. Sometimes the men are already sweating in this position and they're already having a lot of challenge. If that's the case, I…

Full show notes at the publisher

Our TOPPODCAST Picks

Follow Us

Stay Connected

Related Podcasts

Links

Stay Connected