TopPodcast.com
Menu
  • Home
  • Top Charts
  • Top Networks
  • Top Apps
  • Top Independents
  • Top Podfluencers
  • Top Picks
    • Top Business Podcasts
    • Top True Crime Podcasts
    • Top Finance Podcasts
    • Top Comedy Podcasts
    • Top Music Podcasts
    • Top Womens Podcasts
    • Top Kids Podcasts
    • Top Sports Podcasts
    • Top News Podcasts
    • Top Tech Podcasts
    • Top Crypto Podcasts
    • Top Entrepreneurial Podcasts
    • Top Fantasy Sports Podcasts
    • Top Political Podcasts
    • Top Science Podcasts
    • Top Self Help Podcasts
    • Top Sports Betting Podcasts
    • Top Stocks Podcasts
  • Podcast News
  • About Us
  • Podcast Advertising
  • Contact
Not in our directory?
Add Show Here
Podcast Equipment
Center

toppodcastlogoOur TOPPODCAST Picks

  • Comedy
  • Crypto
  • Sports
  • News
  • Politics
  • True Crime
  • Business
  • Finance

Follow Us

toppodcastlogoStay Connected

    View Top 200 Chart
    Back to Rankings Page
    Health

    #PTonICE Podcast

    The faculty of the Institute of Clinical Excellence deliver their specialized content every weekday morning. Topic areas include: Population health, fitness athlete management, evidence based spine and extremity care, older adults, community outreach, self development, and much more! Learn more about our team at www.PTonICE.com

    Advertise
    • Apple Podcasts
    • Google Play
    • Spotify

    Latest Episodes:
    Episode 1602 - Breathing, voicing, and the pelvic floor Nov 20, 2023
    Show notes

    Dr. April Dominick // #ICEPelvic // www.ptonice.com In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick discusses the anatomy & physiology of phonation, the mechanics of breathing, and the relationship between the pelvic floor & the demands of speaking/singing. In addition, April covers unique considerations for professional singers & speakers and implications for physical therapy treatment. Take a listen to learn how to better serve this population of patients & athletes. 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 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.APRIL DOMINICK What's up PT on Ice fam? This is Dr. April Dominick from the Ice Pelvic Faculty Division here today to talk about the pelvic floor and its role in breathing and voicing today. I have a feeling it'll take your breath away. But first, some updates from our pelvic division. First, we have our last live course offering of 2023. It is happening December 2nd and 3rd. with Christina Prevett, and that is gonna be in Halifax, Nova Scotia. And let's not forget about not one, but two of our online eight-week course offerings. Level one is going to kick off next year on January 9th, and the brand new level two advanced concepts are going to get rolling on April 30th. So head over to ptonice.com and secure your seat in one or all three of those offerings. So we wanted to hop on today to outline what we know about the pelvic floor and its essential tasks and things that you've probably already done today like breathing and talking. THE PELVIC FLOOR & PHONATION I'll discuss the essential anatomy and then the structures that are involved and then we'll unpack the complex physiology of breathing and voicing with a special focus on what the literature supports right now in terms of what the pelvic floor's role is in phonation. Spoiler alert, there's not a ton. And when I say phonation or voicing, all those terms mean talking. So we need to understand what normal function is in order to identify dysfunction during pelvic floor assessment, especially when it comes to an individual complaining of any bladder issues or bowel dysfunction, leakage, pelvic heaviness, or pain during tasks like breathing and talking, or yelling and singing, This can happen to anyone. Think about the last time you were in a really loud bar or at a concert and you're yelling at someone or trying to talk to people and your voice gets a little fatigued. Maybe there's some fatigue in the pelvic floor as well. This can also happen with other occupations that primarily use their voices. So I'm thinking about teachers, maybe chefs in a busy kitchen or coaches, professional singers even. Another point to bring up is breathing and more recently phonation have been used in the clinic by physical therapists to treat pelvic floor dysfunction. Yet we lack robust evidence to support these clinical practices. So when it comes to breathing and voicing, I want you right now to think of some body parts or structures that are involved. I'll give you three seconds or you can pause. THE ANATOMY OF PHONATION Most of us probably thought of the obvious structures like the nose, the mouth, the lungs, and maybe even the diaphragm. And those are great starts. And we're going to run through the other important players for breathing and voicing. Breathing and voicing work in a closed system, which involves the interplay of three regions. with different diaphragms. So the cervicothoracic diaphragm, the respiratory diaphragm, that's the diaphragm that you think of when we talk about the diaphragm, the dome shape, and then the pelvic diaphragm. So when it comes to the cervicothoracic diaphragm, the major surrounding structures of interest are the oral and nasal cavity, the larynx, which is also known as the voice box, and that houses the vocal folds, the trachea, and then there's supporting musculature. There's paralangeal musculature like the SEM and scalenes, as well as the intercostal muscles. From a nerve standpoint, we cannot talk about the pelvic floor or voicing or breathing even without talking about the vagus nerve, as well as the phrenic nerve that runs along this area. The vagus nerve innervates the vocal folds and the phrenic nerve innervates the diaphragm. So that's the cervicothoracic region and diaphragm. Then we've got the respiratory diaphragm. That's going to separate the thoracic cavity from the abdominal cavity. And the diaphragm at rest, it's that dome-shaped muscle And it's got many origins, the xiphoid process, some of the lower ribs, the lumbar spine. Indirectly, it also attaches to the psoas and QL or quadratus lumborum. And then in that same region, we have the abdominals and they aid in power production for respiration or phonation. We're talking the internal and the external obliques, the rectus, and then the transverse. Then we have the pelvic diaphragm, our third area. The pelvic floor muscles are actually the floor of this entire closed-core canister system. Its three layers involving the levator ani, the coccygeus, piriformis, optorenus, and ternus are all muscles that span from the pubic bone back to the coccyx, and then from the ischial tuberosity to the other ischial tuberosity. Functionally, the pelvic floor is involved in so many things, abdominal and pelvic support, modulation of intra-abdominal pressure, postural and respiratory support, bowel, bladder, sexual function and arousal, and reproductive function. When those pelvic floor muscles contract, they close off the urethral, vaginal and anal openings. When they relax, they open those openings so that if we need to, we can urinate or poop or do any of those things. So that's the anatomy piece. THE PHYSIOLOGY OF PHONATION Now I want to go into the relevant physiology when it comes to pressure generation and management. So breathing is the transmission of air into and out of the lungs. Sounds simple. Right? No, not so much. We're going to go through how each region that we just discussed supports respiration in two forms, inhalation and exhalation. For the cervicothoracic diaphragm, the vocal folds are there and they march their own drums. So during inhalation and exhalation, those vocal folds stay open, and that's to allow airflow in and out. In terms of the intercostals, during inhalation, the external intercostals are going to elevate the ribs and go upwards and outwards, which expands the thoracic cavity, and then they'll relax on exhalation. The SEM and scalenes are going to assist in the inhalation portion as well as provide some postural support for the head and neck. So that was a cervicothoracic diaphragm. THE MECHANICS OF BREATHING Now we're going to go into the respiratory diaphragm physiology and mechanics of breathing. So during inhalation, that dome-shaped muscle contracts and changes from dome-shaped and then flattens as it descends towards the abdominal cavity. This is going to create a vacuum that pulls air in. And then during exhalation, that flat diaphragm passively relaxes and returns back to its dome shape. Then we have the abdominal muscles. They are a little more straightforward. On inhale, they're going to relax and expand outward. On exhalation, they're going to contract and draw inward. Then we have the pelvic diaphragm. So during inhalation, the pelvic floor muscles relax and elongate. Then on exhalation, in the presence of now increased intra-abdominal pressure, the pelvic floor should contract and lift, which closes those openings, preventing any unwanted leakage or prolapse symptoms. And we have a few confirmations of this happening in the literature. In 2011, there was a group Telus et al, and they confirmed that these pelvic floor movements are happening with respiration during real-time dynamic MRI. We love some of that research. We also have other studies that show, hey, via EMG activity, there's actually some pelvic floor activity prior to resisted expiration. And this is cool because it demonstrates that maybe the pelvic floor has some sort of neural pre-planning during the expiration phase. So I know that was a lot of information, so I'm going to put it all together for you in terms of respiration, what's happening from head to floor. During inhalation, the vocal folds are open to allow the air to flow in. The external intercostals are going to elevate the ribs up and out. The SCM lifts the sternum. and clavicles, the diaphragm contracts and descends downward, the abdominals expand outwardly in response to the displaced organs, and then the pelvic floor elongates inferiorly. Whereas exhalation is more of a passive process of the muscles relaxing. But it can be a forced process as well, like during exercise or playing an instrument, or if we're under any stress, So now I'll run through the muscle responses during passive expiration, which is essentially inhalation in reverse. The respiratory diaphragm and inspiratory muscles relax, the pelvic floor and abdominals, synergistically contract, and there's this beautiful parallel lift of the pelvic diaphragm and the respiratory diaphragm upon exhalation. And then finally, those vocal folds, remember they stay open. so that air can exit the body. So that is respiration. It is the foundation and the power source when it comes to phonation or talking. As far as phonation goes, the entire body is a vocal organ. So the next time someone asks you at a party, hey, do you play any instruments? Be sure and tell them, heck yeah, I play this little thing, the voice. So next I'm going to detail the symptoms or systems involved in voice production. And I'll point out the differences in function of the two major muscles between respiration and phonation. As I said, the voice is a highly complex instrument involving many different body parts. THE FOUR SYSTEMS OF PHONATION And so we're gonna think of phonation as comprised of four major systems. And these systems are like a four-legged stool. When they're all working in sync, that stool or the voice is nice and stable. When one leg of the stool is a little off, then your whole stool is wobbly and your voice is a little wobbly. Another key thing to remember is that phonation occurs during the exhalation portion of respiration. So the first of the four systems is the air pressure system. It's going to manage pressure and flow. It sets vibration in motion. We can liken that air pressure system to a musician's breath as they are playing the saxophone. In the human body, the structures that are involved in the air pressure system are the trachea, the chest wall, the lungs, diaphragm. Then we move on to the second of the four systems, the vibratory system. It's made up of material that can vibrate when activated. So if we're thinking about the saxophone, we're thinking about the reed as the vibratory system. This creates pitch. In the human body, the vocal folds, are what create pitch. They open and close, and that lets short puffs of air come through the glottis at high speeds. And the number of vibrations per unit of time is what creates pitch. Low pitch is the result of the vocal folds shortening and vibrating more slowly. Whereas high pitch is created by lengthening the vocal folds and vibrating more quickly. Loudness is determined by the subglottal pressure which is generated by the abdominals and modulated by the pelvic floor. And then we have our third system, the resonators. They are going to amplify the vibrating sound. It's the actual physical saxophone itself. They affect the richness of the vocal tone. In the human body, that's going to be the throat, the oral and nasal cavities. This is what is going to create someone's recognizable voice. Then the final and fourth system is the articulators. They are unique to the human voice. So there is no analogy for an instrument here. Articulars add quality and timbre. They modify sound shapes as they leave the mouth, which creates recognizable words. And these are the tongue and the soft palate, the lips. So in summary, for phonation or voicing, the voice is produced via the interaction of those four systems. Subglottal pressure creates sound pressure and intensity, via rapid oscillations, the vocal folds produce sound pitch. Via the vocal tract, the glottal sound is articulated, adding in someone's unique voice timbre. And then intra-abdominal pressure is controlled and generated with the rest of the core canister. And that's going to be mostly the pelvic floor and abdominals helping out with that piece. So during phonation, the primary muscles and their actions involved in the inhalation portion remain the same. So prior to speaking, we usually inhale and then we talk, talk, talk. The exhalation portion of respiration is like I said, when we phonate. COMPARING EXHALATION TO ACTIVE SPEAKING So I'm going to talk about the two differences between quiet exhalation and actual phonation or speaking. One is that the vocal folds don't stay open like they do in quiet exhalation. During phonation, they are doing the vibration, opening, and closing through the different frequencies to produce pitch. Second, when it comes to the pelvic floor, there's very little research on what it's actually doing when we are phonating. Aliza Rudofsky is paving the way in these uncharted waters when it comes to research on the pelvic floor, phonation, and the voice, A study she published in 2020 looked at the glottis and the pelvic floor via bladder displacement. So they used 2D ultrasound imaging and folks without pelvic floor dysfunction. She had participants in a standing position. We love that because most singers stand or most people when we're talking, going about life, we're either sitting in an upright position or likely standing. And she had participants, she cued them to do a pelvic floor contraction, to do a pelvic floor strain, as if they had to go to the bathroom. And she also gave them some cued phonation tasks, like saying, ah, for three seconds at different pitches. She also had them take a note and go from low to high. And then she had them do some grunting. She found that during the pelvic floor contraction, the bladder moved cranially, or upwards, and during straining, the bladder moved caudally, or downwards. This is what we would expect. Interestingly, for the phonation…

    Full show notes at the publisher

    Episode 1601 - The running off-season Nov 17, 2023
    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 introduces the concept of an off-season for runners in order to focus on physical recovery, mental recovery, strengthening, and rehab. Rachel lays out a structured off-season approach for clinicians to use when working with runners. Take a listen to the episode or read the episode transcription below. 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 SELINA Good morning, everyone, and welcome to the PT on Ice Daily Show. Okay, I'm happy to be here as your host today. My name is Rachel Selina, and I'm a TA within our Endurance Athlete Division. So I TA for our Rehabilitation of the Injured Runner, both our live and our online courses. Our online course starts again on January 2nd, so if you're hoping to get into the next cohort of that, registration is open now, you can jump in online. It'd be a great way to kick off your new year Um, so we'd love to have you there again, January 2nd is when we start that next cohort. Um, so today, today we are going to dive into some running related topics. THE RUNNING OFF-SEASON I want to talk about the running off season and kind of what it is, how it could be structured and really at the end of everything, like why we should take one or why we should encourage our runners to be doing an actual off season and what that could look like. Why do we need this? It's a big missed opportunity. I don't think many of our runners are taking an actual off-season, even though in almost any other sport, we see an off-season that has a particular structure that looks different than our typical in-season, pre-season kind of training. But we don't often see that in running. And here I'm mainly talking about our recreational runners. So not our elite, elite, highly competitive, like they're getting paid to run. Um, but our everyday person that has goals has things they're trying to achieve with their running. Um, but again, not quite that high end elite athlete. Um, and it's really not what I see people doing. Okay. So what I often see. And I live in Michigan, so this is a bit skewed for kind of our timeline, but the same kind of like concept applies. I live in Michigan, so most people end up having like a fall goal race. And that might be a like a marathon or a half marathon. But they train a lot over the summer, building up to that race. It happened in the fall. And maybe they're using that race as a like a they're going for a goal. They're going for a PR or they're using a lot of people are trying to qualify for Boston. OK, so either way, that that fall event is something that someone is really training for, has a specific time goal, and is pushing, usually pushing their limits to get there. After that, right, event happens, and then people usually take one to two weeks off totally, like no running. And then usually I see it as people kind of taking that totally off of like anything. And then after that two week period, I kind of jump back into running, back into training, maybe slightly less volume, right? Long runs aren't going to be quite as long, but I typically see people kind of jumping back into the same type of schedule, like training five to six days a week. I'm still usually working in some like sprints or hill work, track work, something like that. Um, so really not a, apart from those two weeks immediately after not a clear, like differentiation from what their training was prior to that race. On the flip side, I see some people where they do the race and then they're just done running. Like I don't want to run in the winter. Um, so I'm, I'm not going to run it all after my goal race until spring. Can I argue both of those probably are not our ideal situation. So I think, like I said, it's a missed opportunity and I think it's missed because there's a lot of benefit in doing an off season. Primarily four reasons we're going to cover. So I'm going to take this down a little bit. PHYSICAL RECOVERY I think the first one is physical recovery, right? Someone typically, if they're building up to a goal race, has just spent the last three or four months, like progressively overloading every single week, building, building, building mileage, right? It's a continuous training cycle that adds up to a lot of fatigue. Some runners, right, we can encourage to take recovery weeks during their training, which can be helpful to like mitigate a little bit of that fatigue. But for the most part, people are constantly building their mileage, increasing their mileage and intensity over that three to four month period. So by the end of it, right, that's been a big stressor on the body, whether someone feels like recovered after their one to two weeks off of running, right? There's probably a little more going on underneath that the body is not actually fully recovered where they could jump back into full-on training and expect to do well. Okay. MENTAL RECOVERY So physical recovery and then also mental recovery. Training to that extent, having to put in that amount of mileage and time into running to train well, right? Means we have to say no to a lot of other things during that time. We maybe have to say no to some family obligations or time with friends or just other activities that we like doing that aren't running, kind of everything takes the back burner. So it can also be really just mentally fatiguing and draining. So coming off of that, being able to have a period of time where we can be a little bit more flexible, be able to do different activities, not have to say no, and also be able to prioritize sleep. or like how many people are trying to fit in their running around a work schedule, family schedule, right? So often we compromise on sleep to be able to make that happen. So having a period of time where we can really build back some of those recovery practices is huge. And I think what we miss. And then it also gives us kind of that third point. STRENGTHENING It gives us an opportunity to really help our runners do a full on strength training cycle, like intentionally trying to build strength. Um, we talk about this in the running, our live running course about trying to have runners incorporate strength training into their train, like into their endurance training, um, separate sessions, but concurrently meaning they're, they're doing aerobic training and then they're also in a separate session doing strength training. And we want that because it can help reduce the risk of injuries, but it can also help improve their performance. However, in that in-season cycle, that preparing for competition, most people aren't able to load to the intensities needed to really build strength. And it kind of takes second place to the running training. So having a two to three month period, where we can switch that narrative and make strength training the focus can be super helpful to actually help someone build the capacity in their tissues, right? Here's a two to three month period where strength training is going to be kind of our priority. We can actually build the capacity of your Achilles tendons, your quads, right? Your glutes. And make sure that when you go into that next training cycle, you're actually coming in more resilient, ready to train. Your tissues can tolerate more load. ADDRESING REHAB & PREHAB NEEDS Sweet, and then our final thing I think that we could use off season for is really having a period of time where we address nagging injuries, right? Oftentimes we're seeing people come in, they're in the middle of training, their goal is to do this race. So we might let some things go or people might avoid addressing some issues because they want to finish their race. So having, again, having a period of time where we can fully address that injury, not just kind of do what we need to do to reduce symptoms and get someone to the starting line, um, could be a really helpful thing so that it doesn't become this chronic, um, you know, it goes away when I stopped training a little bit, but then it comes right back because I've never actually addressed it. It's also a good time to address our running mechanics, right? Sometimes when we're in the middle of like a really high volume training, We might want to make some changes to mechanics, but those mechanics, when we change them even a little bit, can have a big impact, which can be good, but it's also hard when the volume is so high. So having a period of time where our volume is lower lets us adapt to that new running pattern, whatever the changes that we're making in the gate mechanics, without it being such an overload because the volume's lower. Right. So we can kind of ease into that new pattern when we go back to our like building cycles for running, we're able to kind of already have that, um, but like internalized and have our body adapted to it. So it's kind of the, like the, the big pillars of what it could be, but then what that would actually look like, like, okay, that's great. STRUCTURING THE OFF-SEASON How do I actually help my runner to structure an off season? If we go back to that initial goal race, race happens. And then we do want to encourage people to take that next one to two weeks off of running, but that doesn't have to mean off of all activity. So I'd encourage runners to focus more on active recovery, not running, but maybe they're doing some light cycling, swimming, yoga, anything else that kind of helps them to recover. But then also really focusing on refueling, right? Making sure we're sleeping enough in that time, just kind of replenishing the body after everything we depleted it from, from that baby vent. So that would be like one to two weeks. And then having another one to two weeks of a reverse taper, which is where we go from not running in those two weeks off and kind of gradually build the running volume back up, um, to kind of just a moderate level. So if we think of an actual taper before a race is the opposite where we're, we're at a higher volume, we kind of drop over one to two weeks. Um, and that purpose is to allow the body to be fully rested going into a race. So that would put us about a month out from a goal race, a month after it. And then I would encourage you to ask your runners to take two to three months after that of an off season. Okay. And that would look like keeping the volume at like no more than 60 to 70% of what they were previously running. Like as their, like their top training weeks or kind of their, their average volume week over week. So if someone was training 40 miles a week in preparation for, say, a marathon or half marathon, having them drop down to where they're not doing more than 24 to 28 miles a week. And that might look like going from training five to six days a week, running training, to dropping that down, running only three or four days a week. And that extra time, again, it doesn't have to be Like you just have to rest. Um, but filling it in with other activities that someone likes to do strength training, maybe it's CrossFit or swimming or yoga or climbing. Okay. And then finally, the intensity of this time should also be dropped down. Okay. We don't want, this isn't the time to like be working on our hills, our hill repeats, our sprints, our interval work, our track work, right. Keep the pace. low enough that it's like easy running. Okay. And then when the body is actually fully recovered, we can enter into that next cycle, ready to go, ready to push again and actually see benefit because the body's recovered and able to adapt to that new training stimulus. So the, the only other, um, It's kind of different situation here. Like what I've been talking about is someone who running is their main thing. Like they like to run year round, they're maybe doing a couple of different races in a year. If we have someone who's a true like multi-sport athlete, where they'll run during say like summer and fall, but then in the winter they switch, maybe they switch to skiing. Okay, that person's going to maintain their aerobic training, from the skiing, and they might not really wanna run at all, which I think we also need to have a bit of caution there, using that other sport as the off season, because running has such a different training load, right? It has that impact that differentiates it from any other activity. So we don't want someone's tendons and tissues to become unadapted to that stimulus of loading and running. So even if someone is taking their off season to pursue a different sport, still encouraging them to get like two to three, at least exposures to running or plyometric training. And it doesn't have to be long, right? Maybe it's asking your runner to do like, can you give me two 20 to 30 minute runs a week, right? Even with your other like skiing training. If they're like, nope, I don't want to run at all. Can we at least get some plyometric training? Can we work a little bit of jump rope in there? Can we work some just other kinds of jumps, box jumps, drop jumps, anything like that to still get exposure to impact loading? And I think like a lot of that can be more coming from a coaching perspective, but I think it's also important in the clinic, especially if we think that most people, when they have a running injury, they don't come to us until it's a big deal. That's kind of our typical pattern, which usually can look like someone coming to us shortly before a race, right? So our focus there to help them meet their goal has to be a little more on kind of like putting out the fire, helping them get to the starting line for their race. But if we can set patients up with the expectation, hey, this is going to help you get to your race. But then afterwards, like I want you to come back and see me. so that we can really address what's going on, right? I want you to take, especially if someone's dealing with an injury, I want you to take this off season afterwards. We're going to work through to make sure you're 100%. We're gonna drop your running down a little bit, make sure you recover so that when you go back to that next cycle, you are actually ready to go. This issue is no longer nag…

    Full show notes at the publisher

    Episode 1600 - Your tribe dictates your vibe Nov 16, 2023
    Show notes

    Alan Fredendall // #LeadershipThursday // www.ptonice.com In today's episode of the PT on ICE Daily Show, ICE Chief Operating Office Alan Fredendall discusses how and why behind more carefully curating the digital & social media content you consume on the internet. Take a listen to the podcast episode or read the full transcription below. 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 Team, what's up? Welcome to the PT on ICE Daily Show. Happy Thursday morning. I hope your day's off to a great start. Glad to have you here on the PT on ICE Daily Show. My name is Alan. I'm happy to be your host. Currently, I have the pleasure of serving as the Chief Operating Officer here at ICE and a lead faculty member in our Fitness Athlete Division. Leadership Thursdays, we talk all things practice management, small business ownership, and general leadership tips for all of you out there who are leaders in your own way. Leadership Thursday also means it is Gut Check Thursday. This week's Gut Check Thursday couldn't be more challenging but also simpler than getting out there and hitting a 5k run or if you can't run hit a 5k row. Great aerobic test. As I get more into endurance running, I would argue I've been learning to hate 5Ks the most if it's a really uncomfortable distance to settle into kind of a longer, slower pace of, you know, you're setting a good pace on the first mile. Dang, I'm almost a third of the way done. Second mile, third mile. can be quite an aggressive distance. It's the most commonly programmed CrossFit workout if that surprises you. I've posted some benchmark times as far as percentiles for both the 5k row and the 5k run to kind of compare yourself to where I stack up against the general population. So have fun with that one. It's good to test that at least once a year and see how your 5k has changed, especially if it's a goal for you to get your aerobic, your longer energy system a little bit more efficient, and specifically to get better at maybe 5k runs. Some courses coming your way. Before we talk about these courses coming up before the end of the year, I want to challenge you that if you are in the market for an ice course, and you're able to purchase a course before the end of this year, you should do that. Wink, wink, wink, right? There might be a change being announced soon that would make you regret not purchasing now. So you'll see that maybe an announcement coming soon. courses before the end of the year we're almost done we have some courses this weekend but that's probably too late for you we'll be off next weekend for Thanksgiving and then we have just three weekends left of live courses in 2023 December 1st through the 3rd that weekend you can catch Paul up in Bellingham Washington for dry needling upper body You can catch Zach down at his home base at Onward Tennessee for cervical management. Christina will be up in Halifax, Nova Scotia, A for Pelvic Live. Ellison will be down in Tampa, Florida for dry needling lower body. Cody will be on the road for extremity management out in California in the Bay Area in Newark, California. Brian Melrose will be in Helena, Montana for lumbar management. and Julie Brower will be on the road in Candler, North Carolina for Older Adult Live. That's right outside of Asheville. The weekend of December 9th and 10th, we have Fitness Athlete Live. That's your last chance to catch that course this year. That'll be with Mitch Babcock out in Colorado Springs, Colorado. You can catch Extremity on the road again, this time with Lindsey Huey in Fort Collins, Colorado. And Older Adult Live, your last chance this year will be in Portland, Maine with Alex Germano. And then our very last course of the year, of course, we expect nothing less than a person of Paul's caliber to be the last person working this year. He will be in Salt Lake City for dry needling his upper body. That'll be the weekend of December 15th, 16th and 17th. That's a three-day course. So if you're in a state that needs a lot of hours like Washington, or Maryland, that'll be a chance to catch a three-day version of that course. A course is coming your way from us here at ICE. YOUR TRIBE DICTATES YOUR VIBE Okay, let's talk about today's topic. Your tribe dictates your vibe. You've often maybe heard the other way around. Your vibe attracts your tribe. How you carry yourself, your personality, your values, kind of attract the people around you that are maybe in your friend group, your colleagues at work, that sort of thing. I want to talk about it from the other angle your tribe dictates your vibe, of the people you choose to follow, whether they're actual in-person people or specifically today's topic, of the people you follow on social media can really dictate not only how you feel about yourself, care yourself, but of what you might begin to spend your time and money on for the worse or for the better. So I really, really, really want to stress that social media, I think, is destroying our society for the worse. Certainly, it has value in things like this and sharing information and education. from one person to a large group of people. But I think overall, we can begin to follow people who appear really relevant to our lives. But actually, if we do a really deep dive, we understand they actually have very little in common with us. And then ultimately, at the end of the day, we're in charge of who we follow. Many of us are not on social media against our will. And so that the emails you subscribe to, the social media accounts you follow, all of this digital content that you consume can have positive or negative effects on you. And to really stress, if you take nothing else away from this episode, to be really diligent in the streams and feeds that you begin to curate as you begin to follow email newsletters, social media accounts, and the like. THE PITFALLS OF THE INTERNET: TALKING TOUGH & SOUNDING SMART The first point I want to make today is The pitfall of the internet, as it's always been since its inception of consumer-based communication, is that it's super easy to talk tough and sound smart on social media. We live in a very impatient, rapid-fire, fire-and-forget type of world now. You may not know, but certainly, if you work at all in customer service, you experience, that the average expected response time to an email or social media message is now 10 minutes or less by the average customer. That's a study from Forbes from this year in 2023. I could say a whole bunch of crazy stuff right now on this podcast. I could say it in a social media post and I would have almost no side effects come to me because our society now is so rapid-fire, so fast, so consumable that you would consume this. Maybe what I'd say you would resonate with, maybe it would make you upset. It doesn't matter because you will forget about it in three minutes when you scroll on to the next piece of content. on your social media feed or the next podcast episode that you queue up. The only regulation on what we say is from you all, from the consumers. What's noticeable on social media is that the people who tend to be the most aggressive and make the largest blanket statements are often those who do so without any sort of evidence or support. They're also not the people who tend to engage in the stuff that they create, right? They're very aggressive. They fire something out there. They know it might make you upset. You might actually make a comment. And that's kind of their goal, right? That drives their engagement up. That shows their post to more people. Maybe it further upsets people. It gets more comments. And what we need to realize is that cycle is kind of what fuels those people to have large follower bases, to be able to advertise different things to you. Hashtag, you know, ice barrel, try out your hashtag toe spacers, right? Those people are trying to strike a nerve on purpose to get more engagement, more followers, more followers, engagement equals I can make more money selling sponsored things to you. So we need to be aware of that trap that is out there for us on social media and be aware of the pitfall of the internet and social media itself of this very consumable temporary transient content and recognize if you're falling for that trap of if you are getting upset and making comment or if you're following people who make kind of outlandish, unsupported statements. If that makes you upset, again, the whole theme of this episode is why are you following accounts like that. YOU HAVE NOTHING IN COMMON WITH THE MAJORITY OF PEOPLE YOU FOLLOW The second point I want to make of why are you following accounts like that is that you have nothing in common with the majority of people that you follow and obtain content from. You're making less money than you want to. You're working more hours than you want to. You're not feeling as physically well or as fit as you want to. You're not happy with how your body looks. Maybe you're not happy with how your marriage is going how you're raising your kids how your sex life is going, and how your postpartum recovery is going. You name it, you're being told that whatever is wrong with you, X is Y with you. Y is the solution, right? You are not having a good life because you don't wake up at 4 a.m. and do a 6-hour morning routine. You're not having a good life because you don't wake up and do a gratitude journal, use toe spacers, do yoga, meditate, do a cold plunge, or a sauna, or any of these other things that you're told are the difference between this apparently very successful person and you. But often when you do your research, when you look behind who are these social media influencers, you're often being sold solutions by people that are usually millionaires and who are usually millionaires, not because of the stuff they're telling you that they do, but because they're convincing people like you to buy the stuff that they're selling. And that's how either they are making their money or they're maintaining the level of income that they already have, right? Or maybe they started out in life and mom and dad footed the bill for college and for grad school and for their first house and they don't have a lot of debt and so they have a lot of extra time, they don't need to work as much to become this social media influencer and begin to sell you supplements and Toast Facers and all this kind of stuff. And the more you listen to those folks about what's wrong with you is that you're not consuming this stuff, the more money they actually make and the bigger that asymmetry actually comes. What's not said is that a lot of those folks have made their money by living what they're doing right now, which is a very imbalanced life of working more than you want to in order to try to pull yourself up the socioeconomic ladder. You're told that you're burned out or whatever and really the cause of their success is doing what you're doing right now and eventually getting to the point where their success comes to a level where they no longer need to work as much and maybe now they have more time to show you a video of them working out on the beach in Bali. And by the way, use my promo code Stephen10 for 10% off, whatever. And again, the more you consume that, the richer that person becomes. But at the end of the day, you do not have a lot in common with that person, yet you are trying to model your life after them, even though that's not how they currently live their life. And maybe that's not how they ever lived your life. These people are happy, healthy, and fit because they don't have to go to work anymore. Or maybe they never had to go to work. They can wake up and do their morning routine and go surfing because they're able to afford a full-time nanny to take care of their kids. Or maybe they don't even have kids and they get 12 hours of sleep because they have a night nurse. Or again, maybe they don't even have kids. And you get my point that they are living a very different life than you and maybe they never lived the life that you did. So it doesn't make sense for you to spend a lot of your time consuming their content and buying the stuff they're selling to somehow try to fix your life. Follow people who represent you, who represent your values, who are honest about where they made their money or how they got to the level they are at. I tend to follow people who are very upfront about how they got where they're at by pulling themselves up from being very, very, very, very poor, working a ton, and pulling themselves up the socioeconomic ladder. Is that ideal? No, but sometimes that is life, as true as it can be. And I resonate a lot more with those people who say like, look like this was the way that worked for me. It may not work for you. And I appreciate those people who are honest that look, it was a lot of years of 100-hour work weeks, working multiple jobs to pay off my debt to afford a house, to raise kids, and kind of get to where I'm at now. And I really, really appreciate that transparency, especially more as life goes on. So, what can we do about this of recognizing that Social media is meant to be fire and forget, instantaneous, consumable? It's meant to sell you things. It's meant to show people who maybe have nothing in common with you that you want to see yourself become only if you buy these products. If that's the way it's designed, what is the solution? CUT THE CORD The solution is to cut that cord, right? Take a serious examination of the accounts you're following, of the newsletters you subscribe to, of in general the content you consume digitally via social media, email, whatever, and stop following stuff from people who make it seem like the only reason you're not obtaining the fulfillment you want is that you aren't buying enough of the stuff that they're selling. Stop following accounts that tend to speak on best practices, but speak so dogmatically. Manual therapy sucks, it has no value. On the other side of the continuum, manual therapy cures diabetes, right? Stop following that stuff if you don't actually believe that stuff. Some of us follow that stuff just to watch the c…

    Full show notes at the publisher

    Episode 1599 - Patient education: finish the drill Nov 15, 2023
    Show notes

    Dr. Julie Brauer // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Julie Brauer as she discusses that the problem with patient education lies in the tendency of healthcare professionals to overwhelm patients with excessive recommendations, mistakenly believing that this approach is effective. They often act like a "fire hose," bombarding patients with information without considering whether it is truly understood or has a positive impact. This ineffective method of simply talking at patients, providing detailed explanations, or presenting long to-do lists is often learned from clinical instructors and perpetuated without recognizing its limitations. To enhance patient education, healthcare professionals should adopt a three-step framework. This framework involves "show and tell" by combining education with action and intervention, clarifying and recapitulating information to ensure comprehension, and following up and following through with patients to establish mutual accountability. By implementing this framework, healthcare professionals can avoid overwhelming patients and ensure the effectiveness of their education. Take a listen to learn how to better serve this population of patients & athletes. 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. JULIE BRAUER Welcome to the Geri on Ice segment of the PT on Ice Daily Show. My name is Julie Brauer. I am a member of the older adult division. Excited to be here with you all on Wednesday where we jam on all things older adults. Excited to be talking to you all this morning about patient education. Our topic specifically is patient education finish the drill. All right, so what we are going to talk about this morning is the problem with what many clinicians perceive to be effective patient education. And then I'm going to unpack a three-step framework that you all can use to level up your patient education interventions. And I'm going to then share a few really detailed examples of how you can implement this going forward using clinical scenarios that many of you all experience pretty frequently. The goal here is that we just walk into the rest of our week doing 1% better, okay? THE PROBLEM WITH PATIENT EDUCATION: THE FIRE HOSE All right, so what is the problem with patient education? The standard. Too often, we act like a fire hose. We flood our patients with too many recommendations, and we think that it's effective patient education. Team, we cannot fool ourselves. that simply talking at our patients, right? So explaining the very detailed pathophysiology of their condition or explaining their fall risk profile after running your outcome measures or giving them a 10 item to-do list of safety and lifestyle recommendations that they have never heard before and assume that we are making a positive impact. Many times I think this comes from the fact that we didn't really learn in school how to be effective at communicating to our patients and providing education. And then we just kind of followed what our CIs did, right? I am so guilty of this. I remember as a new grad going into a patient and you're so excited because you want to tell them everything in your brain that you know, you want to share your knowledge. And I remember I would just fire hose, fire hose for 10 to 15 minutes and I would walk out of that room and be like, man, I crushed it with Dolores. Like she just learned so much. I just did an awesome job. And then I would sit down and write literally a paragraph of all the things that I educated my patient on. And for some reason, because I wrote an entire paragraph of my educational interventions, that must make it good, right? Like I perceived that I did this awesome thing. So I think that's a scenario that we find a lot. The other scenario, which I've also been here, and many of you have probably been here too, is that you constantly have this productivity being shoved down your throat, or you are just so freaking burnout and so exhausted, you look at your clock and you're like, I gotta get this last patient in. I gotta get this last patient in. I'm exhausted. I don't have a ton of time. I don't know if I'm going to get a second set of hands to get them up to do any exercise interventions. So what am I going to do? I'm going to go into this room and I'm going to sit there and I'm going to educate. I don't even know if I can stand up to do it. So I'm going to just stay in my chair, educate and type as I'm there. I know a lot of us had been there, right? I know a lot of us have been there, but are we really helping our patient? Do we really think that just by sitting there and telling them a bunch of stuff, it's going to cause any positive impact? We have to really start to dig in there. So I want to offer you all a solution. I'm going to explain this three-step framework. So what does finish the drill mean? It means one, we're going to show and tell, Two, we are going to clarify and recap. And then three, we are going to follow up and follow through. So let me unpack each of those. SHOW AND TELL, CLARIFY & RECAP, AND FOLLOW-UP & FOLLOW-THROUGH Show and tell. Are we pairing our education with action on our part, an intervention, a demonstration? Are we facilitating action on our patient's part? Show and tell. Next, clarify and recap. Are we ensuring that the education that we are giving, the literal words, the process, the steps that are coming out of our mouths is actually being understood? Are we ensuring that the message we are sending is being received in the way that we intend? Are we asking the patient to recap what they heard? Are we asking questions to clarify misunderstandings or gaps in knowledge transfer? And then lastly, follow up and follow through. Are we following up with the patient after we make those recommendations? Are we following through with a caregiver or the next provider? Are we holding ourselves accountable and the patient accountable? That is what it means to finish the drill. Show and tell, clarify and recap, follow up and follow through. Okay, let's go through a few scenarios to give you guys a very detailed, clear example of how you can implement. I have a massive list of these, but I'm just gonna give you three here this morning, okay? All right, for you acute care clinicians, You have Dolores on your caseload. She has just had a lumbar fusion surgery, and you go in to evaluate her. Instead of just telling her, Dolores, you have movement restrictions. No bending, lifting, or twisting, right? We all know the BLT restrictions. What we know is that restrictions can cause a lot of fear. A lot of patients never discharge them and they walk around like they're in straitjackets for a really long time. So instead of just telling Dolores what she can't do, let's show and tell. Let's show Dolores how to hip hinge safely. and distinguish that from actually bending and flexing at the spine. So how do we do that? If many of all have been following ice for a long time, you know this awesome hack. You can take the toiletry bucket that is in Doris's room. You can go take some towels, roll them up, soak them in water and put them in the toiletry bucket. You can put that toiletry bucket on an elevated surface like the bed or the chair, and you can show Dolores how to safely hinge. Let's clarify and recap. Let's ask Dolores, hey, Dolores, do you have any questions about moving your back safely and rebuilding its strength? Let's have Dolores recap the points of performance of that hinge motion and demonstrate it for us. Lastly, let's follow up and let's follow through. If you are lucky enough in acute care to see your patient twice, let's say it's the very next day, or maybe it's later in the day, on the same day, you can ask, Dolores to set the environment up. Show me how to pick this up. We are checking for Dolores's ability to have those points of performance and be able to form that hinge movement. Let's follow through, which is very hard to do as an acute care clinician because many times you have no communication with the next provider. You don't ever get to see Dolores again. How can we do it to the best of our ability? We can follow through by talking to Dolores, maybe putting it on her phone or on a piece of paper. I need you to show this to your outpatient PT. And what does it say? Can you please teach me how to deadlift? Right? We are planting a seed, passing the baton, trying to make sure she stays in that fitness forward lane because we don't want her back on our caseload. Maybe we even take it a step further and we actually recommend to Dolores a specific fitness forward PT in the outpatient setting who we are going to want Dolores to go to. Finish the drill. Okay. Let's talk about a home health example here. So let's say you have Dolores in home health. We know that her visual acuity is impaired, right? Maybe you have done an acuity test. You know that her prescription on her glasses are really outdated. Let's not just tell Dolores about the importance of vision, helping her balance to prevent a fall. Let's not just tell her to make that eye appointment with her doctor and then walk out the door and hope that she does it. Let's show her how to send a message via MyChart. Guys, systems are starting to charge patients for MyChart messages. Let's start to show them how to send appropriate messages via MyChart, right? Let's make this actionable. What if we call the doctor, put them on speakerphone with Doris, guide Doris how to schedule her own appointment to increase her self-efficacy? Let's clarify with Dolores by asking, are there any barriers that you can perceive getting to this eye appointment? Let's follow through by contacting a caregiver to schedule with them. Hey, this appointment, Dolores has a eye appointment this day, this time. Are you going to be able to take her? Let's make sure it's on both of your all's calendars, right? Or maybe we plan ahead with a service like Go Go Grandparent so that we know that the transportation piece that was a barrier is now something that is facilitated and that we have taken care of that. Okay. Lastly, let's talk about an outpatient example. All right. You're working with Dolores, an outpatient. She lives with her partner at home. She's got some balance issues. She has had a fall. So you are treating her. Let's not just tell Dolores to take up her rugs and put nightlights around her house. How often do we give that cookie cutter recommendation of let's remove all your rugs, right? Instead, How about this? How about we make this actionable and we get Dolores or Dolores' partner or a caregiver to get a video walkthrough of the pathway from Dolores' from the edge of her bed into the hallway, into the bathroom, into the living room, out her front door, whatever her normal pathway is for the day. What if we get a video so that we can actually see what her home environment looks like? And then we can say, okay, Dolores, that rug, that one, the one with the tassels that you know she's probably gonna trip over or she has tripped over. Can we get rid of that rug, Dolores? Why don't we clarify by asking, Dolores, are you willing to get rid of that rug? She may, older adults, we know this guys, right? It's really hard to tell them to get rid of rugs. They may be really resistant to that. So Dolores, are you willing to get rid of that one rug? Because you have gone through and you've triaged out of all of the rugs, that's the one that's gonna cause us the most problem. What if we ask Dolores, what are your feelings surrounding getting rid of your rubs? And you dig a little deeper there. Let's follow through with talking about how we're going to actually get this done. Because maybe Dolores may not have the capability to get down on the ground and remove her rubs. So what if our follow through is calling nephew Johnny to ask him, Hey, will you, within this week, come over to Dolores's home and help her take up her rubs? Right? What if, We don't just tell Dolores to have those lights throughout the home. Now that we have the video, we say, Dolores, the lights would be most helpful if you put them here, here and there. Here is the Amazon link of some cheap but effective ones to buy. Let's put it in your cart right now. That is how we follow up and follow through and make this actionable, right? Then we can say, Dolores, here's your follow-up. Bring in a video in the next week and show me what your pathways look like now. So you are able to see that we have followed through with this recommendation. The nightlights are where they're supposed to be and the rugs are taken out. Guys, this is what it means to finish the drill with our educational interventions. Show and tell, clarify and recap, follow up and follow through. I would love to hear you all take this framework into the rest of the week. And while you're with your patients and you're starting to just fire hose and spew out those recommendations, I would love for you to pause take the pause and really think how you're going to finish the Drew. How are you going to show and tell, clarify and recap, follow up and follow through? All right, team, that's all I got for you today. Lastly, let's talk to you all about our courses that are coming up. We have some sold out courses, which is wild to have at the end of the year. November, we have a sold out course in Illinois. In December, we are sold out or we're very near sold out in Portland, Maine. And then we have another chance for you all to catch us on the road in Asheville, North Carolina. In January 1st of the year, we are going to have both of our online courses, our Level 1 and Level 2, formerly known as Central Foundations and Advanced Concepts, that are going to be starting up on January 10th and 11th. You know where all that info lives, ptinex.com, mmoa.online. Hit us up if you have any questions. Go out there and start to make those educational interventions. Just 1% better team. All right, y'all. 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 th…

    Full show notes at the publisher

    Episode 1598 - A fitness-forward approach to post-op extremity care Nov 14, 2023
    Show notes

    Dr. Lindsey Hughey // #ClinicalTuesday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Extremity Division Leader Lindsey Hughey discusses various approaches to promote system-wide healing. One key aspect highlighted is the importance of education in the healing process. Lindsey emphasizes the need to educate patients about their condition and what to expect during their recovery journey. This includes providing information about tissue healing timeframes and milestones for progress. By equipping patients with this knowledge, healthcare professionals can help them understand their recovery process and make informed decisions. Mindfulness is another approach mentioned in promoting system-wide healing. Lindsey suggests that practicing mindfulness techniques can help reduce stress and promote a calm mind. This can be achieved through activities such as breathing exercises, journaling, or spending time outdoors. By incorporating mindfulness practices into their daily routine, patients can support their overall healing process. Exercise is highlighted as a crucial component of system-wide healing. Lindsey emphasizes that exercise should not be limited to traditional rehabilitation exercises but should also include activities like walking programs. For instance, in the case of total knee surgery, she suggests starting with a 10-minute daily walking routine and gradually increasing it to reach the recommended 30 minutes per day. Engaging in regular physical activity can improve overall fitness and support the healing process. Diet is also mentioned as a factor that can promote healing, especially after a trauma such as surgery. Lindsey emphasizes the importance of nutrition in supporting tissue healing. Specific dietary recommendations may vary depending on the type of surgery and individual patient needs. However, healthcare professionals are encouraged to promote a healing-focused diet that provides the necessary nutrients for recovery. Lastly, sleep is highlighted as a crucial element in promoting system-wide healing. Lindsey acknowledges that getting enough sleep can be challenging during the early stages of healing. However, they suggest providing patients with sleep hygiene tips, such as turning off electronic devices before bed or maintaining a cooler room temperature. By facilitating good quality sleep, patients can support their body's healing processes. Take a listen or check out the episode transcription below. If you're looking to learn more about our Extremity Management course or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey 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. LINDSEY HUGHEYGood morning, PT on ICE daily show. How is it going? It is clinical Tuesday. I am Dr. Lindsay Hughey from Extremity Management. I led that along with Dr. Cody Gingrich, Dr. Mark Gallant, and Dr. Eric Chaconas. So happy to be with you all on a clinical Tuesday. It's been a little while. Today I'm gonna talk with you about fitness forward post-op considerations for extremity management. It's a topic that often gets asked about on our weekends and our weekends don't actually have the bandwidth to hold those questions. So I'm gonna start sharing on PT on ice a little bit more here. So I'm excited to talk with you about that. But before I do, I want to share some upcoming courses that Mark, Cody, and I have because there are only a couple more opportunities left to catch us this year. And for those courses, we are getting close to 30 for each. And so spots will run out. So if you're on the fence, consider purchasing that in the next couple of weeks. So Fremont, California, Cody will be there on December 2nd and 3rd. And then the final opportunity this year is at CrossFit Endure in Fort Collins, Colorado, on December 9th and 10th. And that one's going to be a blast and numbers are growing. So please sign up now. If you miss those two opportunities just because family stuff's going on, know that we have offerings early in January as well. So Mark in Richmond, Virginia, on January 13th, and 14th, that same weekend, we're also offering a course with me in Louisiana. So please check out our calendar. We hope to see you on the road soon. A FITNESS-FORWARD APPROACH TO POST-OP EXTREMITY CARE So today's topic at hand, we're going to dive into what a fitness-forward approach looks like when we are managing extremities post-operatively. So I want to first just talk about the framework generally, and then use an example. And the example today we'll talk about is total knee replacement. But there are five underlying pillars that I see that are required if we really want to have an all-inclusive approach that is fitness forward for these folks. So number one, we have to be really familiar with tissue healing timeframes of that condition and what to expect and not expect for that patient along their healing journey. So we have to be intimately acquainted with what's normal and what's not, and then be willing to educate the patient about that. So that second pillar is really education. So letting the patient know in whatever surgery they have, whether upper or lower quarter, what's really gonna facilitate healing? What are the expectations for recovery in regards to milestones that they need to hit by certain times and what milestones allow them to progress? There are certain timelines that we can't violate and range of motion precautions based on that specific surgeon. So really make sure we educate the patient and they are fully aware of those precautions. As Zach Morgan said in one of his podcasts recently, we have to catastrophize rest. I'm really letting someone know that rest will never be the thing here post-operatively. Yes, we might have to rest that directed limb, at times, but our body needs movement. It needs blood flow. And so really getting that message early that just because you just have surgery doesn't mean you'll just be sitting and laying around. We actually need to move to promote blood flow and healing to that extremity. Number third pillar is the protocol. Really being intimately aware of whatever protocol the surgeon gives knowing the timelines and actually reviewing them with your patient. Not all surgeons will have a protocol, right? Every surgeon's a little different, but find an evidence-based one based on that surgery and compare a couple of them if the surgeon isn't giving you one. It is really important to kind of sit down with the patient and briefly review that so they really understand, again, what's normal and what's not, knowing what safety precautions are on board from a range of motion and active range of motion versus passive range of motion perspective, and then again, those milestones. Pillar four, system healing. How do we promote system-wide healing? Well, I already mentioned a little bit about our education, about how we're going to catastrophize rest, right? We are going to keep our humans moving, but here's where meds will come in again. And if you've heard me on the podcast, you know, or even seeing my reels, you know, meds is something I'm really passionate about. Mindfulness, exercise, diet, and sleep. And really unpacking what each one of those is for your patient, right? So mindfulness, something that kind of soothes their stress and mind or soothes their soul, helping that connect them with that, exercise, keeping that human moving in whatever way possible, diet, promoting nutrition that promotes healing, especially after a trauma, even though it's a controlled trauma, surgery is traumatic on all of our tissues. So make sure the diet matches that, and I'll unpack some of those things that promote healing as we talk about our total knee example. And then sleep, really helping facilitate ways to help a good deep sleep, that seven to nine hours, and it's so hard in those early healing stages, but giving the tips that you think will help. And it could be as small as turning your phone off an hour before bed, right? Or keep the room a little bit cooler, around like 65 degrees to help them sleep, just giving them those sleep hygiene tips. more on that as we talk about the total knee example. And then the final pillar when we're thinking about fitness forward postoperative care is capacity rebuilding. And what I mean by that is considering all tissues involved in the surgery. So think muscle, think tendon, Think ligament if that's on board. Think skin integrity, right? Because there's an incision on board. And think bone. All of these are challenged. Their capacity is challenged because there is a period where there needs to be some precautions and rest on board. And there needs to then be a period where we gradually build up that capacity as it's going down. And it is our job to prevent loss of capacity as much as possible, and then also build it up as efficiently and safely as we can. And so there are three subsets in this capacity rebuilding phase. So consider when we're thinking about like the muscle, intend and think working locally, but then also think globally right. We don't want to be just so focused if it's a shoulder surgery just on the shoulder right. We also want to be thinking about scapulothoracic muscles. So local and global considerations are key. The second subset is nervous system offense. I think unless someone complains of numbness, tingling, and vague pain sensations, we kind of ignore the nervous system. But consider the nervous system is extensive, and our muscles, ligaments, bones, and tendons are all mechanical interfaces of the nervous system. So we can use the nervous system to promote intraneural healing and blood flow offensively. So consider using your nerve glides early more for tissue healing blood flow and intraneural nutrition. So thinking about it offensively prevention. In addition, consider central sensitization prevention, right? Again, this is a controlled trauma. And we know that folks who have surgeries or injuries are more predisposed to getting injured again. So consider that things like two-point discrimination training, laterality training, and pain pressure threshold are something we should both check on and possibly train if we see impairment side to side. And I'll tell you, in those initial early stages, that four to six weeks, there is definite nociceptive pain damage on board, but consider as we get towards the end, halfway through to the end of our care, we have to make sure central sensitization hasn't occurred in those tissues or become widespread. So check and then train if necessary. And then finally, the third subset of capacity rebuilding is functional pattern training. So consider we want healthy full body patterns. And what I mean by that is initially thinking of getting someone independent in their ADLs and IADL functions. Initially, they might need some assistance, but then eventually we want to normalize those patterns so they don't need any kind of assistance, whether that be a brace or an assistive device. And then we want to prepare humans not just for daily living, normal daily living, but think of job and sports demands. ultimately functional patterns will train those good functional patterns without assistance but then think about preparing for the unknown as well because things in life and sports will happen right maybe our older adult after total knee prepare for falls right think about our person after a meniscal repair like pray prepare for unstable landing. So that's what I mean when I say prepare for the unknown, right? Prepare for real life, which we'll do in a multi-segmental compound way. So to summarize, The five things. Tissue healing time frames. Two, educate your patients. Three, know the protocol and review it with your patient. Fourth, give a meds education for system-wide healing. And then five, think about how you're going to build up capacity in muscle, tendon, ligament, bone, nervous system, and then full body capacity. I wanna briefly take you through a total knee example, how we'll apply these five pillars, just so you can consider how you can apply this really to any post-operative condition. So let's think about someone with a total knee replacement, uncomplicated. TISSUE HEALING TIME FRAMES So tissue healing timeframes, considering just the timeline of care initially, it's gonna be anywhere from four to 12 weeks. And we're really usually seeing them right for those two to three months. letting the patient know, that that's a realistic timeframe. And that there are multiple things on board, right? We have an incision to heal, a muscle to heal, and then bone. And so that four to 12-week timeframe really encompasses that and lets that human know that this is just not a quick rehab process. POST-OP EDUCATION In regards to our education for someone with a total knee replacement, considering our first education strategies really need to be about signs of infection, right? And anybody postoperatively, this needs to be on board, but specific to this total knee replacement, right? If there is red, hot, and warm redness that is spreading outside of that incision. Here's where we make that circle around, we see that redness, and if it spreads outside that, that becomes an emergent thing that they need immediate medical assistance for. Consider letting them know the systemic temperature. If they're running a fever greater than 101 Fahrenheit, they need to, again, get to their doctor quickly. These are things we don't wanna mess with when we think about infection associated with the prosthesis. If there are dramatic increases in pain that are debilitating, another coinciding sign of infection. So that needs to be a part of our initial early stages of education. And then obviously we're educating about our HEP and its importance, but then we need to get into some of that nitty gritty of what facilitates healing. And I can't keep echoing Zach Morgan enough that we need to catastrophize rest, that letting that patient know that they shouldn't be sitting or laying around more than 30 to 60 minutes at a time. They need to keep moving so that systemic healing can happen. Giving them specific movement HEP parameters about exercise, and we'll talk more about the specifics on this in the med section for holistic wellness, but walking, a walking program, or cardiovascular program is crucial with someone with total knee replacement because we know of the underlying metabolic disease that coincides those. that are getting a total knee replacement. And then again, in our education bucket, ex…

    Full show notes at the publisher

    Episode 1597 - Varicosities and varicoceles Nov 13, 2023
    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 describes pelvic varicosities & varicoceles. Rachel breaks down the difference in how these present in both male and female pelvic physical therapy patients as well as how to conceptualize treatment in the clinic. Take a listen to learn how to better serve this population of patients & athletes. 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 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 MOORE All right, good morning PT on ICE Daily Show my name is Dr. Rachel Moore I am here this morning. It is Monday morning. That means it is our pelvic day here on this podcast So I'm here with the pelvic division and I am super excited to talk to you guys this morning We're gonna be kind of diving into varicoceles and varicosities, vulvar varicosities, and the way that those are actually incredibly similar in our treatment approach, whether we realize it or not. Before we dive into that though, if you missed it, we've officially rolled out all of our certifications here at ICE. So we have certifications, we've had them before in the clinical management of the fitness athlete division and an MMOA, but now we have new ones. So we have orthopedic, we've got dry needling, we've got an endurance athlete, and then what we are super excited about in the pelvic division is we have our pelvic cert as well. So this is three courses, two online, a level one and a level two, and then one live course. If you're looking to get in on that certification, our upcoming courses, we actually have one this weekend in Bear, Delaware. That's going to be with myself and Alexis Morgan. So super excited about that. Still, time to hop into that if you want to buy yourself a plane ticket and get out there. And then we also have one on December 2nd. If you are north of the US border in Canada and Halifax, Nova Scotia, Christina is bringing those live courses to Canada. So we're super excited about that. Our next L1 cohort kicks off January 9th, and then our L2 you can already sign up for. So if you want to be in that first cohort of that L2, it kicks off April 30th. So if you're interested in getting that cert, all of the options are out there. Hop into one of those courses. We're excited to see you in them. VARICOSITIES AND VARICOCELES Let's dive into our topic for the day. So a lot of times those of us in the pelvic space if we are maybe majority see women a lot of us tend to maybe start there and then maybe branch off into seeing men but if we are in this kind of blinders-on situation where we're like no no I only see women sometimes we may be uncomfortable or unsure if somebody gives you a call and asks about a certain diagnosis or maybe you have a friend or somebody that you know that is struggling with something and asks for advice on the pelvic space and you're trying to figure out how to get them into your clinic. And so I wanted to draw a parallel this morning between two diagnoses that we see as fairly common that actually are very similar in the way that we treat them. So that is going to be varicoceles and varicosities. So in utero, the reproductive tissues of males and females begin developing similarly. If you guys remember that from PT school, when we were learning about the brief amount that we cover these types of topics, once testosterone starts being released, that's when the reproductive organs shift and either develop into male organs or continue on the path of female organs. And so if the testosterone is there, then the tissue that is becoming the scrotum becomes the scrotum. But if the testosterone is not there, then that tissue continues on to turn into the labia. So when we think about our tissues and our anatomy, we often talk about how male and female anatomy really aren't that different. It is similar parts arranged differently and maybe to different sizes and proportions. But when we look back all the way in utero, we can see that developmentally these things start the same and there's a certain point where things branch, but we have these kind of analogous, um, uh, tissues within males and females. So, We know that the tissues are similar between the scrotum and between labia. When we're talking about varicosities, this is important for us to know because these are two diagnoses that we tend to see come up fairly frequently. VARICOSE VEINS IN THE PELVIS So before we dive into the specifics of varicose veins in the pelvic area, let's talk about what varicose veins are. Varicose veins, if you're not familiar with them, are enlarged twisted veins. So oftentimes this comes from damage to the valves in the veins. So our veins have one-way valves that help push blood up and prevent backflow back down. If there is damage to the inside of the vein and the valves are damaged somehow or maybe are not operating at the capacity that they need to be operating, we can see kind of a backlog of blood and that can lead to this kind of inflamed or swollen look to the veins and that blood just kind of pulls in there. The causes of the damage, quote-unquote, Inside of the vein can be known. So this can be something like high blood pressure or it can be unknown Things that increase your risk for developing varicosities are gonna be things like being female So that's always fun when gender is one of the top things can't control for that genetic predisposition so if you have a family history of varicosities then this might be something that you're really keeping an eye on and older age as we get older maybe those valves within the vein become a little bit less competent increased body mass and then in pregnancy we'll dive into that here in just a second and then also interestingly having a history of blood clot that's really important to kind of keep in mind on our radars not only in our post-surgical patients but we're starting to see blood clots kind of popping up more and more um and so if you have somebody who might be not hitting any of these other risk factors but has a history of blood clots it's still something that we want to kind of keep on our radar varicose veins aren't a medical emergency by any means but they can cause some like uncomfortable unpleasant symptoms like heaviness aching pain and then swelling. VARICOSITIES Let's dive a little bit deeper into varicosities of the pelvic region so in our biologically female counterparts we see vulvar varicosities this is varicosity that develops on the vulva so anywhere along the outside of the vagina so that tissue of the vulva It can happen on labia majora, labia minora. It can be going towards the inner thigh, more into that groin area. Really just kind of depends on the area that is affected. The risk factor for this specifically is pregnancy. So we see this come up in pregnancy for a few different reasons. One reason is that we have an increase in blood volume during pregnancy in order to support the baby. So that increase in blood volume means that our veins have to work harder to push more blood up. we also know that we see relaxin circulating and that does have an effect on all tissues and then we have an increase in pressure so we have increased pressure from both the weight coming down of baby placenta amniotic fluid and all the things but then if we also think about like the anatomy of a pregnant belly as people progress through pregnancy get into this maybe anterior pelvic tilt their belly maybe drops low it can cause some congestion or some backup within that system which then leads to less efficient drainage. This is something that we see pretty often in the clinic really and you might be familiar with this if you're in the pelvic space. but what we tend to not really think about is how this parallels varicose seals. So a lot of times we're pretty confident and comfortable with vulvar varicosities, but then somebody comes in with a little bit different anatomy, and we kind of get thrown for a loop. So a varicose seal is a varicose vein that's located within the scrotal sac. This can actually develop during puberty because blood flow to the genitals increases during puberty. As those tissues are maturing things can just get a little thrown off, but it can also happen as a result of surgeries So think about vasectomies even though those are like minor office procedures surgeries vasectomies or trauma to the scrotum They're surprisingly common, especially in the adolescent puberty side of things. And just because you have a varicocele doesn't necessarily mean you'll even know it, aside from feeling it, potentially. So the biggest way or hallmark of this is called the bag of worms. because within the skirt sack that varicocele feels like a thick ropey worm and so as people are feeling around checking testicles for different things then you might feel that bag of worms type sensation or that that feeling with your fingers and other than that you may not have any idea However if you have a varicose seal that is causing problems We can see swelling pain and heaviness as I talked about earlier and if this is left alone and becomes severe it can actually impact fertility in men because it can lead to decreased sperm in the ejaculate and so it can be something that if it happens in adolescence and somebody is trying to conceive later on in life with their partner and they're struggling, it's an area to look at. Just like vulvar varicosities, we see an increase in symptoms when we're standing for prolonged periods, but uniquely to this population, we can see potential pain with ejaculation. So with vulvar varicosities, we might see pain with intercourse because of the pressure on the outside of the vulva during intercourse. But with this population, it's going to be more so during ejaculation that there is pain. WHAT TO DO ABOUT VARICOSITIES AND VARICOCELES We have our person in front of us, male or female, who comes into your clinic, some varicosity of some sort going on. What are we supposed to do? Jess actually did a really fabulous episode on this topic. It's episode 1198, so if you want to go back and listen to that, she talks specifically about varicosities during pregnancy, and those same concepts can be applied to varicoceles in men. So I highly recommend giving that a listen. We're going to dive in just really briefly touch on some of those topics and then I'll let you guys really dive into justice. External support can be a game changer for these folks, especially those with varicose heels whose anatomy is already putting things in a gravity, um, disadvantageous position for drainage. So giving some type of support, whether that is like when you're getting up and moving using your hand to support or getting some type of support garment. There are specific support garments that are made both for males and females for varicosities. soft tissue massage and when we think about this we're really thinking like mimicking lymphatic drainage I talk about this all the time with breast tissue and engorgement but the same thing we're thinking about this like congestion within the pelvic region and so we want to think about clearing more proximally up Towards the iliac vein so that we can kind of promote that drainage and then work our way down Rather than coming down to the bottom and just shoving everything up and causing more congestion Superiorly, so we're starting closer to the midline Draining quote-unquote that area. So if you're watching on Instagram, we're saying we've got a guy in and he's got varicose heels maybe we're starting here and then we're working lower and then working lower and until we get to that most distal tissue. From an exercise intervention standpoint, the pelvic floor muscles, of their functions are a sump pump. So when they contract and relax, they push fluid out of areas. So teaching our patients how to do pelvic floor contractions, how to lift up and contract into the attic, relax down and go into the basement, get that pumping mechanism going, and then teaching them belly breathing on top of that to help facilitate that as well. Finally, from a positional standpoint, we can have our patients if at the end of the day, they're super symptomatic and they're feeling rough after being on their feet, laying on their back, propping their legs up on the couch, or on a wall to get some passive decrease in gravity pressure on the pelvic region, and we can even take that a step further, have them plant those feet on that surface and do some bridging where they're squeezing their glutes, maybe adding in that pelvic floor contraction, layering that in, so we've got gravity coming down, we've got our muscles contracting and relaxing, really everything helping to push that fluid up and out into the drainage system to go bring that blood back to the heart. So, if you have somebody come in your clinic tomorrow, and you are a pelvic floor PT who traditionally treats females, and a guy walks in and he's like, I have a varicose seal, I don't know what to do. I hope that you can put your cap on, thinking cap on, and realize like, you got this, you know what to do. At the end of the day, we have to remember that our males and our females, although the anatomy is arranged a little bit differently, and proportions are a little bit different, they are similar tissue. So keep that in mind. You guys are rocking it out there. Have a happy Monday. Thanks for having me. Bye. 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 CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

    Full show notes at the publisher

    Episode 1596 - Cadence Nov 10, 2023
    Show notes

    Dr. Megan Peach // #FitnessAthleteFriday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Endurance Athlete division leader Megan Peach discusses the importance of cadence in running, variables that may affect a runner's cadence, the relationship between cadence & speed, and finally the "optimal" running cadence. Take a listen to the episode or read the episode transcription below. 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. MEGAN PEACH, PT, DPT, OCS, CSCS Alright, Instagram. Here we go again. YouTube, we're on. Okay, finally. Sorry about that a couple minutes ago. I think I actually got it to work this time. Okay, we are live on Insta. We are live on YouTube. I am Megan Peach, probably the most technologically challenged person next to Jason that we have in this community. So, I apologize for the previous live feed that didn't actually work. Again, I'm Megan Peach and this is PT on Ice, your daily show. I'll be your host today. I am one of the lead faculty for the endurance division and specifically in the injured runner course, both the live and the online courses. And although our courses have wrapped up for this year actually, We are super looking forward to next year. Over the next couple of months, Jason and Rachel and I are basically doing like a big revamp of Rehab of the Injured Runner online. And so that course is going to look entirely different come January than it does right now. If you haven't taken that course and you've taken the live course already, or even if you haven't taken the live course, this is going to be a great time to hop onto that course, just because the material is going to be really complimentary to the live course, even more so than it has been in the past. And then if you have taken Rehab of the Injured Runner online already, it will be a really good time just to check in because it's going to look entirely different in terms of the material and what's in there. Remember, if you've taken that course already, you have lifetime access for as long as that course exists. And so check in with us in January for a full revamp, full update. We're super excited about it. RUNNING & CADENCE Okay, so to get to today's topic, I wanna talk about cadence. And cadence is something that I think if you treat injured runners at all, if you have in the past or you've taken one of the courses, This is a topic that's pretty familiar. It's a running gait retraining tool that we use probably more than any other tool that we have in our gait retraining toolbox. And it's used for a variety of different injuries. We could use it globally for injuries like patellofemoral pain or IT band syndrome. exertional compartment syndrome. There are even prospective studies that have looked at healthy runners and the risk factors for their injuries. And they've seen that low cadence is a risk factor for things like bone stress injuries, things like medial tibial stress syndrome. So we can use it not only to treat injuries, but then potentially as an injury prevention tool as well when somebody has a really low cadence. And then we can also use cadence retraining as a way to treat really specific gait abnormalities or mechanical faults after we've done a running gait analysis. And so typically when we are using cadence as a gait retraining tool, we're increasing the cadence by at least 10%, at least that's the goal typically. And when we increase somebody's cadence, what we typically see are first, changes at the knee joint. At least those are the most prominent changes that we would see in a runner. And the changes we see at the knee joint are things like increased knee flexion at initial contact. We see a decrease in stride length, or a decrease in foot to center of mass, in terms of where the foot falls in relation to the center of mass. We also see changes at the ankle joint, not as prominent as the knee, but we still see them there. We see with an increase in cadence, we see a relative increase in plantar flexion. So whereas we might see a lot of dorsiflexion with a very slow cadence, we see relatively less or more plantar flexion as that cadence increases. Or you could look at it as less angle of inclination as well. We also see changes at the hip. Again, not as prominent at the knee, but they're still there. With an increase in cadence, we will see increased hip flexion also at initial contact. Not only do we see kinematic changes, but we can see kinetic changes while somebody's running as well. And so some of the kinetic changes that we'll see are decreased vertical loading rate with an increased cadence, as well as decreased vertical center of mass, which can then translate to decreased overall loading for that runner with each foot strike. And so while some of those kinetic variables aren't always accessible to us in a clinical setting, typically they're just lab-based variables. we can still use cadence retraining and still make some of those assumptions that it is going to affect some of those kinematic variables as well. So we can not only use cadence as a gait retraining tool to treat specific injuries, we can use it to treat kinematic variables, but we can also use it to treat kinetic variables. VARIABLES INFLUENCING HABITUAL CADENCE What I want to talk about and spend the rest of the time today talking about is some of the variables that might influence somebody's habitual cadence that we don't normally discuss or sometimes don't even consider when we are using cadence as a gait retraining tool. And so somebody's habitual cadence, it just means that the cadence that they're running at normally, without any outside influence, without anybody saying, you should run at this cadence, or you should run at this cadence, or you should increase your cadence. It's just their normal everyday cadence that feels good to their body. And so some of the variables that might influence that are leg length, running experience, BMI, as well as speed. So leg length plays a role in that somebody with a shorter leg length, typically has a faster cadence, and somebody with a longer leg length typically has a slower cadence. Okay, now there's obviously a very wide range of a spectrum there in terms of cadence and leg length, and so these variables are typically related to cadence only at, or I guess more strongly, at the ends of the spectrum. So somebody with either very short legs or very long legs their cadence is likely a little bit more related to their leg length than somebody whose leg length sits kind of right in the middle or maybe that like middle 50% range. And so none of these variables are going to apply to everyone, obviously. The next one, so running experience can play a part as well. Somebody who has less experience running, so like a novice runner, typically has a slower cadence. I've definitely found this to be true in clinic versus somebody who has a lot of experience running or who is a very high level runner, maybe even a professional runner, typically has a very high cadence, upwards of mid 180s, upper 180s, maybe even low 190s, depending on that runner. I've definitely found that variable to be true within clinic, but again, Take that with a bit of a grain of salt because the ends of that spectrum in terms of novice versus experience tend to ring more true with a relationship with cadence than the middle of that spectrum for experience. BMI can also play a role in that somebody with a greater BMI tends to have a slower cadence versus somebody who has a lower BMI tends to have a bit faster of a cadence. That one, clinically, I really can't speak to that one, but that's what's in the literature. SPEED & CADENCE All right, and speed is the last variable that I wanna talk about because I think intuitively, we know that speed is related to cadence, and that's true to a certain respect. And intuitively, if we think of as somebody speeds up their pace, then their cadence is going to speed up as well. And that's true, but only to a certain extent and really only to higher speeds. And so for most people, their cadence is going to speed up only as they approach sprinting or a very, very fast run. And so when we think of speed and we think of running pace, We have two different strategies that we can use to increase our running pace or our speed. And one of those strategies is to increase the stride frequency or increase the cadence. So we increase the number of times our legs turn over, and that alone can increase the speed. The other strategy to increase speed is an increase in stride length. So rather than increase the stride frequency, we can also increase the stride length. And when we increase the stride length independent of any other changes, we can actually increase the speed even when we're maintaining the same stride frequency or cadence. So if we are using these variables independently and considering them independently, most humans are going to take the stride length strategy first up until they get to a point where they're almost sprinting. So a very fast run, a very high intensity run. And at that point, then they're going to employ more of a stride frequency or a cadence tactic to increase their running pace or running speed. So let's think about when you have an injured runner on a treadmill and you're choosing to use a cadence gait retraining tool to address either their running-related injury or certain gait mechanics, and you get them back on the treadmill, and you're having them run at their 6.0 mile per hour, whatever they did their running gait analysis at, and you say, okay, I want you to run at this new cadence, and you've increased their cadence, and now you have it on a metronome, and you put the metronome on the treadmill, and they hear that click, click, click, click, click when they're running, and the first thing they do I think you've all experienced this. If you have treated injured runners before, the first thing they do is that they increase the speed on their treadmill, right? So why we don't want them to do that is that if they increase that speed on the treadmill, chances are they're also going to employ this increased stride length strategy to increase the speed. They may also increase their cadence as well, but we have to remove some of those variables. If we keep them at the same speed that they did their running gait analysis, which should be a fairly comfortable speed for them, something they would run just an easy run, or even a moderate run, but let's say we have to keep them at that same speed that we use for the running gait analysis while we're using that increased cadence, then they have no choice but to increase the cadence rather than increase their stride length. We don't want them to do that. If they increase their stride length by increasing the speed on the treadmill, what's going to happen is that they're likely going to reach out further, meaning they're going to increase their over stride, which is definitely a variable we don't want to influence negatively. We want that over stride to reduce. They may get increased knee extension at initial contact, which again, not a gait mechanic that we want to encourage. We want to encourage more knee flexion at initial contact. We also want to encourage more or less dorsiflexion at initial contact, more plantar flexion, relatively speaking, which is likely also going to increase in the negative direction if we increase the stride length by increasing the speed on the treadmill. All of these variables are very much related in terms of the gait mechanics and the speed of the treadmill and which strategy they employ to actually increase that running gait speed. But if we take out the speed component and just leave that pace at the same pace on the treadmill, then they have no choice but to then change their cadence to match the cadence that you've chosen. And in turn, what we're hoping to see is a positive change in their gait mechanics. "OPTIMAL" CADENCE" Now we often get a question in both courses of what's the optimal cadence for a recreational runner, and really there isn't like a set in stone, everybody's gotta run at this cadence. It's a range, anywhere from mid 170s to mid 180s is typically what we kind of range for for a recreational runner. It may go higher than that. For a more experienced runner, I find that they can tolerate higher cadences, for a very novice runner, generally sometimes they don't even tolerate like a mid 170s and so although it might be a goal, it's something that we may have to work up towards in the future and with different gait retraining strategies. Okay, so I hope that helps. I hope that clears things up for some cadence questions that we commonly get in both the rehab online and the rehab of the injured runner live. I hope you have an awesome Friday and a great weekend and we'll see you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

    Full show notes at the publisher

    Episode 1595 - Clinically relevant statistics: the forest plot Nov 09, 2023
    Show notes

    Dr. Christina Prevett // #LeadershipThursday // www.ptonice.com In today's episode of the PT on ICE Daily Show, ICE faculty member Christina Prevett emphasizes the crucial role of understanding statistics in making clinically relevant decisions. While staying up to date with the literature and being evidence-based are often emphasized in healthcare, Christina points out that it is not enough if one lacks the ability to comprehend the meaning of statistics and their application in a clinical setting. Christina acknowledges that interpreting statistics can be challenging, even for individuals with a PhD and experience in the field. This understanding leads the host to empathize with clinicians who may find statistics intimidating. It is recognized that being evidence-informed and evidence-based requires clinicians to possess the skills to understand and interpret the data they encounter. To make statistics more clinically relevant, Christina suggests utilizing systematic reviews and meta-analyses as tools for interpretation. Specifically, she delves into the interpretation of a forest plot, which graphically represents the results of a meta-analysis. By understanding how to interpret and analyze the data presented in systematic reviews and meta-analyses, clinicians can determine if the findings are significant enough to drive changes in their practice. Christina also highlights the importance of considering clinical relevance when interpreting statistical findings. The concept of the minimum clinically important difference (MCID) is introduced, which refers to the smallest change in an outcome measure that is considered clinically meaningful. An example is given of a statistically significant improvement in a timed up-and-go (TUG) test, but it is explained that it may not be clinically relevant if it does not meet the MCID for the TUG. Take a listen to the podcast episode or read the full transcription below. 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. CHRISTINA PREVETTGood morning everybody and welcome to the PT on ICE daily show. My name is Christina Prevett. I am one of the lead faculty in our geriatric and pelvic health divisions. So usually you're seeing me on Monday and Wednesday, but today I'm putting on my PhD research hat to talk a little bit about statistics, which I know sounds really boring, but I promise I'm gonna make it really exciting. But before we do that, we have a couple of courses that are coming up across our divisions. So MMOA is in Wappinger's Falls, NY this weekend. Extremity Management is on the road in Woodstock, Georgia. And Cervical Spine is heading to Bridgewater, Massachusetts. And so if you are looking to get in some Con Ed before the end of the year, we still have a couple of opportunities across all of our different divisions. And so I encourage you to go to ptinice.com and take a look at some of those opportunities. Okay, so a little bit about my kind of hat outside of working with ice is that I recently finished my PhD at McMaster University at the end of this year. I just announced that I'm doing a part-time postdoctoral fellowship at the University of Alberta looking at resistance training and its interaction with pregnancy and pelvic floor function. BUMPING INTO STATISTICS What that means is that I am bumping into statistics all the time. And I'm going to like kind of start this off and say, I've been asked to do some webinars and things around statistics for the ice crew for a while. And to be honest, it's been really intimidating for me to do that, despite the fact that, you know, I have a PhD and I'm interacting with this stuff all the time. Um, statistics is hard and, you know, discussing statistics in a way that makes sense is also challenging. And when I reflect on that and the fact that you know, I feel uncomfortable sometimes with interpretation and you know, I did a part-time PhD for seven years and I'm in a postdoctoral position. I recognize how challenging it can be for clinicians. And, you know, we get told all the time, like, you know, stay evidence-informed, like it's important to be evidence-based. It's important to stay up to date with the literature. But your ability to stay up to date with the literature is only as good as your capacity to understand what it is trying to tell you. And I mean that in the best way possible, that it is so tough for us to gain insights from what the statistics mean into what is clinically relevant for us to understand and be able to bring into our clinics. So today I'm trying to take our statistics and make them clinically relevant to you. SYSTEMATIC REVIEWS WITH META-ANALYSIS One of the first ways that I want to do that, and if you like this type of podcast please let me know, and I'll do more, is around the systematic review and meta-analysis and then trying to kind of deep dive into interpreting a forest plot. So when we're thinking about a systematic review, this is the highest level of evidence when we have a systematic review of intervention or prospective studies. When we take a systematic review, we ask a very specific question. And I'm going to use the example, I'm working on a systematic review right now on resistance training and pregnancy. And I'm going to take some of that to make this relevant to how this happens. This is where we're trying to get an idea of the state of the literature. So we use a PICO format, which is the population that we're trying to look at. So in this case, it's individuals who are pregnant. The intervention is what you are trying to see if there's a positive or negative benefit or whatever that exposure may be. And that for me is resistance training. The comparison group is to usual obstetrical care. And then the outcomes, we are looking at fetal delivery, pregnancy, and pelvic floor-related outcomes. So we're looking at the investigation of resistance training on incidents of gestational hypertension and preeclampsia, gestational diabetes, rights of cesarean section, the size of babies, and babies more likely to be too big or too small. What does their birth weight look like? How long are they pregnant? And then are they at increased risk for things like urinary incontinence, pelvic organ prolapse, diastasis recti, or pelvic girdle pain? So that's kind of the format of a systematic review we're trying to answer a very specific question. From there, we go to the literature and we want to make sure that we encompass as much literature as we can. in our search strategy. So that is usually why you'll see a list of PubMed and OVID, CINAHL, Sports Discus, like these types of different big searching platforms that are looked at. And then you're going to get a Prisma plot that you're going to see in the first figure. And that kind of describes a person's search strategy. So how many hits were given when this search was done? How many were excluded because of duplicates? How many were excluded from the title and abstract because they were done in rats instead of in humans? Or they were looking at an acute effect of resistance training versus being on a resistance training program like you're going to have a lot of those that are excluded. And then you're going to have kind of what is included in your systematic review, and then what is included in your meta-analysis if a meta-analysis is indicated or possible. When we're looking at a systematic review, we're looking at a qualitative synthesis. And what we mean by that is that we're trying to figure out, you know, where the state of the literature is. And when I'm reporting on something like the systematic review portion of a paper, You're seeing things like, you know, how many studies were done in resistance training in pregnancy? How long were those interventions? Were they done in the same cohort of individuals? What was, how many of them were statistically significant? What was the dosage of that intervention? Those are things that kind of come under the systematic review umbrella. But I would say really now the emphasis is being placed on the meta-analysis and that is the quantitative combination of these studies and that is what gives us this forest plot. So when we are going through and doing a meta-analysis, there are a couple of things that we need to make decisions on very early on. So the first thing is on a random or a fixed effects model. This is kind of getting into the weeds, but almost all papers are going to be a random effects model, which means that we're going to expect some variability in the population that we are working with, and we're going to account for that variability in the calculations that we're using for our forest plot. PRIORI SUBGROUP ANALYSES The second thing that we are looking at is a priori subgroup analysis. And so I'm going to use my research study to describe this. Before going into this meta-analysis and putting this forest plot together, we have to brainstorm around where possible sources of skew or bias would come into a forest plot. For example, in the resistance training intervention, it would be very different when we have resistance training in isolation versus resistance training as a component of a multi-component program. And so one of our subgroups analyses a priori we discussed was that we were going to subgroup studies that were only resistance training compared to our big meta-analysis, which included our resistance training in isolation or as a multi-pronged program. Another example in our systematic review is that some of our studies were on individuals with low risk at inception into the papers versus those that were brought into the study because they were diagnosed with a complication like gestational diabetes. we could think that the influence of resistance training on a person who has not been diagnosed with gestational diabetes versus those who have could be different. And so we did a secondary subgroup analysis where we looked at the differences between studies that looked at only individuals with gestational diabetes versus those that didn't. And so when you are looking at a forest plot, you will see the big analysis at the top, including all of the different studies. And then after that, you will see different subgroups where there's a repeater of what was in the main group, but it's a subsection of the included studies. And that's what we see. And then we try to see, you know, is resistance training and isolation positively associated with a benefit? versus multi-component or is there no difference and that gives us a lot of information too? So that's that subgroup analysis. Then you go into the results of the paper and there is a forest plot that is there and this forest plot has a bunch of different names of studies It has the total number of incidences and the weight. It has a confidence interval with a number around it. And then on the right-hand side, there's like dots with lots of lines and then a big thick dot at the bottom. I'm trying to explain this to our podcast listeners so that you can kind of understand. And I hope you're kind of thinking of a study in your mind that you have seen in the past. But we're going to kind of explain each of these different things. Okay, so when we're looking at what we are trying to find, it is going to depend if we are looking at a dichotomous variable like did gestational hypertension get diagnosed or not? And if it is a dichotomous variable, what we're looking at is an odds ratio with a 95% confidence interval. So if we are thinking that no difference between usual care and resistance training is one, then a reduction in risk for gestational hypertension with resistance training would be an odds ratio that is less than one. When it is less than one, it becomes statistically significant when the 95% confidence interval encompasses all numbers less than one. When the confidence interval, say for example, our odds ratio is 0.8, we can say that there is a 20% reduction in risk, because a one minus 0.8, of getting gestational hypertension because of resistance training. I'm making these numbers up. But that is only statistically significant if the confidence interval is 0.7 to 0.9. then we can say there's a statistically significant reduction in risk for gestational hypertension with resistance training in this systematic review of this meta-analysis. Where we cannot say it's statistically significant is if the odds ratio is 0.8 and the 95% confidence interval is 0.6 to 1.2. That crossing of one means that there is a higher likelihood that there is that variation is because of chance and not because of a true difference. And so what you see is that when you're looking at the odds ratio, the combination of all of those odds ratios from the individual studies are then pooled in that bolded line at the bottom of the forest plot to give us the confidence that we have based on all of the studies combined, that there is a true effect of resistance training in this example on gestational hypertension. I-SQUARED HETEROGENEITY The other kind of statistic that we're looking at is the I-squared statistic or the amount of heterogeneity. So when you're looking at that forest plot and you're seeing all the dots and those lines, the heterogeneity is basically saying how close are those dots? How much spread is there in those dots? And so if the heterogeneity is low, we can say that not only did we have a statistically significant result, but across all of the studies, we tended to see a trend in the same direction. So it allows us to have more strength and confidence in the results that we are getting. If we see a high amount of heterogeneity, so like there are some that are like really favoring control and saying that resistance training is bad for gestational hypertension, and then some are having really positive effects of gestational hypertension on resistance training, that I square statistic would be high, and then we would probably have to be doing more evaluation, and that's where we would rely really heavily on the subgroup and say, Well, is there certain subpopulations of this group that are skewing the data in one way or the other where their results may be different than the results of other individuals? And so that gives us a bit more information. So the odds ratio is when we're looking at the presence of an eve…

    Full show notes at the publisher

    Episode 1593 - But did you die? Nov 08, 2023
    Show notes

    Dr. Zac Morgan // #ClinicalTuesday // www.ptonice.com In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Christina Prevett delves into the need for a shift in the perinatal space, moving away from a fear-focused message and towards one of empowerment. Christina emphasizes the significance of understanding and respecting individual risk tolerance when it comes to making decisions about exercise and healthcare during pregnancy and postpartum. Christina argues that healthcare providers should not impose their own risk tolerance onto their patients, but rather support and empower them in making informed choices that align with their own comfort levels. She also highlights the presence of unwarranted shame in the perinatal space and encourages listeners to critically evaluate their own risk tolerance zones, challenging any beliefs or practices that contribute to this shame. Christina underscores the importance of evidence-informed practice and the facilitation of movement and exercise, rather than creating barriers based on fear. Take a listen to learn how to better serve this population of patients & athletes. 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 CHRISTINA PREVETT Hello, everybody, and welcome to the PT on Ice Daily Show. My name is Christina Prevett. I am one of our team within our pelvic health division. And if you have been catching all of the news coming out of the ice world, you know that we just announced our pelvic certification, CertPelvic. And we are so excited to bring this to you all. One of the missions that we have been kind of on this journey for over, you know, the last four or five years has been to try and flip the script in pelvic health and really create a fitness-forward approach to pelvic health, just like we are trying to do in the orthopedic spaces. And so our cert pelvic is our next Step in that trajectory. And so we are going to have three courses in our cert pelvic curriculum We have our two-day live course and then we're gonna have two eight-week online courses level one and level two if you have taken Our live course that is going to count as your cert pelvic The only additional piece is that there is going to be an added skills check to the end of our second day. If you are interested in becoming CertPelvic, you will have to find a time when we are near your area to be able to take that skills check for the end of day two. You don't need to take the course again. You do not need to pay a fee for the skills check. We just have to get that from you for individuals who have already taken our live course. And if you're interested in catching our live course one more time, or getting in before the end of 2023, we have two opportunities left. Alexis is gonna be in Bayer, Delaware on the 18th and 19th of November, so in two weeks. And then at the beginning of December, December 2nd, and 3rd, I am gonna be in Halifax. And that course you'll see is slightly less because we are making it equivalent to the Canadian dollar. So if you're wondering why that course is at a different price, it's because we're creating an equivalency to the Canadian dollar. And so if you're interested in catching us before the end of 2023, those are your last two opportunities. EXERCISE IN THE PREGNANT & POSTPARTUM SPACE Okay, let's talk about exercise in the perinatal space. You know that we have been on a huge journey to reframe the idea around Pregnant and postpartum exercise it is no surprise to any of you who are listening and have listened to our division that we are very pro pushing the boundaries and that we believe from a fitness perspective that the answer should be yes For health promoting behaviors instead of flipping to the no and proving it I did a podcast episode a little while ago where I said is it ethical, you know to remove resistance training in a pregnant individual and because we don't have an abundance of literature. And I made the argument that it isn't. Until we have safety data to take away a health-promoting behavior, we should start with the yes. And so this kind of goes into this reframe. I was talking to Sinead DeFore, who is a Ph.D. who's looking at diastasis recti and pelvic girdle pain literature, and she created this idea around risk tolerance within my brain and it has really helped me to solidify our thoughts and feelings about exercise our sparks notes a very first thing is that We are going to have individuals who are going to have their own Risk tolerance and I'm gonna give you a couple of different examples. So everyone is gonna have their own risk tolerance when it comes to exercise. Personally, when I got pregnant with my daughter five years ago, I was a national-level weightlifter. A barbell was an extension of my hand. I knew where it was going to go. I knew what it was going to do. I could make finite, tiny little details and I would be able to manipulate my technique. I felt extremely confident moving around a barbell during my pregnancy. Was not a runner. I had done CrossFit but I wasn't doing CrossFit at that time so my body was not used to the impact of running and So I didn't feel that good running after about 18 or 20 weeks of pregnancy And so I removed running from my exercise routine I was not running that much to be good with but I removed it and I kept Olympic weightlifting all the way up until delivery and That is my risk tolerance. I decided what felt good for my body and I made decisions within that. That does not mean that I do not have individuals that I have seen that were running right up until delivery and then a heavy squat or squatting below parallel just did not feel good for them. It didn't feel good on their pelvis. So many people have their own risk tolerance. we are starting to see people push the boundaries in almost every stretch from a pregnant and postpartum fitness perspective. We are seeing individuals, part of my postdoctoral work is some of our team members are talking about contact sports, for example, and contact sports are contraindicated during pregnancy. People are told to not do equestrian, for example, during their pregnancies. And then you have some equestrian riders who feel extremely confident with the horse that they are working with and may continue to ride. Even though right now our data says that maybe we shouldn't do that on the chance that somebody falls off a horse. I treated an individual who was snowboarding, 17 weeks pregnant, fell so hard she broke her collarbone, baby ended up being okay. Another one of these decisions would probably not have been within my risk tolerance, but individuals are starting to push the boundaries. We are starting to see changes in the military with respect to flying restrictions. We were being told that when you found out that you were pregnant you were grounded with respect to flying hours. Yeah, right. Someone says, I grew up showing horses and you couldn't get any of those ladies I knew at the barn to get off that horse. Absolutely, right? And that is, again, literature that we are basing off of a lack of understanding. I'm sure that there are so many examples exactly like that, where individuals feel so confident with their horse that they are not worried. We don't have any evidence to say that Riding a horse is bad, but we just don't want to minimize the risk of falling But here's the thing if we kind of take this back and talk about risk tolerance as grown-ups We can decide it for grown-ups or not But as grown-ups we are taking risk every single day every time we walk out of our house We are deciding if it is snowing and we decide to jump into a car. We are making a decision and we are calculating We are creating risk thresholds. When we are even talking about health-promoting behaviors, we are talking about stacking the deck in our favor or away from it, right? We are health-promoting or we are taking things that are going to increase the risk of an adverse event. But none of these things are guaranteed, and everybody is going to have their own risk tolerance zones. BECOME A PRO AT PUSHING THE BOUNDARIES As physical therapists who are working in the perinatal space, it is time for us to embrace that risk tolerance, embrace the fact that individuals' risk tolerance may be different than ours. And I'm talking about kind of pushing the extremes of exercise, but I'm also talking about allowing individuals who do not feel safe continuing to do certain exercises to be allowed to step that back if that pulls them within their risk tolerance zone. We do not have a movement problem in our society. We have a lack of movement problem. All of our divisions are screaming this from the rooftops. You're going to hear me say this in geriatrics. What that means though and what we see is that during pregnancy and postpartum exercise goes down and we see that fewer individuals are hitting the exercise guidelines despite the fact that our guidelines during pregnancy from an intensity and a Duration perspective mirror that of the general population what I mean by that is we are still trying to accumulate 150 minutes of moderate-intensity exercise during pregnancy and moderate intensity resistance training are Recommended but what we see is that during pregnancy for a whole slew of reasons Not just the fact that individuals are pregnant and getting scared away from exercise though. That is a component We are seeing that individuals are less active so Then we go into the postpartum period, and it's the same thing. THE RISKS OF NOT EXERCISING DURING PREGNANCY Our division is adamantly against the six-week blanket statement that we shouldn't be doing any exercise, and we are 100% against the five in the bed, five around the bed, five in the home type of rhetoric. The reason is that it's going to increase our risk for blood clots, and it is unrealistic for so many individuals who do not have a village that allows them to be able to do that. If you are trying to bond with the baby and that is something that you want to do, excellent, but I also think that it's important for us to be able to make informed decisions, which includes the fact that early movement, and I'm not talking exercise, I'm talking about getting out of bed, is really important for the management of postpartum complications. risk tolerance is going to be different. We see a lot of individuals who want to go to the gym two weeks postpartum. Are they jumping into a CrossFit workout? No, but are they becoming around their village because they feel really lonely and sad and their hormones are all over the place and somebody is going to take their baby and tell them and have an adult conversation and that's something that they want to do completely. their risk tolerance is going to be different. Do we have some individuals who adamantly want to wait until six, eight, 10, or 12 weeks, who do not have the mind to go in, who are struggling with sleep, who are having trouble with hormones? Absolutely. And so we are going to meet them where they're at. REFRAMING RISK TOLERANCE And so why is this reframe around risk tolerance so powerful? we don't have a movement problem, which means that we need to push our recommendations within a person's risk tolerance. And the message needs to be around facilitating movement, not creating barriers to exercise, right? As physical therapists, our job is to help facilitate movement. And when we create fear in the perinatal space, by moving or shifting a person's risk tolerance down beyond the level that they want to accept. We are not providing evidence-informed practice, right? One, we don't have the evidence to show that there are things that are adverse, and many of these things are mechanistic based on theory and are starting to be disproven. But the second thing is that we need to be taking our clients' wishes and hopes into perspective and that is an equal part of the triangle of evidence-informed practice and then obviously our clinical experience. Our clinical skilled care is where we can move those buoys, and give individuals ways for them to navigate exercise so that they know what they are listening to their bodies for, in order for us to be driving change in this space. When we accept this model of risk tolerance, we get to move from the no or I don't know to the yes within these kinds of buoys or navigational obstacles that we're going to be able to keep individuals within. We need to think that we want to move individuals away from being more sedentary out of fear in the perinatal space and move them to more empowered movement of their bodies in order for them to feel strong and empowered. We are starting to see over and over and over again that Individuals who maintain strength during their pregnancy have a much easier time postpartum from a muscular physical reserve perspective. We see this across everything in rehab. Our body needs to be strong enough to handle what we're asking it to do. It doesn't it breaks down. There are overuse injuries if the tensile strength of our bone does not match the force at which we hit the floor We have a fracture we see this in orthopedics the same is true in the perinatal space like our body needs to be able to respond to the stress is on their body in the pregnant and postpartum period and if we are deconditioning our pregnant individuals we are not setting them up for success and so we need to be able to have a shifting and moving risk tolerance to meet the risk tolerance of the person that is in front of us and then if there's obviously some big risks or red flags, we are going to educate on that. But most of the time, it's our own discomfort because their risk tolerance doesn't match our risk tolerance. And then we are making recommendations that are not serving them, but making us feel more comfortable. And so my call to action for you all today is to push your comfort zones. Really reflect, is there a discrepancy or difference between your risk tolerance and mine? And if there is, is that because of my own experience in this space? Is it because of my own lack of experience with somebody with this type of risk tolerance? And then how do I marry those two things to respect where the evidence is, but also where my client's perceived risk is? And then how can I bring my own clinical practice to help marry those two things together to serve the person that is in front of me? All right, I went off on a soapbox. I can't believe I'm already 14 minutes in. I hope that you found that helpful. This idea of risk tolerance and being able to see this as a moving target, I think is going to shift us away from a fear-focused message in the perinatal space towards more one of empowerment. And if your risk tolerance is less than your client's, that is not bad, but it is not our job to project our risk tolerance onto a patient, especially when we don't have any justification for that kind of shifting or that moving away from a person's own tolerance zone. And I really challenge individuals to not make individuals feel bad. There's a lot of shame in the perinatal space that is unfounded. And I think it's really import…

    Full show notes at the publisher

    Episode 1592 - Exercise risk tolerance in the perinatal space Nov 06, 2023
    Show notes

    Dr. Christina Prevett // #ICEPelvic // www.ptonice.com In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Christina Prevett delves into the need for a shift in the perinatal space, moving away from a fear-focused message and towards one of empowerment. Christina emphasizes the significance of understanding and respecting individual risk tolerance when it comes to making decisions about exercise and healthcare during pregnancy and postpartum. Christina argues that healthcare providers should not impose their own risk tolerance onto their patients, but rather support and empower them in making informed choices that align with their own comfort levels. She also highlights the presence of unwarranted shame in the perinatal space and encourages listeners to critically evaluate their own risk tolerance zones, challenging any beliefs or practices that contribute to this shame. Christina underscores the importance of evidence-informed practice and the facilitation of movement and exercise, rather than creating barriers based on fear. Take a listen to learn how to better serve this population of patients & athletes. 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 CHRISTINA PREVETT Hello, everybody, and welcome to the PT on Ice Daily Show. My name is Christina Prevett. I am one of our team within our pelvic health division. And if you have been catching all of the news coming out of the ice world, you know that we just announced our pelvic certification, CertPelvic. And we are so excited to bring this to you all. One of the missions that we have been kind of on this journey for over, you know, the last four or five years has been to try and flip the script in pelvic health and really create a fitness-forward approach to pelvic health, just like we are trying to do in the orthopedic spaces. And so our cert pelvic is our next Step in that trajectory. And so we are going to have three courses in our cert pelvic curriculum We have our two-day live course and then we're gonna have two eight-week online courses level one and level two if you have taken Our live course that is going to count as your cert pelvic The only additional piece is that there is going to be an added skills check to the end of our second day. If you are interested in becoming CertPelvic, you will have to find a time when we are near your area to be able to take that skills check for the end of day two. You don't need to take the course again. You do not need to pay a fee for the skills check. We just have to get that from you for individuals who have already taken our live course. And if you're interested in catching our live course one more time, or getting in before the end of 2023, we have two opportunities left. Alexis is gonna be in Bayer, Delaware on the 18th and 19th of November, so in two weeks. And then at the beginning of December, December 2nd, and 3rd, I am gonna be in Halifax. And that course you'll see is slightly less because we are making it equivalent to the Canadian dollar. So if you're wondering why that course is at a different price, it's because we're creating an equivalency to the Canadian dollar. And so if you're interested in catching us before the end of 2023, those are your last two opportunities. EXERCISE IN THE PREGNANT & POSTPARTUM SPACE Okay, let's talk about exercise in the perinatal space. You know that we have been on a huge journey to reframe the idea around Pregnant and postpartum exercise it is no surprise to any of you who are listening and have listened to our division that we are very pro pushing the boundaries and that we believe from a fitness perspective that the answer should be yes For health promoting behaviors instead of flipping to the no and proving it I did a podcast episode a little while ago where I said is it ethical, you know to remove resistance training in a pregnant individual and because we don't have an abundance of literature. And I made the argument that it isn't. Until we have safety data to take away a health-promoting behavior, we should start with the yes. And so this kind of goes into this reframe. I was talking to Sinead DeFore, who is a Ph.D. who's looking at diastasis recti and pelvic girdle pain literature, and she created this idea around risk tolerance within my brain and it has really helped me to solidify our thoughts and feelings about exercise our sparks notes a very first thing is that We are going to have individuals who are going to have their own Risk tolerance and I'm gonna give you a couple of different examples. So everyone is gonna have their own risk tolerance when it comes to exercise. Personally, when I got pregnant with my daughter five years ago, I was a national-level weightlifter. A barbell was an extension of my hand. I knew where it was going to go. I knew what it was going to do. I could make finite, tiny little details and I would be able to manipulate my technique. I felt extremely confident moving around a barbell during my pregnancy. Was not a runner. I had done CrossFit but I wasn't doing CrossFit at that time so my body was not used to the impact of running and So I didn't feel that good running after about 18 or 20 weeks of pregnancy And so I removed running from my exercise routine I was not running that much to be good with but I removed it and I kept Olympic weightlifting all the way up until delivery and That is my risk tolerance. I decided what felt good for my body and I made decisions within that. That does not mean that I do not have individuals that I have seen that were running right up until delivery and then a heavy squat or squatting below parallel just did not feel good for them. It didn't feel good on their pelvis. So many people have their own risk tolerance. we are starting to see people push the boundaries in almost every stretch from a pregnant and postpartum fitness perspective. We are seeing individuals, part of my postdoctoral work is some of our team members are talking about contact sports, for example, and contact sports are contraindicated during pregnancy. People are told to not do equestrian, for example, during their pregnancies. And then you have some equestrian riders who feel extremely confident with the horse that they are working with and may continue to ride. Even though right now our data says that maybe we shouldn't do that on the chance that somebody falls off a horse. I treated an individual who was snowboarding, 17 weeks pregnant, fell so hard she broke her collarbone, baby ended up being okay. Another one of these decisions would probably not have been within my risk tolerance, but individuals are starting to push the boundaries. We are starting to see changes in the military with respect to flying restrictions. We were being told that when you found out that you were pregnant you were grounded with respect to flying hours. Yeah, right. Someone says, I grew up showing horses and you couldn't get any of those ladies I knew at the barn to get off that horse. Absolutely, right? And that is, again, literature that we are basing off of a lack of understanding. I'm sure that there are so many examples exactly like that, where individuals feel so confident with their horse that they are not worried. We don't have any evidence to say that Riding a horse is bad, but we just don't want to minimize the risk of falling But here's the thing if we kind of take this back and talk about risk tolerance as grown-ups We can decide it for grown-ups or not But as grown-ups we are taking risk every single day every time we walk out of our house We are deciding if it is snowing and we decide to jump into a car. We are making a decision and we are calculating We are creating risk thresholds. When we are even talking about health-promoting behaviors, we are talking about stacking the deck in our favor or away from it, right? We are health-promoting or we are taking things that are going to increase the risk of an adverse event. But none of these things are guaranteed, and everybody is going to have their own risk tolerance zones. BECOME A PRO AT PUSHING THE BOUNDARIES As physical therapists who are working in the perinatal space, it is time for us to embrace that risk tolerance, embrace the fact that individuals' risk tolerance may be different than ours. And I'm talking about kind of pushing the extremes of exercise, but I'm also talking about allowing individuals who do not feel safe continuing to do certain exercises to be allowed to step that back if that pulls them within their risk tolerance zone. We do not have a movement problem in our society. We have a lack of movement problem. All of our divisions are screaming this from the rooftops. You're going to hear me say this in geriatrics. What that means though and what we see is that during pregnancy and postpartum exercise goes down and we see that fewer individuals are hitting the exercise guidelines despite the fact that our guidelines during pregnancy from an intensity and a Duration perspective mirror that of the general population what I mean by that is we are still trying to accumulate 150 minutes of moderate-intensity exercise during pregnancy and moderate intensity resistance training are Recommended but what we see is that during pregnancy for a whole slew of reasons Not just the fact that individuals are pregnant and getting scared away from exercise though. That is a component We are seeing that individuals are less active so Then we go into the postpartum period, and it's the same thing. THE RISKS OF NOT EXERCISING DURING PREGNANCY Our division is adamantly against the six-week blanket statement that we shouldn't be doing any exercise, and we are 100% against the five in the bed, five around the bed, five in the home type of rhetoric. The reason is that it's going to increase our risk for blood clots, and it is unrealistic for so many individuals who do not have a village that allows them to be able to do that. If you are trying to bond with the baby and that is something that you want to do, excellent, but I also think that it's important for us to be able to make informed decisions, which includes the fact that early movement, and I'm not talking exercise, I'm talking about getting out of bed, is really important for the management of postpartum complications. risk tolerance is going to be different. We see a lot of individuals who want to go to the gym two weeks postpartum. Are they jumping into a CrossFit workout? No, but are they becoming around their village because they feel really lonely and sad and their hormones are all over the place and somebody is going to take their baby and tell them and have an adult conversation and that's something that they want to do completely. their risk tolerance is going to be different. Do we have some individuals who adamantly want to wait until six, eight, 10, or 12 weeks, who do not have the mind to go in, who are struggling with sleep, who are having trouble with hormones? Absolutely. And so we are going to meet them where they're at. REFRAMING RISK TOLERANCE And so why is this reframe around risk tolerance so powerful? we don't have a movement problem, which means that we need to push our recommendations within a person's risk tolerance. And the message needs to be around facilitating movement, not creating barriers to exercise, right? As physical therapists, our job is to help facilitate movement. And when we create fear in the perinatal space, by moving or shifting a person's risk tolerance down beyond the level that they want to accept. We are not providing evidence-informed practice, right? One, we don't have the evidence to show that there are things that are adverse, and many of these things are mechanistic based on theory and are starting to be disproven. But the second thing is that we need to be taking our clients' wishes and hopes into perspective and that is an equal part of the triangle of evidence-informed practice and then obviously our clinical experience. Our clinical skilled care is where we can move those buoys, and give individuals ways for them to navigate exercise so that they know what they are listening to their bodies for, in order for us to be driving change in this space. When we accept this model of risk tolerance, we get to move from the no or I don't know to the yes within these kinds of buoys or navigational obstacles that we're going to be able to keep individuals within. We need to think that we want to move individuals away from being more sedentary out of fear in the perinatal space and move them to more empowered movement of their bodies in order for them to feel strong and empowered. We are starting to see over and over and over again that Individuals who maintain strength during their pregnancy have a much easier time postpartum from a muscular physical reserve perspective. We see this across everything in rehab. Our body needs to be strong enough to handle what we're asking it to do. It doesn't it breaks down. There are overuse injuries if the tensile strength of our bone does not match the force at which we hit the floor We have a fracture we see this in orthopedics the same is true in the perinatal space like our body needs to be able to respond to the stress is on their body in the pregnant and postpartum period and if we are deconditioning our pregnant individuals we are not setting them up for success and so we need to be able to have a shifting and moving risk tolerance to meet the risk tolerance of the person that is in front of us and then if there's obviously some big risks or red flags, we are going to educate on that. But most of the time, it's our own discomfort because their risk tolerance doesn't match our risk tolerance. And then we are making recommendations that are not serving them, but making us feel more comfortable. And so my call to action for you all today is to push your comfort zones. Really reflect, is there a discrepancy or difference between your risk tolerance and mine? And if there is, is that because of my own experience in this space? Is it because of my own lack of experience with somebody with this type of risk tolerance? And then how do I marry those two things to respect where the evidence is, but also where my client's perceived risk is? And then how can I bring my own clinical practice to help marry those two things together to serve the person that is in front of me? All right, I went off on a soapbox. I can't believe I'm already 14 minutes in. I hope that you found that helpful. This idea of risk tolerance and being able to see this as a moving target, I think is going to shift us away from a fear-focused message in the perinatal space towards more one of empowerment. And if your risk tolerance is less than your client's, that is not bad, but it is not our job to project our risk tolerance onto a patient, especially when we don't have any justification for that kind of shifting or that moving away from a person's own tolerance zone. And I really challenge individuals to not make individuals feel bad. There's a lot of shame in the perinatal space that is unfounded. And I think it's really impor…

    Full show notes at the publisher

    Previous 1 38 39 40 41 42 223 Next

    Related Podcasts

    The Joe Rogan Experience

    1

    The Joe Rogan Experience Comedy
    Casefile True Crime

    2

    Casefile True Crime Games & Hobbies
    Reply All

    3

    Reply All Games & Hobbies
    Good Life Project

    4

    Good Life Project Education
    Happier with Gretchen Rubin

    5

    Happier with Gretchen Rubin Health
    The Other F Word: Conversations About Failure

    6

    The Other F Word: Conversations About Failure Health
    footer-logo

    Contact Us

    Toll Free: 844-670-7747

    Links

    • Home
    • Top Charts
    • Networks
    • Apps
    • Independents Podcasts
    • Podcast Advertising
    • Podcast News
    • Contact Us
    • About Us
    • Analytics & Insights

    Stay Connected

      Privacy, Terms of Use & Our Code of Ethics Protecting Content Creators Copyrights