19 Episode results for "Dr Mark Sheppard"

Clinical Podcast: Think Before You 310 | Dr. Neil Sheth

Evidence In Motion Clinical

23:17 min | 1 year ago

Clinical Podcast: Think Before You 310 | Dr. Neil Sheth

"Welcome to the. AM clinical podcast. Your host Dr John. Childs and Dr Mark Sheppard Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of of what was to. What are you ready? Let's go welcome to another edition of the I.. M. Clinical podcast. My name is John Childs and and joined by my co host. Dr Mark Sheppard as always days and we are privileged to have on the show of physical therapist who works actually with us at Texas physical. Therapy specialist Dr Neil. Sheth Neil completed completed the sports residency back in two thousand seventeen or so and really brings a unique perspective to all things certainly physical. Oh therapy but particularly related to strength training and so. We're really looking forward to having Neil on the show neil welcome to the clinical podcast. Thank you guys for having having them really excited so neil to get US kicked off if you would just give us a brief bit about your background maybe where you went to. PT School and sort of how you got into sort of the path that you're on now. Okay so I went to school in Philadelphia at the University of the sciences. It was a direct program so I actually didn't have to do the. Gre Three in reapply. I was just sixers don which is exciting. After that I was really well by my second year I really wanted to do. A sports. Resin team started looking looking around what I could apply to. and Luckily I am sports residency in Georgetown which XP was open and they took me on and finish that in twenty seventeen after the exam in March twenty eighteen. And now I'm down in San Antonio with one of our sports clinics where I get to mentor. The incoming residents now do a lot of teaching with that. Neil thanks for that background if you would talk a little bit about your perspective on strength with training and sort of where you think strength training sort of fits if you will and where the sort of the state of strength training I asked the question because you know oh manual therapy was sort of the decade of the two thousands and maybe overemphasize perhaps relative to strength training and it seems like the pendulum maybe swinging the other direction. Now where like all everyone talks about is like cross fit and those sorts of things. And it's like it's gone the other way so I'm just curious is like what's your perspective on strength training and what's the state of it within the profession. He adds though this really excited about. If I get to fired up just calm me down if you guys need need but again on tirades in the clinic all the time but as ours when I think I actually think that this is the biggest area that we need to improve on as a profession. Kind of like what you send John Worth starting to swing in the other way. I definitely sealed up but I think a lot of issues are that Patients are under loaded and under dosed as far as strength training principles and a lot of people. Just don't implement proper. Strengthening like thera bands are good to start with his initial seen in acute injuries. But after that initial phase there needs to be a shift to load it and having some awaits actually being put on these patients in. I could see that this so boxes. Something Neil that many people probably will resonate with and you. You know it's interesting because when you're in clinic you see you know thera bands everywhere at you know different types awaits that are usually hand weights right. If you go I went to the everyday. Outpatient clinic are even one within the hospital. It's kind of like those are the staples but you don't really see anything that can actually load people. You the heavyweights and it always kind of bugged me in two different ways one is like why is that the case too is I wasn't really comfortable understanding ending how to load people with squat racks or different types of bar. Waiting things landmine stuff like that. That took some time after I graduate sweet so when you talk about you know where the state of strength training or are really the prescription of exercises like where do you feel like. We miss the mark doc when it comes to these types of things so definitely go with the Swat rack being so at when during residency in Georgetown and even at us or as lane location. I I actually bought thought squat racks for both of those the Knicks in order to low deebo in a when I was little headed that about it but he got the point of it uh but then he was really from the beginning where in school and highly had maybe an hour a week for half a semester of going over any any strength and conditioning related things and that. Just trustees us into the clinic three graduate and we're still doing those eysenck three he by ten therapy and everything similar movements everything. Everyone gets the same cookie cutter approach and there needs to be a shift to that loading being an challenging the patient with actual weights and Neva bodyweight movements is fine but there are just not enough to have any tissue up tation Shen prevent long-term injury in. I think that also comes back to us practising what we preach. I liked to Charles Myself personally in the gym and with other colleagues of mine as far as Hauer thinking about exercise dosage. How a training myself in it leaks into how I treat? Patients Asia's Neil. Could you expand on this a little bit like you give in clinical example of like how you are implementing proper dosage. This is general as it relates to. Let's say strengthening someone's quadriceps muscle if they're coming in for let's say anterior knee pain like how does that look from your perspective when you're dosing dosing. Is it okay that provide a case about actually have a really good one for nepean young So with this. He's like a thirty three year. Old Male in the navy is all him a year after he fell on his knee and has had an tierney pain. Ever since and through the medical carousel paracel he was just prescribed straight leg. Raises and Claude sets for a whole year a whole year. That Yup and he's never done anything else using unlike multiple providers that have changed anything else. So let me stop you there. So you're telling me. Has He seen the physical therapist before this time he saw one. Yeah Yeah Oh man for a short time that kills me to know that the two exercises were still kind of on his radar but anyway. That's crazy yeah so he had no audio to do and he is in the navy he was off duty getting ready to go back to think Iraq Many leaves at the end of this month so he can squat lower than maybe like fifty degrees of neath luncheon. He tries running he kinda Gallup's because he doesn't want to bend that knee so I'm getting some of this very avoid. We didn't an week in doing things that he needs to do with him. I we do something called the Quad Index and we have a makeshift shift version with a hand held item. OMETER cheap way to do it but it works that so there's research out there especially for post. The minimum criteria needed to running is actually eight weeks and eighty percent index. So we use that. Eighty percent is our measurement to start any metrics or impact work. He we started at a at thirty percent. Thirty eight or twenty seven something like that and yeah really really low. So where I started with him outside of the cloud. Odd Settings settings. Good right especially on your continuum it's good for activation in the new progressive straight leg raises for your control and then after that you again to strength endurance endurance. He'd Kinda like that stair stepping progression over him we used. We started off a lot because of his pain with movement. We start a lot with Jafar Ayar flourished and just loading him with bodyweight movement squats split lunges straight leg raise and then eventually eventually shifts to adding weight to all those movements and making sure on his scale on what I do. A lot of patients is and use the rate of preserved exertion. So if it's something I really want them and the challenge you had told me I want it eight plus nine hundred ten anywhere in that range and if it's not there for them we just keep increasing until it's a heavy enough weight where they're actually pushing themselves not just going through the movement. That's interesting meal like so you're telling me that you're using the R.. P. To actually actually understand the reps and potentially sets for which you does your patients is that kind of how you're using yes so with the RPG round like eighty plus. It's usually definitely more my strength side or even power so I the schemes typically x amount of sets for anywhere between two to five Canadian. Six wraps her up and then if I want to get a little bit later on there are definitely increased volume for movement pattern. That were working. Oh that's cool so you know to me it would make sense. That may not be the same number going back to your statement about the three sets at ten Dan. You know that you kinda see everybody's flow chart you know potentially So yours look a bit messy. If this was documented. They're not clean. Three by ten three by tens is something I get so upset about in the clinics and we even have a table that we all work on an I wrote are actually one of my residents wrote. Think before you buy I ten has to me if everything on your flow sheet is three by ten to me. It's lazy programming. Your there's no intent behind find what you're prescribing and my floggings are definitely messy every day. There's I don't write all the way on the left side. I don't know how your flu she'd looks on the left column elements of Big Open Blank. Were most people just write back through size and then it just carries on through that entire life of that flashy for me. I leave that that left side blanket. I write in each for specific day. What I'm working on with my plan is which exercise are going to help achieve that goal and definitely the numbers are very off kilter? There's some people who do like a four by seven five three or five. I even play a lot with strength and conditioning in the clinic to every minute on the minute at a certain load of do Amr APPs so definitely. The flu sheets varied day all over the place. There's intent behind the entire goal. Now is a great discussion and you know as you talk about like this case for example you know number one. I hope you consider perhaps publishing it if you're able to do that. So the researcher in me can't not suggest that so it's thing you can share and on that note what sort of of resources the you lean on whether it be journal articles are the particular authors that you follow when it comes to all things you know how to train patients and athletes in evidence informed sorts of ways. What are the resources that are your go to? I'm definitely big on social media. I follow a lot of physical therapists percent. Strength and conditioning coaches. Some of the big ones as far as in the P. T. Rome that put out a lot of content. Is Dan Laurenz or Eric. Mira or even Mike Reimann on those people I follow. That always have a good tweeter instagram post about it. Even John Rawson has really good things breath. I also have my strength and conditioning Certification so I do rely on the NFC as website as far as articles that are coming out and Alikhan challenge different athletic populations in the clinic. So those are my big ones even J. O. S. P. T. R. J. P. T. are a good example if those that are APD members and then on that note that same train of thought you know. I know you provide a lot of mentorship to residents. So what sort of structure do you have them reading articles on a regular basis. Are You doing journal clubs or you know what's the contemporary way that you really help mentor mentor. Your residents to keep up with the latest knowledge is their email subscription. I'm just trying to think about you know the tools that you know. Residents in clinicians clinician can use to keep up with the evidence for us the way it's structured is. We have rounds on Tuesdays and Fridays like a clinic wide teaching where one one person one of the staff there. History will teach and sometimes the resin. Sometimes it's us so we'll get some of that they're also provide a lot of articles that I come across and I'll just forwarded forwarded them and say hey. Tell me what you think read this and also the big thing that I do a lot which I actually for my mentor during residency is l.. Grab their While they're in clinic and I'm questioning. Why this why that make sure there's intense just not the rebuy ten just because it's an easy number so something we'd early on in the residency is kind of I mentioned before that stepwise progression so if you draw stairs on a piece of paper it's is five steps? The bottom line will be activation if you can turn on the muscle that year intending to then control is the next one on this. This step which is can you turn on while going through a prescribed or set range of motion after that then it gets into strengthening and where can they turn it on and control it through a range of motion with A load and then at that point eight unions a strength and conditioning principles principals where it's creative in eighty percent. RPM sets anywhere reps between for less than twelve after that on your stepwise progression. It goes gender and so on and so then you start incorporating the time under tension component and for development there and the residents. They understand that step and they can visualize. It was easy to teach off that for us. I love that structure their Neil. You know it's always good to have you know a foundation to build off of like you said you know the intent behind the exercise to me is so important Martin because you're just going through a flow sheet just because he can doesn't mean it needs to be done and really over the years challenge myself I self to be able to look at an exercise and say you know what are my goals with this. Am I trying to go for motor control or am I trying to actually look at Playa Lyon metric strengthen training you know what is it in my trying to get back in. I always try to think about how that relates back to the patient's goals in with this in mind and you know as I've mentored fellows in this type of domain. What are some of the questions are challenging your resonance with that you know maybe for the listener could start to almost no cell challenge like what are your top two Kinda like questions that you use challenge a residence African on how I really liked that one and top to be hard definitely the easiest question I asked them when? I'm looking at the Y.. Y This exercise. What's the goal all of the sizes? Are you going for Quad. Strength that you're going for loading that tendon in a certain range of motion and so on the other question would be what exercises can get this patient to get better when our functional Asterik is their goal in like I get back into which movement patterns that you need to work which muscles need to be addressed in a specific range of motion. Even that can get into the rabbit hole about technique and form because there are a lot of side rant a lot of times I see gre squatter box squats where you're Russian angle are kind of where your TV is in relation to the rest of the body. It's what you would call the negative gene angle where it's leaned back in that Claude that needs barely bending and this nor doors e budgets mainly planner flex movement. And when you see that. There's no loading to that. Antea chain in any way. And when you you ask a patient when you do that for three ten for however long you do it and then go on to have him. Try An actual squat. They don't have the strength for and people are surprised. Surprised that they don't have the strength. But when you look back at the things you are working on. They weren't there to build them into that movement pattern. Sorry I I know how. The ran on the sideline think amassing by residents. Neil one question I had you mentioned Blood flow restriction. Therapy a little bit earlier. So I'd I'd be curious to hear your perspective on be Afar and what is application is. Is it the latest fad. That's going to go away or do you think this is something that's going to be the mainstream to continue to have an impact on Rehab. So I love the BEF are. I think it's awesome is definitely not comfortable. I don't know if you guys have ever tried it. Try Hi is one of the worst experiences you can have In new this for our listeners who may not be familiar with the Afar do you mind just kind of describing the application location and how it as far as blur section. So you're including in attendance. Oh legs or arms in the ideas your type. Two muscle pipers the one year for strength and power there mainly anaerobic muscles so the exclusion provided by that cuff creatine environment. Because there's no blood flow. Oh prison environment you just activate those muscle fibers a lot quicker bursar going through the normal pattern of type one type two eggs or type two B and going in that pattern you can just go right to those type two fibers in tennis. Get the type. One in what research has shown is that people can get the same strength benefits as you would with the eighty percent. One Rep Max Movement as you can with Bihar when you're at twenty to thirty percent so it's definitely really exciting to us is with those acute injuries or conditions where maybe that tendon or ligament. That must've just not ready to be loaded heavily in. That's what's kind of application I use it in. Is that acute phase where like that. Haitian I mentioned where move painful. The blood flow restriction is. He's definitely got me. Where or him where he needed to get? And get us out of that. Fear Avoidance and pain three range after a certain point. That is something I also kind of discharge away from and move onto actual loading. I'm sure on the actual research about it. The research search about it regarding tendon health so the big issue with if someone reuse steroids. And what I think the Afar is that you don't load the tendon heavy enough you'll get the muscle strength gains but that tendon that connects to the muscle is not getting enough load as well. So that's why shift to Actual load in movements like a barbell squatter deadliest or anything like that. Additionally with the B Afar there is some research that shows a Hazo in Jesus affect so it could be just because that is so uncomfortable but a lot of painful movements and become pain-free and it's really exciting to get people people to see them. Oh I can squad full depth. Now is no knee pain or Hick and lift my arm or overhead price. And there's no pain so that's really exciting. What I like to use it for awesome? Thank you for that perspective. There kneel on you know. There's a lot of things that we kind of covered here when it comes to strength training where you know you talk about a foundation nations to look towards intent behind your exercise and then even you know looking at the tools that we can use to assess for for strengthening talk about quantity next and how that klay a role in your prescription using F. R. as long as you know other types of Exercise equipment beyond. Just you know the Therre band so as we look at closing up our conversation here kind of want you to look futuristic. Here what is the one thing you think he can do. Better with strength training like if you could could click your hand around it densify the one thing we need to be looking towards. What is that if definitely loading actual loading the patient Dan? A guy even have an eighty five year old lady who had a tk and she's doing twenty five pound blocks squads so loading is the one thing that people or physical therapists need to challenge themselves more within the clinic. Even if you are still three by ten bandwagon it has to be eh three by ten but with the load where it would. RPI that challenge and it's just not three by ten. Because I'm busy. I need to get my notes dawn. I got another patient Asian here it has to be load in in ten love that Neil thanks again for kind of reiterating that piece kind of showing the context on how loading loading is so important within our context and that we need to do a really good job of staying on top of that so we appreciate you coming on her podcast chatting with both myself. I'm John and we look forward to hopefully get back on to discuss. Maybe some of these topics a bit further in the future. Thanks him love that. Thank you guys for having me. Thanks for joining us now. Man It is so essential that we challenge ourselves to have intent in sound reasoning when loading our patients and as he could see from our discussions. Here Neil really brought up some great points highlighting these principles and hopefully does resonated with you. I know it did for me personally. And I can't think after this type of episode any any more clearly that it is so essential for us to optimally lower patients and to think before we three by ten tab as always thanks for listening to another episode of the clinical podcasts. You're listening to the EM clinical podcast with Dr John Childs and Dr Mark Sheppard for more information on the podcast ask guests and the latest physical therapy visit. WWW DOT evidence in motion dot com slash blog. If you like this episode be sure to subscribe like rate and review on your fevered. PODCAST directory

Sheth Neil Dan Laurenz Dr John Childs Dr John Dr Mark Sheppard Georgetown Afar knee pain Claude Philadelphia US Texas sixers Asia John Worth PT School Knicks quadriceps muscle
Clinical Podcast: Building Autonomous Clinicians | Dr. Andrew Bennett

Evidence In Motion Clinical

16:38 min | 1 year ago

Clinical Podcast: Building Autonomous Clinicians | Dr. Andrew Bennett

"Welcome to the EIA clinical podcast your host Dr John Childs and Dr Shepherd we'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap Oh you think about what a clinical development process looks like in helping a company achieved clinical excellence. Yeah that's a huge question child's and we are privileged to have a dear friend and colleague on the show today Dr Andrew Bennett and as a disclaimer of sorts Andrew tuned to go and spend my first four years as a clinician and a fairly large hospital surrounded by some incredibly well known names now I was oblivious you know that's ultimately maybe how you how you grow clinics but you've been super passionate throughout your career on all things clinical development encouraging mentorship clinical development you know there's a lot of attention of course in the outpatient industry on growing managers in the need to have folks that have a business mindset how to run a practice and and if you would talk just a little bit about the value proposition around you know why clinical development matters and then maybe talk some of the specifics in terms of how oh you've played over the years and continue to be a real advocate for proponent of and just facilitator of throughout the entire company is really all things a straight OUTTA PT school even prior to Pt School all things clinical placement internship residency to mentoring to board certification we're so I Finished physical therapy school and just about nineteen ninety nine went straight into the air force was on an ROTC scholarship and had the welcome to another edition of the EE. I M clinical podcast I'm joined today by my co host as usual Dr Mark Sheppard my name is John and I just go way way back in the world of physical therapy back from his days when we were both in the Air Force is active duty physical therapist and then partners in the early days Texas physical therapy specialists with really good friends and you're one of them well Andrew thanks for the for the background and introduction obviously one of the major roles I know is not a show in which I am an impartial and unbiased co host in so andrew it's really great to have you on the show and welcome to the clinical podcast as of Texas physical therapy special growing outpatient clinics in Texas and Andrew has just been a huge influence in my career so time and opportunity finished up air force time went into private practice for about a year in Louisiana and had the opportunity to come back to Texas and start thanks John It's good to be on chatting with friends again or Andrew before we get started it was just a little bit about your background as a PT and sort of how you is to them At the time but got got the share an office with you John and with Julia Whitman and Rob Wehner and gotta be invited happened as a result of being around thinking clinicians clinicians who recognized constantly that there's an opportunity to get better and I just finished up her fellowship and wanted to just help me get better and so she and I arranged to see patients together for about a year those things go work and help Tim Flynn at the time over at the Baylor schoolhouse and really just these were the people that my job site I just didn't know who they were in the world so it was a really a fortuitous St I remember Rob Wehner coming in couple of mornings before clinic and just getting filled greements green book out on the table and he when I would read the the drive to get better gets stronger when you're able to help somebody else get better so I think there's a bit of a a selfish it can just going back to what we just talked about and my time the Air Force I was just in the right place at the right time with the right people and didn't know it sure of the words and look at the pictures and try to figure it out and just just kind of slug it out together and then I remember similar experience with Julie Whitman I need good therapists to do good work and a need good therapist to be able to produce appropriately well in a clinic and I think Gordon Part of just that synergy between it so you know so yeah we've been around it for a long time I some of it comes out of need as you mentioned I I am a clinical operator and you take clinical operations finances metrics and you failed to combine them with evidence based been in my own desire to be involved in mentoring because I keep learning much by being around others who are also learners I just think that's a practice in meaningful changes in patients sometimes which end up with is a product that you're not as proud of on the reverse side of that if all you ever do is his mentor and Clinic try to be clinically excellent you know I think you end up becoming what some might call a wasteful spender right you can get really really really good got plugged into all things starting a practice and then we'll dive into some more specifics related to current role with both text bts incongruent health assure down that very very very last little thing but could you have stopped at about seventy five or eighty percent of that effort and got about ninety five ninety nine percent of the outcome I think part of my been around clinical mentorship as a company has been trying to marry those two up you know how do we take clinical excellence how do we take board certification chip can occur within the organization from any role whether that's a CI got a student it's a residency mentor urge hospital systems that may be associated with the PT school you have those pathways but often times I feel like in your private practice setting there's all ship tracks how do we take that training in myriad up to clinicians who are autonomous in thinking and able to really run their own practice inside of the company many organizations you're right it's you as a therapist and if you're going to get promoted the net means you move into management I'm a big believer that leader director or a clinical supervisor there some folks who just want to be in the clinic they won a mentor they WANNA teach they want to do research and oftentimes at large you know not the right word but it it just it put me out on the right track and this conversation resonates with me because not everybody wants to be a clinical so much of a clear pathway obviously with with the work you've been involved in there is somewhat of that that clear pathway so for you Andrew at least for from the text p. t. s. standpoint what are your thoughts on the components that come into a program that drives someone to be not just a good it's it's a staff clinician for lack of a better term who just is really good in clinic in his able to seek out some niche levels of practice it's a fellow who's Nicole supervisor but someone who wants to go teach even if it is outside of your own private practice Sir do research even if it is outside of your day to day operations I think you're hitting on a key point here in that is the recognition that these pathways they can exist if you create them residency maybe they'll go through some of the product and of course works around the manual therapy certification report certification those have been very helpful and getting people there some us and I think Andrew that you know obviously I'm bias have gone through residency fellowship training and it's it's been just to say career changing is off with clinicians who want to be leaders in whatever role that they happen to fall in in our organization there is a pathway so whether you coming from PT school very arduous process and very few people are able to to take that on just given the number of life demands that that comes with but fellowship is often offers from managerial standpoint clinical metrics finances that type of thing so that's one pathway that's pretty clear another is individual ship you know and obviously that's a I think the recognition of hey this is the first step we want you to be a specialist we want you to be very good at your area and for a lot of people they they'll go through beginning to explore is the idea of the clinical mentor where there is some support and knowledge then it begins to break apart into different paths you mentioned the clinical manager like there are some people who really enjoy leading and developing a folks you know maybe they've been out long enough that they need the just in preparation and do some of the course background work and then sit for the test but the point is we we really don't look for helping promote and develop the clinical excellence culture within the company and obviously within your local clinic as well a third pathway typically is more of what you might consider a niche practice practitioner right so maybe maybe you're an orthopedic Certified Board Specialists Right in the beginning or you've prep she worked somewhere else and you've you've found your way to a clinic the entry point is how do we get you to board that's a recognized by our profession as a specialty you'd have to correct on the numbers but I think the last numbers I saw were less than five percent of the PT's in the nation have that have that credential certification right with that sports women's health or or geriatrics orthopedics the key is to get you to the board certification because partly because one where then at the end of your fellowship in through your fellowship you're involved in teaching other residents and leading the clinical excellence round that we host every month and you're responsible for from eight to five percent or something like that and so in in it's an established product I mean it's a hard test and to have that means you do have something special and so I but you really want to dive into breast cancer or you want to dive into public health or you want to dive into some of the pain science components right three you know therapists talking about well why would I want to become board certified my employer you know you don't get a pay raise necessarily when you get board certified so talk a little bit raining the rest or it's a clinic manager and I do think you have to separate that not every clinician wants to be a manager but I certainly want us around cheol practice involved in developing a clinical mentor who then can be the person or persons involved in supporting those those are the things that you're like man that person has value because again it's not the letters it's not the output it's the product it's the might that advance my future earnings opportunity down the road I'm GonNa answer that kind of Tangentially I don't think it's wise the courses like the drain Ealing coursework the paint science coursework or even some of the AST William type coursework those are all options a fourth one that were look at the next step until folks hit that first one fella that's something we value vacations important after board certification is your ways to do it then going through board certification and fellowship there are lots of other clinic pathways out there you can you can do that but Andrew you know we've touched on a little bit about board certification and you know the role that that plays in the clinical development process you hear a lot of times in the industry industry maybe that's not a common practice for that therapist who let's say may work in an in a setting where that's not the case why would I be interested in getting board-certified in letters that were that were rewarding you for it's what it represents it's the year and a half of you took everything you had and you tried to make this is where a clinical excellence meets operations if that clinical person can take that skill set and know their own lost visit rate all those are sort of a sub specialty and you continue to refine and develop based on on what your abilities are in you know that comes along

Dr Andrew Bennett Air Force Dr John Childs EIA Pt School Dr Mark Sheppard Dr Shepherd Texas five percent ninety five ninety nine percen eighty percent four years
Clinical Podcast: Incontinence is Common but Never Normal | Blair Green

Evidence In Motion Clinical

27:21 min | 1 year ago

Clinical Podcast: Incontinence is Common but Never Normal | Blair Green

"Welcome to the I am clinical podcast your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be. Are you ready. Let's go hello everyone and welcome to another edition of the IM chronicle podcasts. Thanks for joining me my co host Dr John Childs for another episode so here. My name is Mark Sheppard. We're joined today by Dr Blared Green Blair is the owner of calloused physical therapy in Atlanta Georgia in in is board certified orthopedic clinical specialist but also comes to us being certified Helvig health within physical therapy and she's actually actually also faculty in evidence emotions own pelvic health certification programs react to one of them is advanced program in one of them is more of your soup-to-nuts. That's kind of public health program which are both very awesome but the cool thing about glare here is that she has co authored a book called go ahead. Ed Stop and P running during pregnancy in host Parnham with the help of her colleague Dr Cate Edwards so today's conversation will really focus around the enroll physical therapists in particular can have when it comes to bladder function for those who are either pregnant or postpartum so Blair. We're really excited for you you joining us today. Thanks for having me Mark and John. This is something I'm so passionate about member really glad that I get to share it with you guys and with your audience too well. It's not every day that I can say that I'm excited to talk about. I'm pretty excited to dive into the topic today so you know I just I'm I'm always interested in picking you know therapists who work with those who suffer from pelvic health conditions or impairments so I guess we're a star is is tell us a little bit y. You're so passionate about this topic in in particular. What drove you to come up with a guy in particular for pregnant and post-partum sure it's it's funny? You say that you're not always super excited to talk about p. and I always tell all my friends and my patients that probably the one thing I do all day. Long is talk about P. poop insects because when you work in public health that's pretty much what you do all day so very different than you guys but I you you know I came into pelvic health through orthopedic world. I was repeating manual therapist for several years and right. When I got out of school I started seeing a lot lot of pregnant. Women and I found that physical therapists on the whole at least in my experience at the time were really scared to work with pregnant women. They felt they were really fragile. Well and they were scared to treat them for fear of either hurting momber hurting the baby and I kind of embraced that role as the person who can help these women and really took a clinical interest in working with pregnant and postnatal women and I think that just got accentuated once I became a mom myself I have seven eleven year old and a thirteen year old so I've had my own experiences through pregnancy through postpartum through all the physical changes that come along with that and I've kind of taken my own personal experience experiences and I've been able to really put that into my clinical practice as well as all the skills I've learned along the way so so when we came up with this guy it was it was sort of very similar my friend and colleague Kate who she's another physical therapist and she's running specialist list so her son is five in when she became pregnant and he was born she all the sudden realize that even though she also had all this physical therapy knowledge she she didn't really know what to do. She couldn't figure out what's the right thing to do. What's not the right thing to do. Do I need to be worried about anything if I WANNA keep running and stay active through from my pregnancy and so she came to me at the time we were working together and I helped her through her pregnancy. She saw me after her son was born and we got her back in condition where she would be able to run and in doing so realized maybe there's a lot of other women out there who don't have this information and so she came to me years later later and said. Hey I this great idea. Why don't we do this book and as luck would have it. I had already started on writing a similar book as to how to get back to activity after pregnancy and so I said you know what I've got this book already Britain and she and I got together and she put in all the pieces about the running and and I got to put in all the pieces about pelvic health and from that our book was born Blair. I really appreciate that introduction. You know your comments. Let's make me think about a lot of the issues you here with women during pregnancy in in struggles they have with bladder function in some of the conventional wisdom is almost that that just a normal part of pregnancy and saying that women just have to sort of with in so if you would talk a little bit about bladder issues both during pregnancy and after pregnancy. How prevalent are those issues in to. What extent is it really something? That's just a side effect. Quote Unquote of of pregnancy versus actually really something that's dysfunctional and given some amount of attention you can actually do something about that's a great question. John in terms of is it's really a side effect of pregnancy or is this something we can do about so read a number of studies just looking at on the incidents in the prevalence of a bladder problems in pregnancy in typically what we talk about is stress urinary incontinence continence and so for those of you who don't know what that is. That's that's the leaking that occurs from the bladder weather. It's just from moving to stand or the people who complain about leaking leaking with coughing and sneezing and jumping activities like that but about half of women during pregnancy deal with some symptoms of stress urinary incontinence so it is pretty prevalent in the pregnant population and then according to studies in there was burying prevalence on this. It's probably about a third of women in the postnatal period also also experienced this and sometimes. I wonder if it's more than that. It's just under reported because of what you said people think it's normal so we always like to say it is. It's definitely common. It's never normal. During during pregnancy we deal with a lot of changes in terms of the physiological changes in the body one being that urine output in general increases. The kidneys are working harder. The MOM is functioning as vehicle through which the fetus this eliminates ways so all the bees also filtering through the mom's kidneys and in addition. There's a lot more fluid and so because his win the woman's body increases fluid volume. There's also more of a need to urinate just because there's so much more going on with her body. So there really is an increase increase in urine output. Does that mean that mom needs to be leaking probably not what we have to consider though is the posture changes and the growing belly in the growing uterus and the pressure that puts on the bladder so just from the normal physiological changes in pregnancy it creates this new relationship in the abdomen and can increase intra abdominal pressure that pressure inside the abdomen when that happens they re through the bladder muscles in the pelvic floor muscles have to work harder to maintain that continents mechanism so is this a side effect. I would say yes during pregnancy but I also think it's something that we can help doc even during pregnancy now. We're talking about postpartum. I think that's a completely different situation. At that point. The muscles have been weakened. They've been lengthened. They've been dealing with weeks and weeks of change so there is this period where they do need to adapt to go back to what they were doing before mom was pregnant but there's a lot we can do with PT in terms of teaching women how to activate their pelvic floor muscles had a coordinate these nostrils with the other muscles of the core dr which also include believe it or not your diaphragm and your deep abdominals so a lot of times just by helping women learn how to breathe differently in teaching them to be any more in touch with these muscles we can actually help them improve their pelvic floor muscle hunching and keep them from dealing with symptoms of incontinence throughout the postpartum period. It sounds to me that you know when you look at this a lot more than just dealing with a K. goals right. That's absolutely correct. Cables are chemicals are sort of the the big buzzword in the big word that pelvic. PT's don't like to say all at the same time. Cables are fantastic. We need to be aware are pelvic. Hello floor muscles. I think there were a couple of studies that showed that if you asked a woman had to do a cable seventy percent of women or more didn't know how to properly use those muscles else so there's a lot of women out there who aren't even aware of their pelvic floor muscles but once we develop that awareness through cables we have to teach women how to put those muscles back into their body in and work with all these other muscles as well. It's not just an isolated pelvic floor muscle function jollity jump into your question that you were talking about earlier about men's health. I think good kind of senator yeah. Yeah you bet so Blair as we talk about these issues shoes so far we've heard really only about a women and certainly men have a pelvic floor as well in. I think it's unfortunate sometimes as you know that we even call these things sort of women's health because it presumes that only women have issues around pelvic floor dysfunction so if you would just talk a little bit about some of the pelvic floor issues we see in men how prevalent what are those issues and as therapists. What does someone someone who's trained in pelvic floor therapy. What can they do for pelvic health issues specific to men share so I think it's good to remember that aside from a few small changes the pelvic floor in the pelvic anatomy outside of the Genitalia is is completely distinct in men and women so a specific were floor muscles. Men and women have the same muscles so that means that add all of that region. Even men is acceptable to injury and susceptible to problems a lot of what we see a man at least in my in my clinical practice. I treat actually actually a lot of urinary dysfunctions even in men to men deal with symptoms of urinary urgency and frequency where they may feel like they have to go to the bathroom all the time they make a ladder isn't completely empty and so those are a lot of the things that we're dealing with in men the other obvious thing that men deal with is post prostatectomy so when men developed prostate cancer and had the prostate removed that often comes with a risk of impaired urinary function so a lot of men will deal with stress incontinence as a result of that surgery men also deal with a lot of other pelvic pain issues such as Rectal uh-huh pain. Maybe some scrotal anticipate your pain. Maybe just impair nail pain whether it's from sitting or physical activity or weightlifting or whatever it may be we really see a big variety of stuff in men a believe it or not and in terms of what we do a lot of that depends on what's going on so some some of the interventions we may use include retraining pelvic floor muscles just like you would in women men can do to and then teaching men how to incorporate rate of the pelvic floor muscles with the diaphragm with the abdominals with the low back muscles as well but when we're dealing with some of these more what I call overactive active pelvic floor problems which are typically the urgency the frequency the pelvic pain. We do a lot of manual therapy as well and a lot of interventions. It's targeted at teaching these men how to get their pelvic floor muscles to relax a very very interesting to hear. I think you know as I've talk to more and more individuals who work with folks like this you know there's been such a nice shift to this term of pelvic health versus women's health and I think it's just a you know for those points alone or just you know super salient there too we can come back to this idea behind runners and what they deal with if you know what folks were pregnant or postpartum deal with when they're trying to run a return to run. I'm sure there are certain signs and symptoms are complaints. Stat runners in particular will start to notice so what are some things that the every day clinician who may be treated someone who's pregnant or you know typically post-partum. You know what what should be looking for and secondly. Are there some usually things that we can do to to address these may be. Your guide builds on sure so you know I think what happens. A lot is a lot of runners especially the postpartum runner and even the pregnant runner they may not be coming into the physical legal therapists again because they're leaking or because they're having some problems with pelvic floor dysfunction because in their head. They may think that this is a perfectly normal thing usually the as they're coming in for help. It's because they had hip pain low back pain SL joyner pelvic girdle pain. These are very very common things that occur in pregnancy post-partum and so it's usually the orthopedic therapists. That's that seeing these patients. Employees just needs some screening tools to identify whether or not the public floor is contributing beating so there's a lot of questions I'd like to ask in. I think these are good for any physical therapist task their patients who are coming in who may be your postpartum. Pardon or pregnant in are complaining hip low back pain. I always ask about changes in continents and I know that that's a red flag question for a lot of other issues as well but when you ask them. Are they leaking. I think being very specific because a lot of times you just say. Are you having a continents in their mind. They're thinking like a full blown loon. I can't control my bladder at all. They're not thinking that little bit of your in the weeks out when they go for a run so I try to get really specific about that. So how how little is a little bit like you know. That's kind of different for everybody. Is there like a rule of thumb. I don't know that there's any sort of wise criteria Korea Any leaking isn't normal so if someone's leaking even if it's a little bit every time they run if they're noticing that they're leaking that's probably you too much and and the reason is because what we do know is a lot of times these changes that happened in pregnancy postpartum they may be very minor or uh even virtually nonexistent right after delivery and it may not be until ten or twenty years later when that women's maybe in her forties or fifties in his now going through menopause and is starting to have more problems because of the the changes menopause and decreased estrogen in aging that can happen and the childbirth in the pregnancy were risk factors for further on down the line so it's also very preventative. I think to to attack it early and help them not have problems ten twenty years down the road so yeah yeah interesting interesting yeah go ahead you go and finish up and then. I'll ask the next question. I was GONNA say another thing. Another thing that I really liked to ask about in these women is the idea of pelvic pressure so another common impairment impairment that can happen after childbirth is something called Pelvic organ prolapse and that can happen for a number of reasons but what it feels like to woman. It almost feels like something's falling out like my patients come in and they say I feel like my vaginas falling out. I feel like something's coming out of me and it's like this heaviness and pressure and that that's a sign of pelvic floor dysfunction. I think that's something that's really easy to screen for just by asking your patient. Do you feel like something's falling out. Do you feel like there's pressure sure. Can you look down and see something. If you look say in the shower after you go to the bathroom. Do you notice something there because pelvic organ prolapse is something that will keep women from running for certain because it's just not comfortable to be running. When you feel like there's something sitting right there in your pelvis you think about you know how to you know both prevent vent and treat a pelvic floor issues and women. You know these are obviously you know sensitive issues. women are probably better perhaps than men than than talking about them at least based on conventional wisdom but yet you know it's it's still a tough subject for anyone to talk about so in terms of like educating women and men at what point do you start introducing questions during medical exams or during a physical therapy treatments you know women come in for example with you you know hip and back pain and D. Screen for pelvic health issues and just talk a little bit about at what points along the continuum do provide education Haitian and awareness to try to normalize both men and women being able to talk about these issues and have a hope for actually getting better as opposed hose to just seeing these issues as quote unquote side effects yet. You know it's funny. I work in an office with three men so they are all now getting really really good at asking these questions after having me in their in their office with them for two years but it it certainly it certainly isn't comfortable for a lot of female therapist either but I really I try to start the education early on I talked to you in. This is my a bias in my background so certainly it's very different but I talked to all of my patients about pelvic floor problems. Even the ones who come in my my practice focus on clinical clinical focus is certainly pelvic health but not everybody that's walking through. The door is coming four pelvic health but I start on day one. We have several questions on our intake questionnaire that are slanted toward pelvic health whether it's urinary function whether it's definitely Katori function pelvic pain. Are Your periods regular her. Have you gone through menopause. What you know what surgeries have you had an so. We're really starting to screen and address it early. We also you can just put it into our marketing materials. It's pretty regular. Piece of our marketing is stuff about public health. I really think the more we can talk about it. I always say the Pella's. It's just another part of the body pelvic floor. I tell every single one of my patients this the pelvic floor muscles are muscles just like quad just like you're biceps just like your glued so so there's not a lot of difference there accepted muscles are on the inside and outside and I think when you look at it that way and you just start to normalize is the fact that the pelvic floor is a muscle group people start to feel a little bit better talking about it so I always like to start early and when it comes is to pregnancy and postpartum. I see a lot of women when they're pregnant in the whole time. I'm treating them while they're pregnant. I'm educating them on what they need to do. After delivery so every every woman that walks out of the door knows she's coming in for a postnatal screening to make sure that they can get back to what they need to do safely and with minimal minimal environments. That's a good point in if we unpack that a little bit more later you know. I I remember when when my wife was pregnant with Bolsover kids and in particular I I when we went in and they did the whole pre pregnancy kind of educational piece where they talk about. You know what it's like and the things that you need to do what it's it'd be like. When the baby's born there was literally nothing about like how the female's body is going to change from you know pelvic bladder functions auctioned standpoint. There was a lot on other things that were going on that were important but there was none of that or nothing talking about the psychosocial effects that happened postpartum postpartum depression and just adjusting to you your life losing sleep. It was really kind of isolated to a couple L. A. Things are there really wasn't is component that I feel like is missing. What are your thoughts on education that needs to be kind of scaled if you will within the hospital systems and in ob clinics and beyond and again this is this is such a by the minute you might make soapbox boxing and I've been on the soapbox or a number of years but my big soapboxes is that every woman who has a baby should have a postnatal screening like automatic automatic so whether you set it up in the hospital or the doctor tells you about it at your six week post natal visit or maybe it's a visit that happens before delivery and then again after delivery you know the doctors deal with a lot and I certainly don't fault them because they're not necessarily addressing all of these musculoskeletal issues that can happen during pregnancy they have a lot like you said to deal with with all the other physiological changes in pregnancy but that's. I think where PT's he's come in and are very well equipped that we could easily be a part of that education where we can just have someone come in and we can just show them here ways that you can modify modifier sleeping positions here are ways that you can learn to pick up in hold your baby so that you can minimize you know strain on your back here. There's so there's so much we can do in that and that's just the tip of the iceberg even in terms of the pelvic health keys and here's how you use your floor muscles. Let's start working on this now. During pregnancy pregnancy so that the minute that babies born in your muscles start to recover after delivery you can start back on these exercises and we can minimize the risk for future problems problems and I just see PT's as being a key a key role player in that education piece with pregnancy on John. Legit do closing question so Blair in this has been a a super enjoyable podcast and I know it'll be really informative for our listeners as we head towards a close I'd like you to address one issue. We really really haven't touched on and that. Is You know issues around where we're headed relative to women in pregnancy and postpartum in healthcare so if you would just for a moment kind of paint your vision of how this would be done in the in the best of worlds. I mean do all do all pregnant. Women get a referral to who a pelvic health therapist is that overdone. What's the screening criteria so if you're developing the the healthcare system of the future what would that look like relative to all things pregnancy and postpartum healthcare. Yeah this is this is like my vision on this is like my professional vision and what is happening for the world but I I really feel like women need weird to talk about education but I think where her maternal health care could go in the future is just having more her whether it's integrative care interdisciplinary care where we have physicians working with mental health professionals working with PT's in Dulas in midwives arrives in kind of creating almost like the team of professionals that will allow women to get all the pieces that they need because I think we're all all looking at the same goal which is taking woman successfully through pregnancy and the postnatal period but we all have different Arab expertise in ways that we can influence her so that would that would be my first thing is having sort of like an integrative system where women can get all the education they needed from all these different pieces of the healthcare puzzle but then secondly. I really feel that a referral to PT Postnatal needs to be automatic. It needs to be something that's happening like like I said either in the hospital right after delivery or when they go for their six week postnatal visit to the OB that needs to be the next step okay from my hi perspective. You Look Great. I really want you to see a physical therapist and make sure that your your body and your muscles are doing what they need to do so that you can get back to activity eighty because the advice that they're getting now is okay. Everything looks good. You're good to go back to whatever and they're still. There's a hesitation there is a fear and there's these women know that they're they're not ready to just pick up where they left off and they probably shouldn't just pick up where they left off but in that case is getting left out and that's the piece. I think that we improvise. PT's that's awesome awesome stuff glare. Thanks for your thoughts and I'm sure speaking for for John. We we just enjoyed your time today. Your insight and we hope that be back on the podcast here in the near future anytime thanks for having me thanks player appreciate it share what a great conversation we had today with. Dr Green on a real Mitch but highly relevant part of physical therapy practice related the to all things pelvic health. I hesitate to say women's health because we talked about pelvic. Health issues related to both men and women issues related needed to from all things to pregnancy both during pregnancy postpartum to running and really this whole concept that pelvic health issues and incontinence and those sorts of things are not side effects of pregnancy. I appreciate it. Blair's comment that there are common but that they're never normal and so I think that really speaks seeks to the opportunity that we have to really address those issues as physical therapists and really mainstream all things pelvic for both men and women so without further ado thanks as always for listening. You can always reach out to us at team on the various social media channels. A blog is always there mark. Can I truly enjoy hosting this podcast so feel free to ping us if you have any ideas for future guests and would be glad to get them on so thanks again. We look forward to having a new against him. Thanks for listening to the EM clinical podcast with Dr John Childs Else and Dr Mark Sheppard for more information on the podcast guests and the latest in physical therapy visit www dot evidence in motion dot com slash blog. If you like this episode be sure to subscribe like rate and review on your favorite podcast directory factory.

pelvic pain Blair Dr John Childs PT Dr Mark Sheppard menopause urinary incontinence Dr Cate Edwards IM chronicle Mark Dr Atlanta Parnham Long Georgia Dr Mark Shepherd stress incontinence
Clinical Podcast: Looking Back Over 100 Episodes

Evidence In Motion Clinical

22:00 min | 1 year ago

Clinical Podcast: Looking Back Over 100 Episodes

"Welcome to the I am clinical podcast your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what would be. Are you ready. Let's go welcome to another edition of the E. I M clinical podcast as always I'm joined today by my co host. Dr Mark Sheppard. My name is John Childs Child's and today's episode I must confess is GonNa be a special one because we are celebrating the one hundred episode of the IM clinical podcast and with that gotta give a shout out to my previous podcast hosts Dr Jeff Moore who was with US probably for the first eighty or so of those and has now over on pain reframed with Tim. Flan and Marcus stepped up to the plate to fill his shoes and it's been a fun ride rather than having a guest take take a little bit of a diversion and mark and I are going to be discussing our top three podcast over the last one hundred episodes and just do a little bit of reminiscing and walk down memory lane so without further ado welcome to the show will jump right in the most popular episode out of the one hundred in terms of the number of downloads was podcast we did with Dr Stuart Macgill who is a bio mechanistic out of Canada not a clinician by I training but you wouldn't know he's not a clinician by talking to him because he actually is pretty actively involved in patient care so he's one of the non clinicians who who sees patients on a pretty regular basis is obviously than a giant within the profession as it relates to act pain and exercise in particular in really identifying underlying mechanisms that contribute to back pain it was a podcast titled the Truth About Back Pain and so mark. I'll let you kick things off often. What were your top takeaways from that podcast. That podcast for me was just an interesting look because I think in the exercise profession are background within her profession is really been on this debate of general exercise versus specific exercise in listening in hopefully the folks who have I listened to that just got some kind of pearls and nuggets there that I thought were really helpful and will always kind of interesting to me was stuart. MacGill kinda gets a a little bit of a bad rap. I think on at least in social media and some other discussions I've listened in that he's super by a mechanically driven and really doesn't look at the totality Talapity of the contextual factors that come into play when someone has back pain and listening into his approach. He does a fair bit of that and in John like if you've heard him talk. The guy is as confident as ever in man. Can he just spout off the research in he he really knows his stuff and I guess John. My big big piece here is that although he probably falls more on the by Mechanical Pathway Anatomic type of reasoning model. It's just interesting how he flavors offers in some of these other pieces. What kind of memories or experiences have you had with Dr Stuart Macgill. Yeah you bet no. I appreciate that Mark. I I got introduced use to Dr McGill actually indirectly because he was on the Dissertation Committee of one of my PhD colleagues Greg Hicks was at the University of Pittsburgh are call it circa two thousand one two thousand two and oaths to McGill and Gwendolyn Joel was actually on his dissertation in committee and what Greg was really looking at was clinical factors that would predict a successful outcome from what basically is a lumbar stabilization or strengthening thing program and of course if you remember back in the day when and Stu probably couldn't have been on further ends of the spectrum relative to Kinda this generalized versus specific exercise approach and I'm I'm. GonNa exaggerate your little bit. There obviously incredibly accomplish very pretty open minded kind of individuals but to summarize it when was sort of on the side of this very specific localized you gotta be able to contract the transverse dominance in that. That's sort of the foundation for then moving onto more general is exercise of course Stu came from the what I would call more classic sort of approach where the idea was to maximize e. m. g. activity Eddie and that this whole notion of sort of selective isolation of the transverse abdominal was less relevant and so there was a lot of spirited debate that went on that ultimately I think lead greg to develop a more hybrid model of lumbar stabilization that incorporated elements of both of those right and I think he got to the right answer because as usual most of the time the right answer lies somewhere in the middle. I think they got to that and so I've got a lot of respect for stew is not a clinician and yet as you heard on the episode is pretty actively involved in consultation of care and the precision with which he talks about the physical examination wow he comes from the camp where it's a fairly exhaustive couple of two or three hour exam and he really really wants to drill down to causes if you will that contribute to back pain we could debate all day long. There's certainly a lot of literature that suggests identifying mechanisms of back pain is elusive and that too much focus on that can contribute to sort of an over emphasis on pathology and those sorts of things but wow you can never ever criticized stew for his passion and energy and wanting to help some of the most chronic patients with back pain who really have pursued anything and everything thing without benefit so I know from my perspective stews one of the legends in the profession and I should be more clear really he's not a physical therapist so not the PT profession in but just in healthcare in general as it relates to back pain so what a great episode something stuck out to me too is just his respect and understanding of if what physiologically happens when you load tissue and when we think about how we prescribe and dose or exercise he's very very dialed in on that specific mechanism that's happening when you're loading that tissue and I just really appreciated that. His exercise is is very very prescriptive in nature. It's not this three sets. A ten or two sets a twelve. It's nothing like that and I think that just goes to say that. He has a deep knowledge. He's very confident in sharing with the patient. He takes a very systematic thorough approach. When you dose exercise like you would dose of medication I mean why would you not see very specific changes that make a big difference in the patient outcomes and there's definitely something to be said for for somebody who sees patients who've been through kind of the round of healthcare practitioners in the on the podcast is like you know. I see people who've seen five to eight therapists before and you know if he's making changes there. He must be doing something right there so just a lot to gleaned from that episode so check it out if you haven't already now John if we look at one of our other top episodes here you really can't go without looking at Dr Peter O'Sullivan and his work. He's done with persistent in pain particularly those with chronic low back pain if you've ever seen him speak keep just keeps you so engaged and something. I've really loved about his ability to at present the knowledge he has is just the stories he shares with patients who come in and how he can empower those patients to make a difference in their lives so John. Wha what are some big things kind of come to mind with with Peter O'Sullivan and maybe how is he influenced your profession your your outlook on. Let's say low back pain. Yeah you bet so. Peter was another rule rising star. If you will probably already a shining star back in the early two thousands but at least from my perspective perspective I was just getting to appreciate the work that he was involved in. I know he worked very closely with the Australians in the whole mechanisms around back pain pain as it relates to lumbar spine strengthening exercise and he was at least based on my understanding you know part of the camp if you will that was really touting the selective isolation again of the transverses dominance in was colleagues work closely with Gwen and those folks in that whole effort just a lot of passion and energy and what strikes me. Peter is one of those to me penultimate examples of a lifelong learner. He really built his career in an area where eventually lead the data may be suggested that a more generalized approach of exercise was perhaps as effective as a more quote unquote specific approach coach and in particular just the appreciation of all of the psychosocial factors that play into back pain and so what I appreciate about his career career is just the shift that he's made over time where he talks a lot about psychologically informed care and certainly is still very much an advocate of a very a comprehensive physical exam again. It's not one or the other but I think that's what I appreciate about really all of these folks. It's so easy when you see people published and big journals to sort of label them. You don't really know them all you do. Is You sort of know them from some maybe platform presentations or perhaps a keynote where where they're intentionally sort of provoking the audience and oftentimes and I'm guilty of this. You know you say things that you don't actually really believe just because you WanNa it make folks think and Peter is one of those who definitely can make folks think but when you really sit down and you have dinner with them they're actually far more open minded than what there's sort of reputation might indicate and to me that is always been the privilege at least that I feel like I've had in sitting down with a lot out of these quote unquote giants of the profession whether it be folks like stew or Peter Gwen Joel is that they're really scientists at heart and at the end of the day despite what you think think about all of their preconceived notions and bias he's they're actually very very collaborative and change their thoughts based on how the the evidence informs them so I think for me. That's one of the big takeaways that I have from Peter. In this particular episode I think highlighted his willingness to learn over the course of career. It's interesting because you look at what he does and John like. You're saying he he's a shining example of kind of progressing over the years to where evidence is drawing him and whereas clinical experiences drawing him and you know. I think where Peter O'Sullivan Kinda resonates with me. In my practice he's really is opened my eyes up to motivational ovation interviewing and really understanding the firmly held beliefs or patients come in with and you could spout all the literature in the world about why this intervention invention is better than the other but if the patient has a belief that is so strongly held to you're just never really going to be able to make much change until you can understand on that and start to chip away at it in particularly if it is a negatively held incorrect belief about their spine or something along those lines and if if you go on for those listeners listening into this show go onto youtube and just type in Peter O'Sullivan's name and you can see some of the videos he has and there's is a video of him actually out there where he's working with patients on stage and you can just see the way he connects with them so naturally in you just watch his non verbals verbals and just the way he inflex his tone. You could just tell he is so good at connecting with patients establishing that therapeutic alliance that will make them uncomfortable with being vulnerable with some of their beliefs and I think that's a huge growth point at least for myself is coming in. I was like man you know you fit this perfect article here and you need to get this exerciser this manual therapy or what have you and I never really sat down to really talk about what patients beliefs our expectations -tations and he really helped highlight that for me in this episode was one that really just resonated with all those factors in made me kind of think about in my directing those pieces there so was really great to listen into. Let's take a look at our final most popular out of her a hundred here and I mean both of us are not shocked shocked on this next person because I think she is one who is probably on everybody's top ten or at least top five when it comes to podcasts or all-time leading a presentation say seen Dr Shirley. Solomon is just a huge name. We talk about giants in her profession. She is one of them and something I've always loved about about working with Shirley in my limited roles with interacting with her is just the wealth of history that she brings to the table and it's just it's fascinating fascinating talking to her because she's just been through so much with our profession has such a great perspective on where we've been and where we need to go. It's always great. You just can't help but sit and listen so as we've done that the other two John Waters. somethings that come to mind with your experiences with. Dr Shirley Solomon while Yeah Mark we could talk on on and on and on about Shirley. I just have one memory as a PhD student. I was very involved in flushing out some of the treatment based classification the sub-grouping in concept that was espoused and led by Tony Delete Oh Julie Fritz and that whole crowd and it was a system of sub grouping that was at some level you could argue argue diametrically opposed to the movement system that surely hit built actually as time goes on. I think there's actually more similarities than there are our differences. I always sort of viewed her movement system as a subset if you will of the stabilization category for lack of a better description really the exercise based focus and I remember as a young doctoral student I was pretty free wheeling and my comments and often was far more bold than I had had any actual credibility to speak about but nonetheless I did invite a feedback in the way that I spoke out and so I remember bumping into Shirley as a young doctoral doctoral student but yet was starting to kind of develop a reputation and was publishing and that was afraid when I met with her. I was like oh my gosh like maybe I would have offended her sure and I was about to get so raked over the coals and it was nothing close to that at all. In fact we shared a meal together. She was the most kind human being being. I mean completely the opposite of what at least my own preconceived notions were about how that conversation was go. She was incredibly encouraging and we built the relationship over the years and just she's a dear colleague and just his is truly a giant and the profession so like stew and like Peter and like like a lot of other real foremost leaders you don't get to where they've been without building a team around you and motivating and inspiring and certainly unleash surely has done that. If you look at her tenure at Washington University in Saint Louis I mean if you really trace back the evolution of clinical research rich in physical therapy wash U. was an institution that had a lot of those early leaders folks like Steve Rose for example which the Rose Award Orthopedic Section named after was there his men tease included individual like Tony Shirley. was there just a number of really early leaders in the profession that then spilled out into a number of institutions around the country and then next thing you know we've got twenty years of evidence to support what we do so it was leaders like her that back in the day there really wasn't data it just it was a lot of clinical intuition a lot of trial and error and so individuals like her to lead that effort of building a base of evidence is just we can never express enough our token of gratitude attitude for what individuals like. Shirley contributed to the profession and that resonates with me John because when I was a PT student at Sacred Heart University I was was on a committee that helped with the Marquette challenge at the time it was the pit Marquette Challenge on obviously. I'm sure you're familiar. You know raise funds for research which within physical therapy we actually invited her to come out and speak at our school and she did it voluntarily and it was a huge success asks you know obviously people wanted to come in and see what she had to say and teach and it was just spoke to her just ability to really pay it forward in many ways and I had the chance chance to have dinner with her with the number of other students in my program and it was just it's a time that I think back on very fondly in his just really was a behavior. I I hope I can pass on when I get older and my career to but with her podcast. It's just great to kind of listen to some of the pointers. She brings out in particular titular. How as movement experts we have to be very focused in on actually assessing for movement and how we do that and obviously leash. She has a systematic approach to that and I'm a firm believer. If you're looking at anything you should be systematic in nature because it probably helps with your reasoning approach. You're not just going going at it with a really sloppy kind of I'm going to do whatever I feel like today. Versus being consistent and systematic hearing her talk about that really resonated with me in if we are a profession at least as physical therapists that is a movement expert profession. She has a lot of great pointers in that episode there as we come to a closing here as we've mentioned time again in this episode three major giants within our profession so what do you do you feel like these individuals individuals possess that has been something that is put them where they are an has done the things that they were able to do within our profession. Do you have any insights on on what that it might be yeah. I think it comes down to a few basics. I think number one it is a passion to be a smaller part of something bigger than yourself herself in other words. It's not about them. You don't get to those positions without again a lot of doctoral students and a lot of colleagues and a lot of peers that are supporting you along away and all of those individuals. I think do a really good job of building teams around them. In sort of sharing the wealth I think curiosity in humility is a big part of it. It's this idea of not believing everything that you think and being willing to change your mind and be open to criticism and evolving evolving over time so I think curiosity is a big part of their success at be really remiss if I didn't say a lot a lot of hard work work with so easy to look at individuals like them who've had very successful very prolific careers in not appreciate the sacrifice that they've made handedly that their families have probably made spouses and children and just the sweat equity you pour into your career travel the long hours the willingness to do whatever it takes and so some combination of passion curiosity and really working your tail off not just for period of time during your PhD program for example I mean most students in those phases of their careers work I would say pretty hard but you carry that Same Energy Asia and passion into the rest of your career and there's not any folks that are able or perhaps willing to do that and Kudos to them because of their efforts and contributions ends the profession of physical therapy sitting in a much better place in two thousand and nineteen than it was at least when I came into the profession back in the mid nineteen ninety s John thanks for your perspective there and I hope everybody has enjoyed our recap of our top three out of our first one hundred shows it is a privilege to be part of the hundred hundred episode of the EM clinical podcasts hard to believe but again many thanks to Wolf Dr John Childs and Dr Jeff more for being the brains behind in starting this all up and we hope for another hundred shows going forward and we look for your input as well as some of the individuals you would like to hear US talk with with obviously it's very interesting for myself and John to be on here because we get the front seat to talk with many individuals and as you can imagine we've had that wonderful opportunity you to speak with many outstanding individuals within our healthcare profession so we hope that going forward you continue to listen in and as usual you can find us on the socials at e. M. Team and thanks for making our one hundredth episode special one in here's to another hundred more and thanks for listening to the IM clinical podcast with Dr John Childs and Dr Mark Sheppard for more information on the podcast guests and the latest and physical therapy visit. WWW DOT evidence in motion dot com slash blog. If you like this episode be sure to subscribe like rate and review on your favorite podcast directory yeah.

Dr Peter O'Sullivan John Dr Shirley Dr Stuart Macgill Dr Mark Sheppard Dr John Childs stew Peter Gwen Joel Dr Shirley Solomon John Childs Dr Jeff Moore Dr Mark Shepherd Greg Hicks Dr McGill Mechanical Pathway Anatomic Mark Tim Flan
Clinical Podcast: Collaboration and the DSc | Eric Chaconas

Evidence In Motion Clinical

24:18 min | 1 year ago

Clinical Podcast: Collaboration and the DSc | Eric Chaconas

"Welcome to the I am clinical podcast your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was being. Are you ready. Let's go welcome to another edition Shen of the IM clinical podcast. I'm joined today by my co host. Dr Mark Sheppard our guest today is really special when Dr Eric Toconas it is the director of the doctor of Science and Physical Therapy Program at Bellin College which is a partner with EIA. 'em In really trying to offer opportunities for therapists to pursue their terminal doctorate degree so folks that might be interested in getting involved in academics and so I know that at our listeners will really enjoy today show he'll learn more about how a Dea Sea is different from PhD and what that means for qualifications in terms of being able to be on a faculty and perhaps learn about some of the different lines of research that are available to those that are pursuing DC at Belen so without further canoe Dr Eric Conus Eric. It's great to have you back on the clinical podcast. Welcome to the show. Thank you guys yeah so eric. I think it's been probably a couple years or so since we had John in the early days one of our probably I episodes with Jeff more. I believe you still on faculty at the University of Saint Augustine at the time and you've had some career changes recently so I know we'll talk about that but before we do that just give us a sense sense of of your journey got started in the profession and and what you're up to these days yeah so like when I was an early in new physical therapists out of school two thousand six I always knew that I really wanted to advance my training and a wanted that next level of critical thinking skills I was always impressed when I was in PT student by the fellows the people that were am fellows. I always thought that was a need credential and I always looked up to them. In the level that they were at so anyway I pursued fellowship training shortly couple years after school and that really opened up a career in academia for me like most Orthopedic Physical Therapy Faculty members right we get a lot of of those people from fellowship programs orthopedic Manual therapy and so that was kind of the case for me it and I've been really last in just really enjoyed my time an academia for the past decade but this this opportunity with Bellin College College and he I m came up recently and you guys know this better than anybody you know. When Julie Whitman tells you something and recommend something you listen you know she's one of those people well that I just admire and trust and she called me a few months ago and you know explaining about Belen Health in the center of excellence that Balan Health is in this this program that they created this doctor science program that they created so I wanted to be part of that that's awesome and Eric? We obviously work closely together but I'm curious wait to hear what was it about Belen College aside from maybe the health system and some of the other things you just pointed out but what was it that attracted you to the program Graham. There had been some other things that really stuck out to you overall. I mean honestly the end of the day it's the people you know when when an opportunity to work with Dan Ronan jody a young and the team at Belen Mark Bake in this this whole administrative team that they have at bell and these are just all top notch people that that love what they do that are self motivated intrinsically driven and that's just the kind of people. I want to be around him WanNa work with and I think that that's number one for me. I think I think the other thing is this is a really an untapped resource so so with Bell and you have this truly. A center of Excellence in this program is GONNA be able to really produce use a lot of great Scali inquiry based on what we have in health systems if one of the top ACO's in the country that really hasn't been been able to look at any of its own data you know as far as physical therapy at least for what we do and so I just think such a neat untapped resource you know in. You're GONNA see a really a lot of of productive scholarly work. Come Out of this program. Eric appreciate that background in in some folks may not be aware but is as you well know author Therik and mark you know is a strategic partner with Bellin. Em's manual therapy fellowship that has been around for many number of years is now up underneath underneath the Belen flag if you will and a large part of the rationale for doing now some of these issues you've just been talking about Eric and that is the desire to give more and more for individuals and opportunity to go on to pursue a terminal doctoral degree degree and that's something that having the fellowship up underneath of regionally only accredited degree granting institution like Belen really affords us the opportunity to do that and so it's a real win-win and that really gets into this next next question you know there's a lot of confusion in the marketplace on what a terminal doctorate is in how that differs from an entry level will like dpt and then within sort of the family of terminal doctoral degrees. You've got all sorts of varieties you've got. PhD's you've got in our case it Belen idea see opportunity. You've got easy. You've got doctored health sciences in any number of other genres of eternal doctorate accurate so if you would eric what's your perspective on the difference between a DAC in a PhD and when my a student student WanNa pursue one over the other I mean at the end of the day they are equivalent. When we look at accreditation standards so so cap he recognizes these degrees these turn doctorate degrees will they be DC PhD deedee all as equivalent terminal doctor degrees? The difference in DC is is really a a degree that's only really afforded in the United States in in the areas of science and Engineering and so I guess you could say is is a is a bit more broadly applicable in so many different fields and you have. PhD's in art and music and and so many different areas the DNC is a science focused degree. Ours is primarily the courses that you take are specific to teaching curriculum design and development and research and so we have our students take biostatistics mystics courses research methodologies courses than they are plugged into teams to conduct systematic reviews and then scholarly projects so our our DAC really gets down right right to the nuts and bolts of what you absolutely need to develop from skill set perspective as a faculty member and an academician in our profession physical therapy the other really nice thing about our degrees you take all of your fellowship credits and you can roll those into your Ese so RDC can accept up to fifty five credits from your fellowship training for those that have completed fellowship training as the first half if you will of the program and then the second half of the program it are those research courses teaching courses like I described earlier yeah eric if I can just jump right in because one of the sources of confusion a lot of people think that the credits only transfer only applies for em fellows and what we know is that this is actually open to any of the accredited kids fellowship programs regardless of whether you're an em fellow or a fellow from any number of other fellowship programs. This is potentially a really ideal half half to complete your DSP. Is that fair to say Eric absolutely in our team you know he's done a lot of credit reviews credit evaluations so when a fellow comes from another program the evaluate that program evaluate curriculum and then award credits to that program all of the fellowship trained PT's that have come into this DSE have gotten the majority Jordy of their credits from their fellowship training rolled over into the DNC so it's a really neat opportunity to need opportunity in the program because now you've got this program with fellows from all these these different programs sharing all these different perspectives all working together in teams on some of these scholars projects which is really exciting to see the collaboration. I'm glad John You brought that up because I think that's such a highlight here of of the program. Obviously we're trying to really rise everybody up and be inclusive of a number of different programs in the idea too. I know that Julie Julie Really had was that this would further allow for collaboration and teamwork within the O. N. P. T. Field and I've already seen this start to happen so it's it's it's just great to kind of see that happening but as you look at this what are what are some of the ways that you see the collaborative environment between different programs you know when I think back to my phd training thing that stands out the most to me it and we have one of those programs where Nova southeastern where you had people from all over different programs grams coming together and and and in cohorts together the relationships that you develop with your colleagues in the work that you do together to me that's just some of the most meaningful being full and some of the the best experiences that I had in the most amount of skills that I developed and information I learned was really from those colleagues working in teams together and so I'm excited to see these these groups work together in teams and and get their work done I think from collaborative perspective you know we have we've come from this model where we kind of had different camps and different schools of thought and we have wasted so much time and energy fighting amongst the ourselves you know and and now today now in twenty nineteen. We're in such a better place. I don't think you see that as much today and I think we're starting to get away from that helps. Honestly it's science right science should bring us all together other and and we'd if we leave our agendas at the door and our try to minimize our bias and try to just look at things with a scientific lens I hope that can bring us together and ultimately elevate the profession and I completely agree and I would say you know from my experience. Now is the program director at least for from the Bell and Fellowship and my interactions with other program directors and fellowship programs that that is exactly the way that I feel the the lay of the land is coming again as a new program director with with Julie Whitman being such a a huge presence in our R. O. N. P. T. field. You know I was welcomed with open arms and and people are collaborating we talk we work together and obviously some of the changes that have happened with ABC tree have only united us even more because there's been certain threats you guys have heard if you've listened to this podcast for some time or just listen to me get on my soapbox about that but it's truly interesting to see how that's changed over the the past ten years I feel and now people are working towards that common goal and just great to see that next step in DC program that allows for collaboration Shen different types of viewpoints but I think I would say just talking with Julie and even now at there's there's a lot of similarities I think in programs the different fellowship programs out there than there are differences which I think is a benefit if you're looking for that next step towards research or teaching you know where terminal degree is really really needed so that's just great great to kind of have that perspective so Eric you talk about your team and I think it's it's an all star team. You have doctors Dan around and and Jodi young who are really on the research side of the fence what kinds of projects are occurring currently or what lines of inquiry do you did. You guys have going on that will allow for the DNC students to grow and kind of set forth their own line of inquiry so this is really neat because is I think one of the biggest challenges and again back to like what's attractive about this program to me. Were solving a lot of the solutions to the problems. Was it exists in terminal education which for me it really lies in. I'm by myself. I'm a university but I'm kind of by myself and I have to come up with this dissertation right. I have to come up with this randomized controlled trial. I have to figure out where I can get patients from from. I have to figure out how I can collect data and the analysis and everything else is going to be easy. It's how do you get patients. And how do you get data and and so what's neat about this. Program is Dan and Jodi basically have vetted all that and you walk into a turn key system system right. It's a system that's been put in place so they have lines of inquiry. They would like to see students. Pursue in the lines of inquiry are are endless. I mean literally the list they have. We have this this this spreadsheet. There's like fifty different topics that people can pick from these are all invented by that team so it's everything from it's a lot of cross sectional research. I think that there's tons of opportunity and cross sectional research looking at data like I said in that health system that Balan health system but also you know Deanna jody of so many connections and Dan is managing a lot of NIH grant money and he has a lot of projects going on all the wild but but they're so well connected connected that they can plug people into a lot of different projects so it you know it. It's a lot of the new stuff we're looking at patient expectations a lot of obviously paint science education and that whole aspect but then with cross sectional Work Looking at predictors of different conditions and injuries and all these you know if you look at Jody's work I and Dan's work that they've been doing recently. It's really interesting to see when they look at cross-sectional work for instance patients. Though the study was just published everybody should check it out in Janus. PT This month really really high quality study where they looked cross sexually at individuals who were going in for hip arthroscopy surgery military members and looking to see how many of them what was the intervention like prior to hip scope so everybody goes in and gets hit scope but what did they get before that in a very low low low percentage of people actually saw physical therapists and of those it's the physical therapists very low percentage of them actually received exercises in intervention. Yes it's kind out of work. It's exciting that answers some really important questions right now yeah and with that you know in kind of your Lens on the research that's been going on what are some of the current Gabsi see in research within our with our own field in PT well. I think that you know that cross sectional is really important. I think that we you know we anymore. Big Data. I never forget John. We're amped in maybe San Antonio in it was like a panel and in Europe there and you said Ed I'm kind of sick of seeing thirty subject randomized controlled trials comparing manual therapy to sham or supplement and I think I think your your point was we need more big data. You know we need more big data. We need we need really powerful answers you know and and I would also highlight highlight came across my desk yesterday but Chad Cook just published a great editorial in empty this month. It was a five reasons you should be disappointed with randomized demise controlled trials and not to beat up randomized controlled trials. I mean there's a lot of value in randomized controlled trial. I've you know that's been my experience but at the same time there's limitations there's some limitations Sion's in maybe big data is one of the answers Eric I appreciate that perspective obviously I'm super excited about the opportunity to really build a world class the program with Bell and the opportunity to see a lot of individuals pursue meaningful work. That's relevant and answers not just clinical questions but as we've talked about the opportunity with big data and the answer lots of questions in the whole realm of health services research and getting patients to the right place at the right time for the right care which his all super exciting one of the things that I'd appreciate his kind of put your vision hat on and sort of where you see the program going and I might even try to take take a stab not that you need any help Eric but at least give you. Maybe my two cents on a couple things you know number. One is ultimately perhaps multiple tracks right. I get asked this a lot. Okay so you've got this manual therapy fellowship that has the opportunity to have to be a fellow to get a D. S. C. A. my short answer to that is I hope that's not the case a few two years from now where we can have multiple pathways into the DNC not just for PT's that potentially other disciplines whether it'd be you know ot physician an assistant perhaps athletic trainers certainly we've spoken to this already but this recognition that healthcare in the future is going to be team based care and so really being part of a more collaborative collaborative network with other healthcare providers answering meaningful questions is certainly a big one the other one in this is really getting to the heart of some of our larger university partnership ship strategy and Eric. You and I have not even had a chance to catch up on this at length but we've got all these university partner hybrid programs with a number of schools around the country and the opportunity to use the DEA sea program as the epicenter of a Lotta the scholarly work that ties together our university partner faculty holte across programs. We've got you know faculty that are in these various. DPT programs all of whom have lots of experience and desire desire to be involved in research in here you've got this captive audience of DSP students that can collaborate with our DP faculty and and other faculty around the country in really pursuing meaningful work so there's all sorts of to me Eric Opportunities to build and grow from here so kind of put your own Santa Division had on and you know where do you see go in and what are the things you're really focused on over the next few years yeah it. It really is got to think of things in a different way right we're in a different era now now and and we don't have this one campus in one location right brick and mortar like we're in a different phase of evolution of our society today and so I think because of that that I think we have to come up with innovative ways that the DNC being the epicenter of scholarly inquiry for all the partner institutions is something that we were really really excited about. You know could strengthen numbers right and we can really make a big impact if we have that Kinda Pool of resources together but short term it's quality that's one of the big things I mean. I think we are going to be judged based on the quality of the alumni from this program and so we really are investing a lot into our program quality right now and making sure that when our students graduate they are at the top of their game when it comes to curriculum design and development understanding teaching and learning educational channel theory in a that's a really critical component to it and then there's the research component as well and and they need to be highly trained researchers in their specific in what's applicable to what they are doing so like the biostatistics courses are designed around contemporary models of physical therapy research and physical therapy statistics. That's critical because you have statistics that apply to a lot of different areas outside of our field and we don't want to waste that much time time on things that aren't as applicable so we have a very contemporary model for statistics training but you know we we absolutely need open up this to multiple different options chins from different fellowship programs potentially residencies. I'd like to see us have a track for residencies and obviously you're not going to roll in as many credits but for those that have done a residency and maybe undone sports residency there are some residencies that don't have a follow up fellowship specific to that line of training and so for those individuals to be a role into the DNC and for us to really be able to grow for you know sometimes. I think there are those that don't really want to do a fellowship. Don't really want to residency. Maybe more traditional. I just WanNa do Dr Science degree. That's all I wanNA do and so having a track for those individuals so we want to really meet the needs of the profession of the Cap de requires fifty fifty percent of your faculty to hold a terminal doctorate degree in we really WanNa meet that need help grow. This is academic aspect of our profession from from faculty training standpoint where that's terrific. If you look at the rate limiting sort of steps in you know growing. DT programs it certainly recruiting highly qualified faculty. We've been fortunate you know in the university partnerships that we've pursued to have a lot of folks that are interested in hybrid but for existing brick and mortar programs are really struggling Oakland sometimes to maintain really highly qualified faculty recruit new faculty and so the SEC programs like this one no doubt I think will be helpful towards that end and ultimately really improving the caliber of Academic Faculty not just ultimately in dpt education but hopefully other health professions professions as well so Erica's really want to say. Thanks for your time today. I know this episode is GonNa Be Really Interesting for folks that are considering pursuing. Perhaps a terminal doctoral doctoral degree or maybe interested in joining an academic faculty. Perhaps shifting careers from mostly clinical two more academic so if you don't mind before we close leave your calling card folks get in touch with you if they have more questions about the program who do they reach out and talk to. We're really hands on and so myself which which I'm Eric E. R. I C. Dot Tacona. CJ C. O. N. A. S. at Bellin College Dot Edu. John Weiss the program coordinator. Both John and I really liked to have a hands on approach. We liked to have conversations with ten students on the phone answer all their questions. You're you're not GonNa get you know we want you to talk to us and we wanna be able to answer questions and help people understand the program and and really when is it right. I mean I would say the most is common conversation. I have for people right now. As the what time point in their careers at the right time you know so I've talked to people that are like building a house this year and I got this new new business started in almost every now is not the right time anyway we yeah we're here to help in anything we can do to help people we would love to welcome you to the Belen team where thanks for joining us on the show today appreciate your time as always and we'll look forward to another follow episode. Let's say another year. Hold us to it Eric again. We'll get update on where things are awesome. Thank you Dr Eric Chak. ONA's is someone who is a true leader within our profession. Hopefully you've gleaned that just from conversations that we've had in this show there's no doubt in my mind that his team will do great things as well as the DNC students that are part of the program they will truly move her profession forward be sure to check out Belen Colleges Owen PT Fellowship in DC programs for more details you can hit them up at the Belen College website as always we appreciate you listening into this show please subscribe to our show if you haven't already give us a review or follow us on the socials at am team team until next time we look forward to having you join us again on the clinical podcast thanks for listening to the IM clinical podcast with Dr John Childs and Dr Mark Sheppard for more information on the podcast guests and the latest in physical therapy visit. WWW DOT evidence in motion dot com slash blog. If you like this episode be sure to subscribe like rate and review on your favorite podcast directory

Dr Eric Conus Eric DNC Dr John Childs Dan Ronan partner Belen Belen College DC Dr Mark Sheppard PhD Bell Dr Eric Toconas Orthopedic Physical Therapy Fa Julie Whitman Dr Eric Chak eric
Clinical Podcast: Social Determinants & Sleep | Katie Siengsukon

Evidence In Motion Clinical

27:43 min | 10 months ago

Clinical Podcast: Social Determinants & Sleep | Katie Siengsukon

"Welcome to the. I am clinical podcast. Your host Dr John Childs and Dr Mark Sheppard interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to. What will be are you ready? Let's go all right. Everyone welcome to the. I am clinical podcasts. Where we talk with individuals within the health care field and beyond. I am excited to be here on yet another episode. My name is Mark Sheppard and I am joined today by my co host. Dr John Childs and I've been really as I mentioned excited for this episode because we are talking with someone who has really expanded my own view when treating those patients who come in with many different types of conditions and sorters beyond the traditional body systems lens if you will and she has done so really through her research and publication on sleep and we are joined today by Dr Katie Sandakan who is an associate professor in the Department of Physical Therapy and rehabilitation science. And she is also the director of the Brain Behavior Laboratory at the University of Kansas Medical Center or she has an awesome team. Who WORKED TO UNDERSTAND HOW SLEEP IMPACTS health related outcomes recovery in in this is kind of neat because Katie comes from the neurologic world and really has looked at sleep and how they affect those individuals with neurologic injury and Diseases Katie Great. To have you on the show super excited for our discussion today. Thanks for having me. I'm excited to talk with you. Bet Awesome now. Today's discussion for the listeners. We're going to center around a specific topic here related to social determinants of health. And really how this may impact sleep. I find these two topics to be. Really interesting because selfishly. There's something that I think I wanNA know more about. And I think from Katie in her own conversations and work together. You've just really provided a lot of awesome input there so I think when we talk about social determinants of health it seems to almost be more and more of a buzzword these days so I think to kick us off your Katie. Can you expand and define on? What exactly social determinants of health are sheriff so central health are going to be the social factors in the physical conditions in which people are born. They live learn play working age basically where people are and so some common. Examples of such terms of health would be like Ethnicity socioeconomic conditions job opportunities with wages availability of affordable on unhealthy foods neighborhood safety. Don just name a few and I do agree that it is kind of a buzz term now and I think that's a good thing in the sense that there's a lot more interest in evidence of just how important understanding so Sherman's upheld are as far as how they influence help overall and I become really interested in house. Oshman's of health impact people sleep health in particular and as part of our research. We've started to think much more and listen to our clients about how the term it's upheld are impacting their sleep. Yeah and I appreciate you expanding on those thoughts there because I think often times we hear this term may see this term more thrown around. Whether you're either in school or you're out in practicing and I think many people understand that and if we think back on the ICS model the contextual factors in some complicating factors potentially really play a role in our ability to manage folks who come in to see us. And so I think this is a really important aspect to reflect on as a clinician to that these are human beings who come from environments and have different types of background and contextual factors. That may play into their health outcomes and overall ability in prognosis as we look forward so your final comment. They're about how you've been looking at this topic here. With social determinants of health and how it impacts sleep. Can you expand on us like a little bit about what you've found in some some tidbits about how these very tenants of someone's environment or financial background me planned to somebody sleep share wet roads job at home to me one and probably more accurately to say is really opened? My eyes is I was asked to come and give a talk about soup. Hells to the clinic. Are Physical therapy. Students run improvised. Go therapy services to individuals who are uninsured and underinsured and so is my usual spiel about sleep. Help in ways that you can do that and I was talking about the bedroom environment and I was talking about making sure. The bedroom is really dark and I made a comment of. Oh you could go and buy walkout curtains to help. Keep your brother Miss dark as possible and I remember they look back a gentleman who was in India audience that he gave me an He wasn't mad or upset at me but it was. It was just a slip of Gosh lady you really just don't get it and I have this like a pivotal moment while I'm up giving this talk of. I don't even know if this gentleman has home. I don't know if he has bad. I don't know if he shares that bed with family members. I don't know how many family members are in his home that was really a defining moment for me and my work with helping clients sleep better and just think conceptualizing sleep health and all the factors that might be contributing in. So I've taken that moment and really dug a lot more into social rights upheld and particularly how they influence sleep pals and so you know there's lots of evidence now that suggests that underrepresented minorities on more likely to have disrupted sleep and poor sleep quality people who come from Lower Socio. Economic Conditions have oftentimes poor sleep in poor quality. Which again makes a lot of sense because if you were concerned with higher pay your months rant or you're concerned with having adequate food to eat that sleep may not be as a priority compared to these other needs anti think thinking about how seep is a luxury for people. Those are some examples. Of course things about this neighborhood safety again if you will but an area that's not safe. It's very difficult to sleep. And you don't have social support or you're having to get up to take the bus to get to your job. Then it may impact your sleep as well and so obviously there's the evidence that say justice but even in our own sleep interventions that we do so. I do cognitive behavioral therapy prints Omnia as part of several research projects. And just now that the more than I am in tuned into sister hunts Powell the more I recognize it in the clients that I work with. I had just a client the other day who was not sleeping our kind of talking through strategies to improve that then it came about how she wasn't eating three healthy meals a day. And so really how to make sure I divert and spend adequate time talking about those other factors that are impacting her sleep and her billy to sleep while because if I was just focusing on the sleep I had be completely missing the point and missing a critical opportunity to help direct this individual and others to be sources that can help address. Some of those Palce not so interesting to me. Katie I mean it kind of seems almost common sense right that you would think about these. Other factors social determinants health. That play into the overall patient experience a client's experience and wasn't really until I was working in inner city. Baltimore where you just start hearing that pushback from patients you know. Let's say for example. I was giving them home. Exercise Program that involved walking out in their community and it wasn't until a patient of mine basically said. Would you go walk out in the middle of Baltimore where people are getting shot at random or stray bullet and I remember thinking like you know I would even think about doing that and it was just I opening standpoint of reflection for me because I was realizing how much I was seeing the patient for what they were in the clinic in that moment? Not Seeing the patient or client for WHO? They were in their own environment in what came along with that. It just affects me so much when you say something that you know like hey here. I am trying to help someone sleep better. Sleep is so important but we have to understand the complicating and contextual factors. That surround that health behavior. That may need some problem solving or can be really challenging so I think it's just interesting that you know something is right in her face as neighborhood. Safety is is so important when it comes to maybe health outcomes and health behavior change so I appreciate the the context there and and I just know how much of that has been a learning moment for me in my career absolutely and I think I have kind of those defining moments I mean because like you said you had these conversations you think. Oh Gosh. How did I miss this before? And how is not thinking about this too foreign part of it as we don't most of our entry level as therapy education programs are not focusing on SOC chairman of how although I will say that? There's lots of efforts to change that. I think we are seeing that change. I hope I hope that that will translate into you. Know clinical practice and therapist doing a better job of assessing SOC terms of health. Might be good just to change that. We have to implement and carry forward all right everyone. I want to take a quick time out to tell you about an opportunity to learn the latest research on spinal manipulation paint science education. Lifestyle medicine and multidisciplinary care for complex patients and how to apply the research in your clinic. Sound like something for you. You can learn more about these topics and more at Johns Align conference which is taking place August twenty eighth through the Thirtieth in Dallas Texas this year. You won't want to miss this year's topics and speakers and our clinical podcast listeners. That means you get a special deal of five percent off when you use the code clinical podcast at checkout. When you register for the align conference you can find out all the information and register for the conference at a line conference dot com okay. Let's get back to the conversation. Katie this is John to me. This is a fascinating discussion. If you think about sleep presumably we're supposed to be sleeping about a third of our lives right if you assume sort of eight hours and sleep in ideal situations in so given that it's such a huge part of our lives to me. It's at least encouraging that were actually in rehabilitation thinking about and how it impacts recovery from you. Know various neuro muscular skeletal conditions in so. I guess I'm curious. What you think about the social determinants of hell how they impact sleep. I think of these factors in my own mind sort of light psychosocial factors right like fear in anxiety and depression things that confound recovery in that if we know about them early on maybe we can provide let's say bio psychosocial interventions that address these psychosocial issues social determinants of health or sort of similar. Except in my mind and I'm just going to throw out my bias and you can tell me if I'm right or wrong. Most social determinants of health are more at least in the short term more fixed. They're not as treatable for lack of a better description so I guess I'm curious from your perspective. Let's take this down to the clinician level. Everyone acknowledges sleep's important. Social determinants of health confounds recovery influences recovery. How do I as a clinician? Practically think about social determinants of health in my clinic and its impact on sleep because where I go with in my mind with this is invariably you get with a young clinician. Let's say they're practicing at an inner city clinic with a minority patient. Who may live in an unsafe area? They show up with some sort of Musco skeletal problem and invariably the physical therapist immediately goes to some impairment at the microscopic level worrying about range of motion not paying attention at all the fact that the patient came from the streets. Maybe they were homeless than maybe there are. Undernourished never asking about any of those kind of things so as you think about this as a researcher. How as a clinician do you take me up to the thirty thousand foot view and say okay clinician? Like don't forget. There are some major maslow's hierarchy of needs kinds of things that he'll dress those first. This impairment that you're measuring at the very top of the sort of maslow's hierarchy is kind of irrelevant until the person's so that's a little bit of A. I know a diatribe. But how do I as a clinician? Listen to you in actually account for that in the course of a clinical episode right and I think that's all great clients and I think that's honestly. I struggled as a clinician with my sleepnow. Mentions even though we're doing it for research purposes point the intervention to help people sleep better and so if I wasn't considering these other factors Matter when I was telling them to do agree and I grappled with how am I going to address the socioeconomic disparities in my neighborhood and the neighborhood of these individuals and how do I address healthcare disparities underrepresented minorities? I mean those are saying heavy topics that one person can't just go out and change that and so I do think that maybe that's part of the whole back from clinicians is like where do I even start. I think there there has been some great education sessions that were several that were held at. Csm This past year. About what do we do about this as a clinician at individual level? And there's great screaming tools that clinicians could start with as far as just screening social determinants of health and there's different screening tools out there and one that is well used is called the clear. Toolkit I like it. Because it's free and breeze always great and is also available in several different languages and so the readers Google clear to okay they would be taken to the website and they can download but toolkit that they could use again depending on what languages of their clients they might want to have on hand and the toolkit walks you through some example questions that you might ask in your session with your client and it screens for various social determinants of health kind of across different spectrums so it ask questions about like employment childcare education nutrition housing domestic violence on the name a few. And so it prompts you to ask these different questions and then what it recommends. Is that you as a clinic or clinician. Be Aware of the community resources that are available in your area so then you can get your client into those different resources if needed and so that really how. I conceptualize it as that. I'm not in this alone. There's only so much I can do as a clinician. But Gosh there's a whole lot of community resources out there that we need to tap into and probably the best thing I learned about when I was at. Csm This past year. Almost a resource bat was mentioned at one of the diversity equity inclusion sessions that was given by ripple Tau resident. Who's exactly Reif born? And they shared a resource on the American Academy of Family Physicians. And it's called the neighborhood navigator what you do is you go to this website and you put in your Zip Code and then it connects you with all the different community resources in your Zip Code. I mean it's amazing and so like it has where you can book by different topics so like food. Housing transit is go health some other topics and then if so if you just click on food it's one of the categories you then can further search by food pantry is emergency food through delivery and then actually takes you to the various resources in your community that you've been could help your client access tap into so. I think that's really key is one to know how to screen for social determinants of health and then how to access the resources that are available in your community Katie. That's that's fantastic. I WANNA KINDA DRILL DOWN. Maybe to another level in maybe ask what to you is a basic question but perhaps to me not so much. So if I'm if I'm a clinician in let's say a fluence suburbia is screening for social determinants of health. Something that ought to be like a pain scale where it's one hundred percent of patients. I mean there's gotTa be some context specific level screening. I guess my question is if you're really trying to educate clinicians on how to consider these factors does wear your practice resides. I mean dictated or profile patients based on sort of what they're wearing in the clinic and you see them looking fully dressed in polished for the day that automatically makes you profile them in screen for this or you see what I mean like. How do you target this screening around the right patient? Patients are already filling out lots of forms so at the same time. You don't WanNa take for right that someone. That's in an affluent neighborhood may not be sleeping. Well either for other sorts Helped me think about how you target the screening to the right patient based on their demographics to see everyone is screened? So that's not based on any outward presenting appearance or color of your skin or anything like that. I mean I. I think this is something. That goes cross socioeconomic. Status goes across race goes across necessity the screening tool. I WOULD. I would hope be for everyone. That's what I would envision the bug to see. I would love to see it be part of our standard intake questions to the questions that I think are most related to sleep on the queer tool kit so one has about housing. And so the question is do you and your family how to save and clean place to sleep and then the client can could share about that and then another question about domestic violence. Do you feel safe at home. Those are two great examples. I think safety in the home that goes across every economic status in every demographic in so I think again. Ideally everybody would get screened in being able to help those clients tap into the resources that are available are really really important. I think just a blog samples because a lot of the people who do enroll in research. Studies are Caucasian and middle class. But I've had several of them who had either domestic violence in the past or have had some sort of an adverse childhood band that if I wasn't one tuned to the need to assess for those things I would have missed it. I don't know that that necessarily be something that people would not bring up. That's not necessarily prompted to without having a relate quality orthopedic relationship that we developed. I think just being much more in tuned to the possibility of those underlying issues being there and being open to listening and being open to the possibility is really critical for therapists as an excellent excellent point there and I love the thought that he social determinants of health. Because there's so many of them it doesn't pick and choose certain people in certain areas and certain racial backgrounds and it just shows how open we need to be in looking at these things and understanding them and kind of going back to your line of research. Katie with sleep. It's interesting that your journey to discovering the importance or at least the variability of these things really stemmed from trying to make people sleep better and to optimize that really important body function and I think it's interesting a lot of journeys come this way and and I think when you look at trying to change one's behavior. You're not going to be able to do that unless we peel back. The layers of the onion. That may be surrounding our patient or client's background and so it's just. It's a point that I think the listeners really need to reflect on an I challenged listener to think about the patients. They are seeing and the type of behavior change that you're trying to get out of them whether it's trying to sleep better or eat better or move better and are you looking at these. Are you assessing for them in? Are you helping to address them or even refer out to individuals who can help address some of these other factors here and so I think Katie? That's been really helpful there so with that in mind. Are there certain people you find yourselves from an inter disciplinary standpoint Katie referring to when it comes to addressing some of these social determinants of health as it relates to sleep? I do I think with a lot of my clients that are sharing that they've had domestic bonds currently in past or some sort of an address childhood advanced. That's outside my wheelhouse and I most certainly repair those individuals decided to psychologist or to account slow. I encourage them to go meet with that person and definitely we have to recognize as physical therapist waters within our scope of practice in what is without outside of at the practice himself having that referral network built in. So that if you are talking to somebody about sleep health and something like that comes up which it's going to if you are talking to people about their sleep in their sleep health to be prepared for that sleepers for a lot of people to their private behavior very personal behavior. They're inviting you into their bedroom to talk about their sleep. And so I think honoring but that's kind of sacred place in the Saker conversation to have with people honoring that and making sure that we're doing a good job of of referring. Would we need to? I think that's really important so I think Katie the last question I have in my mind here to wrap up our discussion here. I don't know if you can even answer this question because I think it's a bit challenging but is there one specific social determinant of health. That you feel is the most important for healthy sleep. Is there one? And what would it be? Gosh that it's kind of tough. I know I can tell you about the research about underrepresented minorities and having or sleeping on Leslie. Galatian being at risk for that and access to healthy food inadequate housing because often times needs that must be met before a worrying about our sleep. We didn't even talk about light and exposure to light in the nighttimes. There's all these different factors that contribute. I would say though in my in my research that I'm doing what I most often see. Though is the issue if the safe place to sleep. I think it's just the demographic that I work with and safe meeting not often times from an unsafe neighborhood perspective but more often the relationships that these individuals have not having a safe place to sleep because bad being open to to hearing bad and developing relationships that people are willing to talk about those things but I certainly I never assume that the other issues are not an issue and so I do screen for so strict hermits of health just as a bound thing with my clients but I think the other thing to think about is maybe aren't going to admit to you on the initial intake by the domestic violent relationship. And so even though you may screen for this and people may say they don't have these issues I think just keeping it on your radar and looking for those things and then once you do have that relationship with the individual then they might be more. Welcome open to having that conversation with you. Yeah well things Kitty. That's a great way to sum up here and I really think one of the things that stuck out to me on your last point there was. This is not just assess for it on day one and be done. This is something that you have to keep your ears perked for throughout the plan of care because as we get to know patients and clients we get to have a better glimpse into their life. Obviously as you build a therapeutic alliance with the patient they start to talk and you can gain some information and assess so I think that's a pertinent factor there to reiterate so thanks again. Katie for your time and wealth of knowledge as it relates to sleep in this important topic on social determinants of health. Thank you very much for having me on your podcast. Appreciate talking when he does. Yeah Katie thanks for joining us while what a great episode with Dr Katie Sang Kasan. Just a really interesting conversation mark. I thought just really talking about sleep. Which is something that has a physical therapist we don't often discuss and probably unfortunately so given that sleep represents probably a third of our life and in particular really exploring the various social determinants of health and mark you know that patients invariably come into the clinic and instantly we can start focusing on physical impairments and Lo and behold you've got patients who come from situations where there's domestic violence and there's inability to sleep and various other founders and unless we consider those as physical therapists were GonNa miss the mark in optimizing recovery. So Katie is one of those really progressive physical therapists whose research is focused in exploring the influence of social determinants of health on sleep. And so I know this is going to be a really informative podcast for our listeners. As always thanks for joining us on the podcast you can reach out to us on at MTM is our social media certainly on the blog and can certainly reach out tomorrow night directly. We'd love your suggestions on who invite on as guests so police in those our way and we look forward to having you with us on another episode here against thanks for joining us. Thanks for listening to the clinical podcast with Dr John. Childs and Dr Mark Sheppard for more information on the podcast guests and the latest and physical therapy visit. Www DOT evidence in motion dot com slash blog. If you like this episode be sure to subscribe like rate and review on your favorite podcast directory.

Katie Mark Sheppard Dr John Childs Dr Katie Sandakan Dr John Department of Physical Therapy University of Kansas Medical C Dr Katie Sang Kasan Brain Behavior Laboratory director Baltimore American Academy of Family Phy India Dallas Texas Lo
Clinical Podcast: Career Advice for Students | Tim Reynolds and Bryan Guzski Part 1

Evidence In Motion Clinical

26:36 min | 1 year ago

Clinical Podcast: Career Advice for Students | Tim Reynolds and Bryan Guzski Part 1

"Welcome to the I am clinical podcast. Your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be. Are you ready. Let's go welcome to the E. M. Clinical podcast. My name is John Childs and I'm joined as always by my illustrious co host Dr Mark Sheppard and and we have the privilege today of doing something a little bit different on the podcast. We're being joined today by two physical therapists Brian. Guskey and Tim Reynolds. Both relatively in recent graduates graduated from bt school about five years ago and they reached out to me several weeks ago and are working on a project really trying to collate and curate responses from those who've may be you know had some impact on the profession sort of movers. Shakers whatever you WANNA call it leaders in the field and so are conducting a number of different interviews and written responses and so we thought wow. Why don't we use this as an opportunity to have them jump on the show and perhaps interview mark and I rather than the traditional national way that we typically do it so without further ado? Just want to introduce both Brian and Tim. And if you don't mind start off telling us a little bit about the project you're working on and then we'll dive in that great. Thanks John so Brian Gusty here as he said Jonathan Practicing for about five years now currently reside in Rochester New York working with University of Rochester Medical Center treating in outpatient orthopedics just to give a little background on China are Y and you know how he got started with this this book call years ago Kinda proposed this project to ten we kind of kicked it around. It was a pretty good idea man. You know this this year. I'm not sure what what sparked that. I think we both got put in a position where we're getting has a lot of questions. Kyle guiding students as part of the residency program program. Here at the university. Getting ask questions of you know goals and how to stay motivated and you know what are things that we like to read. How do we stay engaged with profession? So Tim and I both reflected on this idea for a book of reaching out to our own leaders and mentors and different thought leaders and innovators within our profession an SM similar questions that we were being asked so that's kind of how he got started on it and then again like I said not sure what sparked it but as of maybe three months ago the one we kinda started sending out emails and doing interviews setting up digital interviews receives awesome feedback when we first out our introductory the email kind of talking about the book see people are interested was like shot in the dark. We both know what kind of feedback we were GONNA get or if we're going to get any response so John you when you replied to to use any email you responded. We were like Oh my dad like John. I hope this is actually. We started getting a ton of good feedback in a bunch support. So it's been really rewarding so far working on this project so we're excited to be here with you today and an Esa you know some of the clashes or asking a bunch a AH leaders within our field. Tim has anything anything else to say about that or about our why we got started. Yeah definitely my name. Is Tim Reynolds. I'm located Ithaca New York Mark. I'm a physical therapist with wellness center. I'm a full time. Clinical Faculty member at Ithaca College well and sort of carry on with what Ryan said. There are so many really talented knowledgeable physical therapists and researchers within our profession that are contributing so much work to the betterment of our profession. Shen as a whole and I think you can go online. You can find out. What are these awesome exercises which we'd be trying to patients with back pain or persistent pain and I think that provides a lot of good knowledge and education for young clinician editions? Right now there's some questions that typically don't get asked I and Brian and I when we sat down and we were trying to generate lists of questions in. Who Do we want to interview? We want to know the why. And the what makes the people we really respect. And who are the leaders in this field and so what are the habits that have helped them develop to become the people that they are and what other things. Outside right of learning humanity techniques or learning different exercises could potentially contribute to making the whole cohort of this upcoming PT generation better quality people and clinicians themselves. Awesome will appreciate that background. And I guess I'M GONNA WE'RE GONNA turn it over to you guys and let you run the show. Go ahead awesome awesome so John the first question is for you. What advice would you give to a smart driven college student about to enter the quote unquote real world? And what advice. I should ignore. Yeah it's a great question and I will confess I think about this question now in a very personal way because I've got five children total but got one that's recently married eight and Now Working Graduate From College. I've got another one who's in college and then I've got a fifteen year old son. You know in some younger kids. So like I've got got kids with editor sort of wanting and perhaps benefiting from whatever kind of advice that I might have so this is like a real world full mid for me not hypothetical I think one of the biggest things I sort of encourage in. Try to advise students that when you go to college and you start thinking about entering the real world you know. There's no longer any participation Tirupati trophies. I think we do kids. This is could get on the soapbox. I think we'd do kids are a disservice when we don't really teach them about winning and losing and you know somehow wow this idea that everybody wins is just not true. I mean when you go to college in you compete for jobs. Some people get the job. Some people don't some people move up the career our ladder. Some people. Don't don't get me wrong. I don't see the world is purely winning and losing but you've got to add value to the organization to ultimately have Success at least if you think about success in terms of advancing your career growing in your knowledge and ultimately you know adding value so I think that's one one of the things I really try to encourage people to maybe think about sooner rather than later is that the real world can be really rough and if if you know if your parents sort of overly protect you from and sort of give you this idea that you know I think one of the worst pieces of advice that I tell people to ignore ignore this idea the That you know you can just do anything you want right and I know parents are well intended when they tell their kids this but the reality is if you're five foot seven you're never we're going to play in the NBA. You're just not it doesn't matter it doesn't matter. You don't have the genetics to do it so actually think we need to crush people's dreams at some point so they don't get distracted down the rabbit holes. You've got to really think about you know where your talents are and what. You're actually good at again. This idea that. Just sort of Willy Nilly follow all your passion and it's great if you can actually really love what you're doing. Don't misunderstand me passion is wonderful but ultimately you've gotTa have passion combined with you know something that you're good at and talented at and can ultimately make a living and you know along with that is you know. Don't get into massive sorts of student debt. we all are well aware of those sorts of issues you know. Education is a great investment. But it's not such a good investment that you should spend your you know to to go into debt for the rest of your life to achieve so those those are just a few of the things at least that I think about a relative to this question. Yeah it's awesome answer. John I completely agree. I have one Kinda just brief L. Question I think he kind of answered but I think the one thing that a lot of students or younger professionals heavily but have conflict with is following their strengths and talents verses following their passion and you talked about value and adding value in terms being used a lot more throughout our profession now both both combat large in our profession but also on the individual level so for a younger therapist. Would you recommend maybe finding out new kind of self analysis on your strengths and talents. Would you recommend following their passion in terms of adding more value to their company or clinic. Or what have you. Yeah I tend to think about it more trying to really identify your strengths and what you're good at and let that be sort of the litmus test for the direction that you go if you're the effective at what you do your talented at what you do you have sort of a camaraderie and feedback of your team. That you know believes your evaluated you you know. Value added member of the team. I think that ultimately ties to you know to passion into you know really enjoying what you do you know. We're we're all well aware of the starving sorts of artists in starving musicians in those sorts of things where they pursue these like pie in the Sky Dreams for ten years and then finally in their early to mid thirties. You know realize they've got to grow up and make a living and again. It's a fine line right because you know one out of every thousand. Listen you know Aspiring country music artists. That moved to Nashville. Actually make it right. So there's there's sort of this this hope but but oftentimes it's really not a a realistic venture so at least for my own in our. At least the way I talk about it with my kids is trying to find something you really good at earn a living and then once like you've gotten atten certain amount of you know sort of income under your belt so to speak you can really then afford to take some risks in quote unquote pursue your dreams. I think people like you know all these Unicorn companies you know. Everybody thinks they're going to be the facebook twitter or the AIRBNB. And you know that is just us not. That's not realistic. That is not what happens. That ninety percent of businesses it start fail. The message is a lot more sinister than that. And it's super super hard. So I I take issue sometimes with the kind of the GIG economy where you see a lot of this in PT. Now you know where you know. Go out bill. The cash based practice you know and all those sorts of in at least everybody. I know who's in a cash based practice. They have second and third jobs. I don't understand that like that's just my bias. I think you ought to it really go into an organization add value find something. You're good at learn the ropes so to speak and then at a certain point you can afford kind of look look up a bit and maybe take some risk that you otherwise wouldn't have taken so that's a little bit of a bully pulpit but that's how I sort of see now. That's that's a great answer. I completely agree ten. You want to jump into the next question. I think. The next one's for mark. Yeah no definitely and SORTA continuing on with what John Is. Talking died octopus students frequently and I asked them what their why like. Why are you here? Why are you sitting in this class? What what's your? What's your intrinsic motivation to inspire you to come Robin show up and studying all sort of stuff because of your experience but the the spoon fed generation of I want the answers to the test? I want to know exactly exactly what's on. It has definitely made academia my end a little bit more challenging the last couple of years and so too here in reinforced. Those ideas of now you gotTa Find Your Passion and and figure out. What are you good at? So that you can pursue that till allow that to become your career choice versus me trying to talk his division. Three athletes out does going to the. NFL is always fun. Part of the job. All right mark the sums feel how has failure or a parent failures. Set you up for later. Success and SORTA SORTA continuing with that. Do you have a favorite failure. Love this question. I think this builds off nicely to to John's point about you know not everybody gets you know L. A. Participation Trophy. You know when you're out in the real world and I think you know it's it's so challenging because in society we look at failure as being something thing that is is a negative in really. It's only a negative if you make it negative and I'll I'll profess when I when I came in to college and I went to PT. School will looked at failing like I was terrible right that I sought. I didn't deserve to be in the position I was in but now as I've matured and been out the field for a period of time. I look back and I am defined wholeheartedly by the failures I've been through. I'll give you a couple of examples of of the ones that stick out and then I'll talk about probably the one that was most defining in my career so far at least I struggled with test taking. I had test taking anxiety to some degree when I was in high school. So when I took standardized tests I bombed them. SAT's or a perfect example. I took the. Sat's this six times to get into into college. And my highest score was like ten ten or something it was low. You know by by all standards of getting into College College at the time and it was devastating for me but when I look at look at it now what happened. I was resilient man I I failed and I I was thinking I might not get into school but I kept trying harder. I worked at other things that I could have more control over. You know. Get into college and I knew I was there because I worked hard for it and made sure that you know it's okay to have fun but you also need to work hard because you're there to learn to grow and you know getting into to to. PT School you know. I had several fail failures in that journey. I didn't get into my first school that I really wanted to get into quite honestly. I got denied ride to every school except one that I applied to and that was sacred heart university. They gave me a chance and It almost give me a little bit of a chip on my shoulder because I failed failed to get into the the top schools. I was like you know I want to go there. That's my top choice and sacred heart was awesome for me and I look back on those like man. That failure was awesome because because I got into a place I wasn't expecting to be such a place to allow me to succeed in bloom and go on and to do things and if I if I let that take the better of me you know you cry about it and you can get upset about it but you have to embrace it and I love failing now because I wanNA WANNA learn how I can be better and when I was in fellowship and this is probably my favorite failure if you will you know as at the tail end of fellowship in and typically you have your your practical exams you have to do a spine practical exam and pass it and Extremity examined pass it. You only get a set amount of tries you get you. Don't get unlimited tries tries to pass so typically it's at it's at the very end. Insert your right of passage to graduating and failed both of them spine in extremity first time around now and I was devastated right. I was at towards the end. You know I thought I had things figured out and I remember. Julian calls me up on the phone. She she KINDA HAS S. You know she's like do you would you. Would you pass yourself and deep down in my heart. I was like I know that's not my best performance but so badly wanted to get across that finish line you know and I failed playing straight. You know it was. It wasn't at the rigor that we profess and fellowship but man that moment define my career because it allowed me to be humble symbol. It allowed me to understand that. We're not perfect at all times even when we're out the fellowship level we're not perfect and guess what in clinical practice we're gonNA fail L. Patients. We're GONNA fail them. It happens I get patients who walk out of the clinic and they say I'm never coming back or they get worse it happens. Nobody's perfect and we have to be okay with failure. Only if we learn from it and we're resilient and use it to make us better so if you follow and Saab and cry about failing then you know it. It sucks but if you look at it you get your emotions you embody those things and get through it man that that makes you a strong person. That's awesome. I mean when I think about a lot of the of our classmates and just the typical personality traits that most physical therapy students are. I would agree that no one wants to fail and with our project what Brian I've talked about. Obviously we're trying to reach current clinicians but also those younger clinicians that might be NPT's pt school and to hear something like yeah. You might not get into your first choice and you might not do well on the sat's and you might not succeed on that had examination but don't worry learn from those mistakes learn from those failures and take advantage of that as a great learning opportunity. I had a chance to interview jeff more of a weeks ago. L. Jesse Great Guy and he said I try to fail every day and I purposely go out and try to put myself at a point where I fail and I think that's awesome advice and sort of hearing that the same message reiterated from from you mark is is really really nice ear. I think it just comes back to As kind of side mark just reflection in framing right. It's all about how you reflect on it and how you kind of process that failure through that is kind of how you've grown get better so I think that's awesome not to give away any a- any snippets from our book but I mean Louis. Dora now gave us great answers awesome responses and he failed his final clinical What Lewis Doing? Now I just think is going to be hugely valuable for for younger clinicians or against students to Kinda here because again it's kind of puts him at ease a little bit and and everyone fails only through that. Can we can grow and get better so thanks mark. That's an awesome answer. Next question is both for John Mark. So you guys can eat answer independently or you guys can Kinda tag team this. You guys have a comment favourite investment but what is one of the best or worthwhile investments you've ever made did. This can be money time energy education. What have you kind of? Sky's the limit. Yeah Al Kick it off and probably say you know it's obviously multifactorial. All right you know. I grew up in a relatively middle class. Upper middle class had parents both of whom were professionals. Who really taught me how to work hard and and you know made sure I got a great education in so you know I always hesitate to answer these kinds of questions because some people might argue that like seventy percent of where I am today was just is the fact that I'm a white Caucasian male and grew up relatively at least a fluent so I'll try to couch it with that right that you know some of it depends on where you were? You start but I will say that. Probably the best thing that I think I did was Go Away for college. I grew up in the southeast and Alabama had no very very Adila if the if you will sort of experience me and I you know it was safe. I had great friends unbeknownst to me at the time I had a fairly limited world you I travelled some but but not extensively and when I went to the Air Force Academy I really just entered into a melting pot of cultures From literally all over the world and was just entered it almost a state of shock of how different some people are from me that I didn't even know really existed and I think that at least for me set the tone for really my career pursuits because I just had a much broader view of what was possible in the world simply because I expanded my you know my horizon so no matter where you grow up at least my own advice for my own. Kids is go away for college. I hope all of our kids leave Texas for for college. That's I you know. They don't have to support no matter what but they're to me. There's just value in getting outside of your of your comfort zone so I'd say in addition to education you know probably the other thing is early in my career. I watched all my friends buy new cars. New Houses sometimes live above their means. And you know I remember feeling a lot of pressure to do that both my wife and I had you know very good jobs. We were active duty military and we really made an intentional decision into live below our means by used cars rent houses. Just do things just do things differently. Go on really modest vacations versus versus extravagant kinds of things and at the same time really working. You know my brain's off `specially before we had kids I was a very much much an early morning kind of riser and could get in a couple of two or three hours of work day before most people woke up and you know that investment I mean I can't get up at three thirty in the morning Any more on the bed investment that I made early on to continue going to school and I don't mean just formal education but lifelong learning. We didn't have residencies and fellowships the ships back in the day but every single weekend you know I was chasing down the latest. Ce course in you know spending a lot of of my excess dollars. The dollars we weren't spending being on you know houses and cars really investing in my education both formally and informally and while the benefits of that invesment Smith. I mean really really paid off in a big way and so I really encourage folks live below your means keep learning lifelong education again. Maybe maybe informal even more important than formal but both are helpful. I would say that those were the kinds of things that to me. Were the best investments. I've I've ever. I've ever made at scrape John. The best investment. I have made in this kind of builds off John says but I moved in with my in laws. And and what that meant for me was you know like Oh man you have to move in with your in laws right like holy cow and I remember I would tell patients and I tell my friends with with that and you kind of get that like you know that people they smile at you a little bit. And they're like Oh man. How about that but my in laws and they're like my immediate family? We're very very close. They live five minutes away from me but I just graduated from. PT School a debt right. I had loan debt. Not nearly what is is seen now a author with their new graduates. But I had I had some significant debt in man when I graduated. I was living up in Connecticut. In you know I had roommates. I wasn't living living a lavish apartment or anything nice at all it was. I was whipping around ninety. Nine hundred ninety eight Toyota Tacoma and I love that truck edge actually just just died last year or this year but I love the truck you know and I was living where I can make ends meet but I was trying to stay within a budget at time. Kind of like what John was saying saying. And you know when I finally got a job I was like call man I can live a little bit better. You know in a nice apartment blah blah blah. So my wife. who was then? At the time my fiancee's we got an apartment Maryland. Not Too far from where I was. You know working where she grew up. We got an apartment and it was a nice apartment. You know and I I liked living kind of on my own and felt like a grownup right because I had my own little place. It was something I was able to start to pay for and then you know as a graduated. We're looking looking at these costs and then we're looking at my loan costs which are like almost identical playing paying in rent right and we're thinking like you know my wife. I got put a lot to who my wife Amy. Who Really challenged me? She's like you know we could. We could pay this off over ten fifteen years but the amount of money you're probably paying extra interest you know if you were able to move in with my parents or such you know we could probably save a lot of money and so my in laws allowed me to to move in a newly married couple we move into the basement of my in laws you know and for me. It was like swallow my pride to be like. Oh man you know all my friends like John was saying they're out you know buying houses new cars getting in a swanky apartments and stuff and here. I am living in a basement of my in-laws house and you know how are patients going to look at me when they're like you know where you live. It's like well where it is but honestly that that was only a year and a half really that we did that but I was able I pay off my loans light speed. You know Because of that it was something that was so meaningful because it allowed me like John saying now to be to be risky to do some things that that that may have been challenging to do to to be able to go through fellowship training and then do risky stuff after fellowship training but that investment I think was was a critical time in my life and it was a hard decision to make but it was the best decision. I think I've ever made so far my career side from going into fellowship it's funny because everyone's runs Delta different hand entering school and then coming out of school right depending on what kind of hand you're dealt that Kinda dictates the amount of risk like you said that you can take or you know. Perhaps the feelings that you're chained a one job area practice because it pays better. Maybe your public loan forgiveness program and those the loans and financial situation in Kinda keep you keep. Marie don't WanNa be which on himself to being discouraged her I'm happy so keeping your your nose to the grindstone so to speak and putting in the early on saying committed saying no saint agnes in as passionate as you can kind of get through those rough years if you if you do have rough years initially after which I'm sure many of us do kind of rewards itself thereafter and again you the only Kinda grow through those tougher times. Thanks again for listening into today's podcast. I WANNA think Tim O'Brien again for their questions and Kudos to them. I'm for working on this project. Where they're compiling these nuggets of advice from those leaders and individuals within our profession? Be Sure to listen in to the second part of our discussion with Tim. O'Brien which will be on the next episode of the. Im Clinical podcast thanks for listening to the EM clinical podcast. With Dr John Childs and Dr Mark Sheppard for more information on the podcast guests and the latest and physical therapy visit. WWW DOT evidence in motion dot com it slash blog. If you like this episode be sure to subscribe like rate and review on your favorite podcast. Directory uh-huh

Dr John Childs Tim Brian Gusty John Mark Tim Reynolds Dr Mark Sheppard E. M. Clinical podcast PT School bt school Now Working Graduate From Coll Kyle Rochester New York Tim O'Brien Ithaca New York Mark NBA Ithaca College Guskey Nashville
Clinical Podcast: Clinical Application of Pain Mechanisms | Carol Courtney

Evidence In Motion Clinical

28:53 min | 1 year ago

Clinical Podcast: Clinical Application of Pain Mechanisms | Carol Courtney

"Welcome to the I am clinical podcast your host Dr John Childs and Dr Mark Sheppard. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be. Are you ready. Let's go hi everyone on and welcome to the clinical podcast for those that do not know me. My name is Mark Sheppard and today I am joined by my co host as always Dr John Childs and on the podcast today we are super excited and thrilled to have Dr Carol Courtney who has faculty at Northwestern University in their department of Physical Therapy happy in human movement sciences and we are super excited because Dr Courtney's research has focused on a number of different things but today will be focusing on her her approach and investigation on pain specifically pain processing functioning mechanisms and how we can clinically Gli apply these to those who are suffering from persistent pain and we're going to dive into these the mechanisms behind pain and really really how we can apply these clinically which I think is really the important thing and Carol Courtney does a great job of being able to tie the two together how we can really translate eight the research evidence into clinical practice so carol super excited to have you part of the show today. Thanks and be a part of this awesome so carol. You are no stranger obviously to the pain in manual therapy world. You've been part of manual therapy fellowship for some time has a program director and obviously doing a lot of research and pain but many individuals may not know kind of how you found your way into practising teaching and researching these worlds what's so can you tell us a little bit about how you got interested in pain and manual therapy and how you've kind of worked to blend the two together yeah we'll you know my original research interests and when I was just starting my PhD was I was very interested in alterations in motor control with joint instability and in particular. I always like to tell the story of you know I have a sports background of seeing some people with ACL injury being able to return to sport without any problems in other people had problems with giving way and other issues in so I kinda dulled into that and I used the the seal injury as my model and we looked at muscle activation patterns in response to unexpected perturbations and you no longer hold and we found these altered hamstring activation patterns in we noted that this was reflexive nature and so supported that process I postulated hey this is likely a central mechanism meaning that this loss of after an input from the AL which had been torn caused a change in the motor program and then we also postulated or I postulated that hey maybe this is a positive thing and you get this change in motor program and that helps people equal to stabilize your knee so I they give me a PhD for that and I published those papers but you know when I started my post doc I was kind of advised to move to neo a win Nice to have John on here but I read one the John Papers in two thousand four in clinical bio mechanics and he was looking at muscle activation patterns and people knew and here I'm looking at his data and I was seeing some very similar muscle activation patterns that I was seeing people with ACL and people oh can interpret that in whatever way they want but for me it was like a a paradigm shift. I thought you know my idea was that loss loss of African input from the ACL was driving these changes but I thought well people didn't necessarily have a joint injury in. I was like why could could these be similar and I started to think well what's causing all this hands during activation. I said maybe it had to do with alterations in the know susceptive reflects now that jump was kind of came from my knowledge of neuro science but you know as the listeners know the no susceptible reflex involves increased hamstring or flexible excited or active nation in an inhibition of the extenders and so at the same time George Hornby who's a very well known spinal cord researcher. I heard him speak because he was a part of the faculty. I was with the same university I was at and he was looking at the he was using the flex reflects in his experimental paradigm with spinal cord patient so I said he I am an idea. What do you think of maybe people with neo way have a heightened flexor election withdrawal reflex or no septic response this. I said what if this is painting and he said that ideas brilliant let's do it and so we looked at that and people with neo way and nets exactly what we found was they had this excitable noces reflects in what that means is they had simple changes in their no susceptive mechanisms and that was a novel thought at the time now everyone says Oh of course but at the time most people associated that with neuropathic pain and they had not thought of it as occurring with with no susceptive pain that can happen with neo way so I know is long winded answer but the next step was George says a we should try to modulate Angela that reflex and he said let's Reiner ramp it up by doing joint compression and I said Yeah. Let's do that and let's let's do the opposite. Let's see if we can rampant down by doing men there in that's what we did in the second follow-up paper to that and that kind of got me on Mike Path Carol if I can just make a comment here so talk a little bit about a kind of as a practical matter with a clinician treating someone and with neo a in using manual therapy you know we seem to know is you've alluded from your own research and that of others. We know it's effective but talk a little bit about dosing if you would. There's some elements around the value of booster sessions in other words do we spread visits out over six months to a year or two. We jam packed them in two to due to three a week and sort of run out of people's benefits early so if you don't mind talk a little bit about your understanding of of dosing of manual therapy specific to neo but perhaps in general will it's a great question because people criticized that were because they said it because I think there were thinking of it as a the trial I said no. This is a mechanistic study. We're looking at mechanisms of how this could work in a follow up study really what the flexible were draw well what when we were looking at that and again that is a basic science sort of way of looking at what's happening at the nervous system and we knew that it it was manual therapy could dampen down that excitability that reflects later studies with we've noted that it occurs because it it kind of facilitates inhibitory mechanisms and what we know now is that many of our physical therapy modalities function then why the celebrating perhaps impaired inhibitory mechanisms and and that would include tens exercise and manual therapy until I think there are these mechanistic studies that are saying hey this works. Some people will argue what they're not always long lived and or they they don't always extend out so I think that's what you're trying to get to John in that. We know that these modalities will help people to become become more functional. Maybe in the short turn but it will at least get them to where they can use other modalities such as exercise to kind of extend now the positive benefits of manual therapy so I'm not sure if I can answer your question specifically like do you do a lot upfront front or I think it's going to be case by case. It really depends on what being affected in these conic pain patients on this kind of gets to are their top down. Drivers are their bottom up drivers in an I really think that if we take pain mechanisms approach coach each patient individually then we can make those decisions about how to dose are manual therapy. I Love Carol how your story kind of starts in the periphery and I think a lot of people when they think about you know someone who's treating pain. There's a lot of this this hold central nervous system kind of focus or we have to dress the brain the brain the brain but there's really a lot of what we see clinically starts in his influence by the periphery and so I love how you got to looking at the central nervous system because of the the periphery and the effects affects that you see more distantly from from the central nervous system if you will and so with that you brought up this idea behind a top down and in bottom up sensitisers and I'm really using this language actually from your two thousand seventeen publication the journal manual manipulative therapy titled Mechanisms of chronic pain key considerations for appropriate physical therapy management. It's probably one of my top ten reads as of the past couple of years because it really just just put into perspective great mechanisms and you talk about these terms top-down sensitisers and bottom up sensitisers. How how do you you see these two components playing out clinically in what is what do they mean will will. I thanks for the compliment. Would I mean by that and again. I'm sure I've oral disturb from other researchers what I mean by that. A top down sensitize her hand be some of the psychosocial factors that can drive live excitability of the nervous system and this could be depression anxiety this can serve to maintain central no secret last again not totally my area of research however as a clinician it's important that we identify those factors factors in they have to be addressed either by physical therapists or by another healthcare practitioner or other because they can continue to drive the process process what I mean by bottom up sensitisers. Is You know we can't forget that with neo way there can be these inflammatory processes is that are continuing sin infant to the spinal cord. I don't mean that scary way. We shouldn't be afraid of these processes because it's an a normal process basis however we do have to try to control that. I like to use the example of the person maybe they have new away and they don't really have have full knee extension so they kind of always have always gonNA irritating these tissues and natch painful input that may be serving to maintain maintain central Jersey plasticity so these are things that the PT can try to normalize through their therapies and perhaps look at that that input to the spinal cord Carroll really appreciate that explanation and along with that one of the things obviously inherent to research especially a mechanistic research is quantitative sensory measures and that's something I know you talk a bit about but a lot especially our clinicians. That may be listening. What do you mean what are some examples of quantitative sensory measures in how how are those used in your research. St Quantitative Sensory retesting or St. You'll hear it referred to is really simply a quantitative or more standardized measurable means of performing a neurological examination until it's it's not really magic. It's really something it's really something that we've been taught as physical therapists. Since the beginning of physical therapy I'm sure and so the difference is that one they're trying to standardize it and then too I think with our improved knowledge of central pain mechanisms that we're we were able to identify signs that may indicate that there's centrally mediated pain occurring and it's not just typical mechanism going on and because of that that's what makes it exciting because the next steps or the steps that are happening in the researches you follow it is that people are identifying and now trying to map it to intervention that will help great so you know as we kind of draw towards the close Carol one of the thoughts that comes to my mind is you know the history of clinical research evolving over in the PT Profession over the last twenty years and really the emphasis around effectiveness and patient reported outcomes and almost this cavalier sort of mentality at times is and I had I was guilty of this in my early in my research career that well the mechanisms don't really matter as long as it works. Just do it right in from your perspective. Live is someone who really focuses on mechanisms talk a little bit about just philosophically. If you don't mind sort of where you see the world in terms terms of needing to have precise mechanisms to explain clinical treatment effects sometimes that seem to be anew explainable and in some cases we hear from researchers saying we shouldn't be using you know treatments that don't have solid mechanisms yes the treatment effects seemed to be relatively large so just talk about philosophically if you don't mind where you sort of fit in that whole spectrum if you put yourself in the shoes of of a clinician which Carol you've got such a long in Notre Dame history of being a a mentor and consummate consummate advocate of clinicians and yet you also have this hardwired sort of researcher in you so talk a little bit philosophically. If you don't mind on where you you stand on mechanisms versus treatment effects and how those interact I think this is a great question John. Because obviously the clinical trials and the a good work that's coming out in that part of the research world are so important for the profession that drives having really great clinical practice actus guidelines in one. I just have to say. PT's need to be following the guidelines of of what we have on the other side of the coin. I I think understanding the mechanisms of why something occurs really helps us in the clinical reasoning process I think back in nearest past how someone with chronic pain would come in and people would patients would be explaining all sorts of really strange symptoms and in the clinicians just would be pulling their hair out there like I'd you're talking about. What do you mean you've got tingling numbness here and there but nowadays we look at them nights a young. I know exactly what's happening and so that sort of the it just really helps in the clinical reasoning process plus you won't you not to be afraid or not fear. I guess or to be like dreading the managing this patient. You're you can really really understand what's happening and I'm not sure exactly answering your question but for me I I love that interplay between clinical medical practice and in understanding the mechanisms because in my world I talked to some people who are just only do as the mechanistic research but I really think that understanding how these to interact has been the really exciting part or enjoyable part of it for me to see the clinical aside and try tied in with the you know the basic science side. I love that interplay too because I think a lot of especially in manual therapy happy because there's so many contextual factors that play a role anytime you lay hands on patient. It's just awesome to be able to have some you know line of research to fall back on and say okay what what exactly might we be modulating on basic science physiologic basis and I think Carol my next question is really we talk about mechanistic components that play into pain and I know you kind of lay out. Different ways is to assess for this so clinically. What what would you tell a patient till or excuse me a clinician to look at and measure if you have someone and coming in and saying like Oh man I feel like I have drips of water on my leg or I have pins and needles here or I can tell when when there's going to be rain because my I need feels different pressures something like that. What what are you suggesting we look at clinically. Thanks for that question. Bring me back to this question. Mark this is this is good now for us. We think that a very solid neurological exam is is very important so if a patient is an because here's the deal when we talk about a pain mechanisms approach to patient management which is the APD as really as really supported using these guidelines for pain and so taking that approach what that means to me is he's using these assessments which is a good solid neurological exam or and or quantitative sensory testing exam can help to identify when you're when there's abberant mechanism so let me give you some examples shirt. I mean Claire Glee. We do with neurologic exam. We may be looking for negative signs or loss of neural input in that could be with reflexes or with two tennis since re-testing we were looking for negative signs which means to be a on neurological deficit however you can get positive signs decisions this these. Albania those are signs of central nosy plasticity. The other thing I wanted to mention was that we also look at static testing and again they talk about static testing for non no susceptive stimuli and that's what I mean in what most people call light-touch better term is a two-tier static detainees stimulus as you're you're trying to not get to Komo susceptive receptors but but to innocuous receptors so I think that you can look at static a measures and then the other side of the coin would be dynamic measures or what I mean by that is what they're suggesting is that you have to give the nervous system a stimuli and see she how it reacts to it so the two that come to mind are condition pain modulation and so you're presenting the system of painful import short and you're seeing if the it can inhibit that pain in simplest terms. That's what it is so I give it a strong painful input and typically see that pain is over five out of ten pain and you get a baseline measure you present the painful stimuli and then you you test again. If your nervous system your inhibitory mechanisms functioning that second stimuli should be less painful to that means your your your brain can inhibit that pave and that's normal. That's a normal response. What we find was certain populations relation to neo a has been studied in our own work and then by Lars Erik Nielsen is that though that people have impaired in pain in ambition and they they when you present him with a painful stimuli they they don't have it that pay so that's one example the other example that you'll see here in our you'll hear talked about is temporal summation so when you get a repetitive painful in foot that's serves as windup response in and they wind up and and they have a because they're nervous systems hyper excitable there that painful stimulus feels more or painful than it would to someone who's who's doesn't have this hybrid system. You will now an example of that. I often say say to when when I'm teaching you know sometimes our manual therapy can serve as a temporal summation we wind people up versus kind of calming down the system so even the old manual therapy gurus were correct about irritability. I I mean they were right is like if someone irritable. You don't want to go in and try to wind him up more. He tried to calm down so it's always interesting to me. How so many of the ideas presented by some of the whole manual therapist were correct. They just didn't understand the mechanism to why yeah yeah and that's why I think your work is so awesome because you know I think when we look at a lot of things you know back over over time you say well you know Oh. I've been doing it that way and it's the right way right but maybe the intent of why you were doing something changes over the years. I think that's what's so great because when I hear you talk about some of these dynamic measures. It's almost like I'm doing a central. PA over you know the LUMBAR spine. It's almost exactly it. You're you're you're putting input put to the nervous system and it's our nervous systems response that helps us understand you know what mechanisms may be at play and then also prognostic how how will this affect the patients you know ability to have a positive outcome but also how do I dose my manual therapy or do. I use something like this. Is this the most effective way to treat this pain mechanism at this time so it just love this to me is the exciting piece now is we're starting to understand more about these mechanisms and then you know what types of interventions we can use to dose appropriately so can't thank you enough for for expanding on this carol in providing some that insight super helpful well mark. I'll just give one other example that comes to mind and we know that was central nosy classes that you get spreading of pain. I mean for me that was an eye opener when I figured that out if you will and and so the fact that with manual therapy or or whatever modality happened to be using that you can get shrinking of pain. I mean think about what we used to think was hat. I mean think think about the concept of since civilization yeah what is is a a shrinking of central sensitization and so if you know what that is is is super important. We're not putting the disc back in place not that I'm aware of we note but maybe what we're doing is just shrinking or missing one simple nosy plasticity and I think that makes a ton of sense and I think you know I think about these mechanisms lot of the things I thought maybe were happening early on when I lay my hands on a patient or even during exercise have really been because of you know the the peripheral and central mechanisms that are at play so I think that makes complete sense to me so Carol Carol as we as we look at our closing question. I wanted to kind of change some of her topics here because I've heard you actually talk about some of the books you've been reading and I know you oh you read outside of just the normal everyday physical therapy stuff so I think which is great. I've been trying to do more of that myself. So can you tell us you know a book or maybe even a TV series as or or a movie or something that you've you've read or watched or listened to that. You feel like you'd like to share with the world at large just so that they can get a glimpse awesome cool stuff to maybe tie into Gosh. That's always a difficult question but I mean if we're talking about paying. If I was going to recommend a book to anyone about pain I'd I'd say Kathleen sloops book on pain mechanisms. Everyone should have that on their shell so that's just that's on pain what I also like to read a lot on is a clinical decision making in clinical reasoning which I think is just the bread and butter of what we do as physical therapist and so I've been reading. ABC's of clinical reasoning so that's that's my other workbook. I've been reading and if I'm reading but I like. I don't always read about PD. I guess the last book I read non. PT Was Milkman by Burns in it's it's simply a it meant it one the bit man Booker Prize into the Irish struggles in all of that so that's my last non Mellon PT awesome well thanks for taking that question and really expanding on different areas and definitely awesome to see the different ways you kind of expand your own mindset and often times. I think when I'm reading a non PT Book I I get these little thoughts that come into my mind that always relate back to something and and I wonder how much have you read is actually been like I wonder how that feels into to pt and maybe stimulated some fought for research anything ever pop out of that. Well I think for me that happens all the time you know even a TV show I I mean really especially about clinical reasoning and understanding narratives because part of clinical reasoning is narrated. Reasoning and storytelling is so important for in education. I mean it if you can tie something into a story I think it just is so much better way for a person to get the concepts and so I'm also a big fan of just using narrative reasoning or storytelling retelling is is a way of educating whether it be our patients sore students. It's really cool and I can't. I can't agree more I've been diving into some of the storytelling aspects as well and some of the stuff we do with our fellowship is definitely in line with that narrative reasoning which is great to hear but Carol you know we could probably talk for hours but I appreciate your time and all you do our profession and just what you've helped us understand about pain and how we can apply that but thanks again and we'd love to have you back on the show hopefully soon all right thanks so much thanks for listening to the EM clinical podcast asked with Dr John Childs and Dr Mark Sheppard for more information on the podcast guests and the latest in physical therapy visit. WWW he w dot evidence in motion dot com slash blog. If you like this episode be sure to subscribe like rate and review on your favorite podcast directory.

Carol Carol Dr John Childs Mark Sheppard PT Dr Carol Courtney researcher program director Northwestern University susceptive George Hornby John Papers depression Lars Erik Nielsen Gli Albania
Clinical Podcast: How to Transition to Online Education | Kendra Gagnon

Evidence In Motion Clinical

27:22 min | 10 months ago

Clinical Podcast: How to Transition to Online Education | Kendra Gagnon

"Welcome to the. Am clinical podcast. Your host Dr John Childs and Dr Mark Sheppard. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be. Are you ready? Let's go to the clinical podcasts. Where we talk with individuals within the healthcare field and beyond Mark Sheppard here and I hope everyone is doing okay with everything going on in the world. The Corona virus definitely has taken a hold of the world. It seems in his shaken really are normal rituals. Many of us hold one of the major aspects. Lease I think of change. That has been really in the news. As of recent is the move from in-person coursework to online coursework and this has really affected a lot of her healthcare programs out there whether you're in physical therapy occupational therapy medical school and beyond in this interesting piece here. Was this literally happened overnight. And many faculty have been given a week or sometimes less transition the rest of their course that is left within the semester quarter to an online delivery model and I can say that this is causing stress out there not only for faculty teaching these courses but also for the students that are part of the coursework as well. Today I am joined by my good friend and colleague Dr Kendra Ghanaian. Who is the director of a hybrid? Learning Certification Program is also the Director of Student Affairs and faculty at Baylor University's Hybrid DPT program so Kendra has been living and breathing hybrid digital learning for probably ten years. Now and our discussion today will really focus on what the shift to online education might mean for us currently and in the future as well as some practical tips for both faculty and students out there who are working to figure this all out so Kendra welcome back to the show. We've talked before so. Thanks for taking time out to discuss. The latest on how the virus is really affecting coursework within healthcare entry level programs. Sure thanks for having me no problems so Kendra I I really when I'm dying to know about all of this is what are your thoughts on this rapid transition to online education. Well it's really interesting. I mean there's so things kind of changing in happening in so many different areas in Asia already alluded to education is just is just one of them and for many people may be a small one. But what's what we're here to talk about today so so that sort of small part but I was actually at a meeting last week. Probably one of the very last meetings that the AP Ta That happened with the ABC. Abc has shut down. All of its meetings at least for the next month and I I happen to be at a meeting with with program directors from all over the country who were sort of in real time learning that their programs were going to have to shift to this online out of teaching format. And it's a struggle in its stress. You know for those of us who have been teaching in these environments. The things that we know in the lessons that we've learned and the mistakes we've made have happened over years and so I can't even imagine how overwhelming is to think about making that whole shift in in a week and that's what most people I think are getting kind of this week to shift to online with a launch of next week is sort of what I'm hearing is a pretty common sort of these institutions are doing so you know. I think that the first thing I would say there's anybody out there listening. That's in that transition. Be Gentle on yourself because this is this is no small feat and the reality is that your course if your course wasn't designed to be delivered in an online format it's not just GonNa plug and play. So you know we're all we need to do the best we can right and just give ourselves a little grace in this process and not expect miracles by any means you know the online education is not going to be This the miracle but it might be sufficient for now. Yeah I mean just I. It's just crazy to think here. You are starting off the semester month and a half ago. You know you have your whole semester planned out you know with Face to face type of model and then you know just seemingly over two three weeks where it really hit home. I think in the US just with the changes. I mean is so rapid and I mean you know I'll be the first to say. I think these changes are needed especially when people are. You know in Undergrad whether in dorms and things like that where you're close to close transition for for this thing but my gosh I mean if you put yourself in that faculty position I mean. Oh my gosh it's just it's it's quick. So with that in mind you know Kendra if you maybe if you go back to when you first started transitioning to hybrid or if you put yourself in a faculties position here with the situation we're in like what advice. Do you have two people who are basically transitioning this overnight. Yeah so I've been sort of paying attention to the resources that are out there in. There are lots of them so I know what Baylor for example our instructional technology department set up a page. Keep teaching a lot of institutions. Have done those similar types pages with full of resources. I don't know about you as a user of a lot of sort of educational applications and technology so I'm getting lots of emails from those folks that are opening up their platforms for free and folks are sharing resources. There's actually I. I was perusing twitter and found a link to a Google doc of all of the different educational applications that are being offered for free. And so I think you know one of the things that I would say. First and foremost is that online education. One of the beautiful things about it is that it really can be very open source and allow for a lot of collaboration and sharing of resources. Which is something that traditional academia hasn't always done well or even really valued that idea of sort of sharing right so the first thing. I know but the first thing I would say is i. Don't I know you're not alone in this and don't feel gift an reinvent the wheel or duplicate your effort if you are teaching. I'm a pediatric PT. So I'll make this you know I'll use that example if you are teaching pediatric. Pt Course Right now and you're working on converting it. There's probably over a hundred other of you out in the universe right now. Doing exactly you know. Reaching those people. Finding those resources you know not duplicating effort. Not Reinventing the wheel. I think I think has really really key and a lot of what I've seen focused on is is just that having you convert your content right and so if you're used to doing you know delivering your courses in a face to face quote unquote kind of lecture format. That's actually pretty low hanging fruit. I mean powerpoint has voiced over Belton. There are applications like explain everything or adobe spark that are free or very cheap where you can do recorded videos. There's you know all kinds of screen captures that snag. It and screen cast matic and things like that where you can do to screen capture. So I think that's a place where a lot of people are starting. That's also pretty low hanging fruit and pretty easy but if you need to start their you know start there and then again. I'd say reach out to other people like you and work on sharing some of those resources as well. I like those points about you. Know the resources that are out there. I think I came across that same. Google doc where there was at least like ninety to a hundred different free resources out there ranging from K. To twelve to higher. Ed and just so much out there you know and I think that's that's important. In maybe we'll touch on some specifics Kendra later on but one thing. I know that you really kind of really reflect on and also kind of call within faculty that you work with and then others at your mentoring within the hybrid. Learning cert is really humanizing. The online environment and so as faculty. I'm imagining when you're face to face you're there you're creating community on your campus. You're creating community within your coursework because you're right in front of the person you're able to have these outside the classroom discussions or face to face office hours. How do you humanize the online environment? Now because everything's GonNa be digital. What are your thoughts on that? Yeah so that's really interesting that you brought that up something. I really wanted to talk about today because something that it's really struck me as I've been looking through all of these pages on websites of with resources of how to keep teaching and all of these sorts of things. That piece does seem to be missing so I think looted to that a little bit maybe with Faculty of building a community among your faculty colleagues right of sharing resources but I think we need to remember that our students this time you know I will online education and being remote can be kind of isolating anyway and so one of the things that we lean on when we when we construct our online teaching and learning experiences in our program and and really best practice across online teaching and learning. Is this the community of inquiry framework? And for those folks. That aren't familiar with that. I mean the the community of inquiry framework basically sort of I guess emphasizes the importance of developing three types of presents when you're developing online teaching and it's teaching presence which again I think that's what most people are focusing on. It's kind of delivering the content. Getting your stuff out there right but then there's also cognitive presence which is about that sort of problem. Solving and critical inquiry in discourse and men are social presence. End You know if you simply record your lectures and throw a text based discussion board up there. There's not a lot of social presence in that because social presence is about exactly you've described it humanizing online learning one of the most. I think powerful ways that we can do that is through video and so I would really encourage instructors to think about how they can creatively use the video to bring their content to life and frankly just connect with students. One of the things that I think is really tricky. Though is that I know a lot of institutions are looking at hosting live classes which I actually think can be really Keno our live classes in our Hubbard program. Baylor really help students. I think they can turn on their video. They can see me. We're talking to each other. They're discussing in the chat. They're sort of multi media connection happening but one of the things that I'm a little bit concerned about. Is THAT IF PROGRAMS. Try to move to these live online classes you can have there's tons of platforms out there. That will work for it in in you can have the best platform ever but you will be limited by the Internet speed of your students out there and so one of the things that we've got to think about is that our students now aren't here on campus with us. They are out in their communities where they might not have great Internet access at home. They might have slow. Internet speed and they might also just be dealing they will be dealing with all of the same sort of fear and stress in scarcity that all of us are dealing with in terms of you know things like learning things about them like what they're sup- facilitation is with food and housing. That's all going to impact their learning. So you know just kind of thinking on a substitution level. That you'll just be able to have this live session with your students and they'll all just be kind of happy and healthy just like they are in person. I think we all probably understand. That's not the reality but I think those are the things that we need to be really thoughtful in intentional about as we build these this online learning for students in such a short amount of time yet. I I love that. I think that's been a big kind of just. Aha moment just in our own discussions Kendra but also in my experience with online digital learning. Is You know that that piece of humanizing in that you know. We need to let students understand who we are as humans. We need to see students as they are as humans just like we do with their with their patients and so if we flip it here we've been talking kind of more faculty facing perspective if we're a student you know in the Healthcare Entry Level Program and obviously advantage. Here is is physical therapy. What advice do you have for students? Getting Ready to head into this kind of uncharted territory. You know they signed up for traditional kind of face to face brick and mortar program. In here they are. They're they're getting a crash course now in digital learning. So what do you have for them? Gosh so you know I would say to you. Know keep in contact with with your faculty and make sure that they understand what you're you're dealing with because again these faculty in these programs and the students in these programs that are now suddenly going to a to a virtual learning format are really now faced with the exact same issues that we we problem solve every day in our hybrid program Baylor. I've got students in thirty plus states all in different communities with different situations and I and I need to be able to support them. We need to be able to support them in their communities. So I would say to students. You know staying in touch with your faculty kind of letting them know what's going on in your life. Many of us are going to be impacted in as far beyond the educational environment. You're some students. I'm already hearing from some of my students who are were were planning on being online right but are already saying. My kids are out of school. So how in I've also and my school has sent home all of these lessons so now suddenly. I'm not only a fulltime student in an accelerated program. But I sort of have this responsibility to kind of home-school my child on some levels. I'm their teacher in this situation. And they're feeling very stretched by that. I think some of our students some of our students will get sick or have family members that are sick or in areas of lockdown. And so we have to be. I think you know so. But we won't know that unless our students are communicating that so I would just say to students and faculty. I'm not sure that we can over communicate with each other right now You know so kind of communicating those those situations. Now assuming that you're a student who those things are all okay for you right now and you're really just thinking about how to access that online content again kind of. I think knowing especially if your if your institution is GonNa have tried to do live classes you might WanNa check your Internet speed and make sure that that's going to be Appropriate there is nothing more frustrating. I think as a student or a faculty than getting dropped off and freezing all of these. I mean you've experienced that that learn and I have to so if you have an opportunity to you know to your Internet speed might be an issue and so just kind of be. Be Proactive about that. I think you know having virtual study groups so again keeping that connection in that you know that human connection so getting using something like Google hangout or facetime to to get in those study groups again. That sort of how we operate all the time in our hybrid program at Baylor. It's always it doesn't surprise me anymore but when I first started it surprised me how. How connected in. How humanizing that that that can really that can really feel and I think the same thing I would say for. Instructors as much as you can use videos and remember. It doesn't have to be perfect. It doesn't have to be perfect. It just has to be real so we all almost all of us have a video camera right in our pocket right so recording. Just a quick overview video for students at the beginning of the week. Hey here's what we're going to be doing. Check in videos using video based discussion boards instead of text based discussion boards. So I love flip grid for example. I'm not sponsored in any way shape or form. Just read a right there with you. That's a great great and super easy and intuitive tool but I would just say I know we. You know talking about students but for students and faculty you know. Don't try to do too much. There is a cognitive load in learning the technology. And so don't forget that and so if we're just dumping all this technology on students to there will be some cognitive load in that and that's not where we want those energies to be focused so I just think for students and faculty in lots of communication utilizing the video technology. We have to stay connected with each other using video sending video updates as faculty using video based dissession boards. All of those kinds of things can really help us. Maintain our community of learners. That we've all built in our programs humanize the experience and really help us better support students where they are which I think is so key. Yeah just a lot of live knowledge bombs there Kendra but You know the things that stuck out to me you know about this is we have to remember what's happening beyond the classroom and that you're exactly right you know. And many of these individuals if they're in more of a brick and mortar program may be still in the community that their schools in that community. Has You know a number of different things that may be going on and and issues that make learning hard and like you said with the Internet. Perfect example is there at their house or wherever the Internet cannot handle the bandwidth. That's needed for running a live session or even just other functions and so. What many students do they go to a public library? They go to starbucks or something where maybe a little bit better but guess what all those places are probably closed so yeah. It's it's definitely something that will make it. Tricky and I think your thoughts about you know everybody's going to have to be patient with each other during this time there's going to be patients on the faculty side as well as the students side and that is really hard. I think communication is key like you said and letting people know where you are and you know at the end of the day. We're here to help each other. Get Better and obviously we have standards and criteria that are needed to show proficiency and competency in courses but man. There's there's a lot going on right now. There's a lot of wrestling anxiety about what the future holds and how this Wolf Affect Faculty will students. I'd be really nervous right now. About how things will shake out and so I just having that that touch point and and just being there for for the students I think is going to be key. Yeah and I think just remembering good. Teaching is good teaching no matter what kind of the medium you're using so don't you know stay true to as an instructor you know staying true to kind of your objectives and what's needed in the course. This might be a time they were. It's you know that kind of critical reflection of the need to know verses. Nice to know if there's a little fluff there that isn't directly tied to your objectives and then of course back to that accreditation criteria. This might be a time to let that go to really help. Students Focus in on the absolutely mean to know using the online environment to do the things that you can do online but understanding. I think particularly in our field. There are things that really. We can only do in a room together. I mean there are hands on skills and techniques that we have to practice and in fact captain came out are crediting body for physical therapy. Came out with sort of a position. Paper our guidance paper last Friday I believe were. They really kind of touched on that. That you know lab. Checkups cannot be done via video so if you had kind of a lab skills check or practical exam and that was the intent of the way the student was going to be assessed on that learning that to maintain the rigor of the program. That you can't just move that video. So rescheduling those labs is probably GonNa be necessary for our programs and so I think again not trying to move the whole course online because even in our in our hybrid programs which have so much online content. We come together for immersive labs. We understand that there are some things that really. We can only do together face to face but what we do is were really thoughtful about what that is so so those are sort of some of the reflections that I think faculty can have right now to help streamline this for their students is to really think about what is the need to know what really is key and critical and what is the thing that we can move online and then kind of you know not trying to muddy the waters by putting lab skills checks and things online which. Kathy's tell us we can't do anyway and just plan for lab to be rescheduled later and then I will tell you that in our program. We do immersive labs which were Regis. Come together for a couple of days in depending on the lab at might be anywhere from two or three days to six or seven days and just knock lab all out at once so that is possible and so once we get to the other side of this and we can come back together. The next layer will be programs learning how to put together immersive. Labs sort of like what we do right in so thinking about you know bringing students in on weekends and things like that but I think there's so many ways we can we can get it done. We can get it in and we can all like you said be patient with each other and get through this yeah. I think it's interesting point. You know about the labs because just the other day rich severin. Who obviously is a colleague of yours at your Webinar and one of the participants in the Webinar whose faculty at a at a program mentioned that they're going to do a quote was see. You like labs so you know more of that weekend longer. Eight hour type thing and just be interested in in seeing how how the future kind of plans change with certain programs. After they see how this kind of may be different or may be better or at least peak curiosity so you know what that mind Kendra. What are your thoughts on the future? D- do you think now. That programs are getting into more of this online hybrid environment. Do you think that will change? How programs deliver or do you feel like it will decrease the barrier to entry like? What are your thoughts there? I don't know I'm a little bit torn on this because again if I'm honest having to transition to this in a week in of course that wasn't built to be online anyway I wonder if they don't make people convinced that online learning is not possible. Because all the you know. They're going to experience all of the frustrations in failures and lessons in a week that we experienced in years of listening to all lights off. I have a little tiny fear of about what I hope. Is that again that I do think? Though that people maybe see some possibilities and see that it is possible and kind of I guess. Appreciate these sort of flexibility that allows because again. You know it's really. It's not lost on me that that ten years ago maybe even five years ago we would have just had to shut down in these students would have just been effectively decelerated. I mean that's just the reality they would have. We would have just had to move them back at a semester or year. Or who knows what we would have had to have done but there wouldn't have been this opportunity just because you know now with with. Internet speeds and things like that so I think this will definitely I'm hesitant to predict how it will influence the conversation but I think it's going to really influence the conversation because everybody's GonNa get a trial by fire a little bit about how this looks and how this works what I hope though. Is that even? If there are some frustrations that what people can appreciate is the flexibility that this allows the the reach that this allows. Because you're exactly right a lot of residential program. A lot of times are going to have students that are more local or more regional. But I think what we have to remember is that for most institutions. This change happened while students were on spring break so many of them had gone back home wherever that is on vacation or whatever so so even though. I think I suspect that most schools are at least fairly regionalized. I also suspect that most programs have students all over the country right now or at least across some different states across the region that they're able to access to to sort of track that they're able to support so yeah. I mean I think it'll be really interesting to see how it influences the conversation but I'm not sure yet which direction that'll go. I imagine they'll be people that sort of fall all over all over the spectrum as far as learning they sorta like this thing and there's cool opportunities there and others that really kind of get frustrated or that learned that this is not like they're happy place in any way shape or form so and I do think we. We can't forget again that people are going to be Are dealing with significant sort of life stress on top of it. That will I think certainly influenced the conversation in the field of all of it. 'cause nobody's doing this because they really want to or they believe in it. They're doing it because it's the right thing to do. And we all Wanna stay safe and healthy so yeah excellent points in. It will definitely be interesting to to see how this pans out in in the next couple months just from a public health standpoint and then also just to make sure that we're working together and and I can say I know Kendra for from your own perspective or definitely wanting to support faculty know through our own lessons learned so Kendra. Good Way. I know you're pretty active and engaged on twitter. Are there ways that people can contact you or at least follow you? Because I know you've been Just the other day you put out some awesome little tidbits on some tips in thoughts to guide people in this time but Sir way that people can get contact as needed. Yeah my twitter handle is at Kendra. He'd P. T. so it's at K. E. N. D. R. A. P. E. P. T. So you can certainly find me there. Follow me there. Send me a direct message that way. You're also welcome to email me. It's Kendra underscore online at Baylor dot. Edu that's also a great way to get in touch with me as well awesome. Well thank you for your time Kendra. I know there's a lot going on with your own your own program with semester starting up and then just dealing with this whole even though you're in a hybrid program. I know like you said yet. People across thirty states. That's thirty different communities and thirty different action plans related to this virus. So and we're talking about our emerson labs and that were scheduled in April. We're GONNA be able to have them now so even hybrid programs are are having to make so it's affected everybody knew for sure. Well thanks again I appreciate it and hopefully this is a helpful. Just talk to have faculty and students and clinicians alike. Just reflect on how these changes are occurring and what what to expect so thanks again Kendra down thanks for listening to the EM clinical podcast with Dr John Childs and Dr Mark Sheppard for more information on the podcast guests and the latest and physical therapy visit. Www DOT evidence in motion dot com slash blog. If you like this episode sure to subscribe like rate and review on your favorite podcast directory.

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Clinical Podcast: Injury Prevention in Elite Sports  Is it Truly Possible? | Matthew Tuttle

Evidence In Motion Clinical

29:04 min | 9 months ago

Clinical Podcast: Injury Prevention in Elite Sports Is it Truly Possible? | Matthew Tuttle

"Welcome to the. I am clinical podcast. Your host Dr John Childs and Dr Mark Sheppard. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be. Are you ready? Let's Go Pie. Everyone and welcome to the. Em Clinical podcast. My name is Mark Sheppard and I am joined by my co host. Dr John Childs today and we are talking with our guest on this episode. Dr Matt Tuttle Matt has been on this podcast before several times and he is a physical therapist for the Denver Nuggets so the professional NBA basketball team and has been involved in a sports pt really an elite sports for past several years and so our discussion today will focus in on the topic at hand. Which is you know. The challenges with implementing evidence based guidelines and really evidence based practice from the research and the literature regarding injury prevention and beyond within Professional Sports. So Matt definitely a lofty topic for today but John and I are pretty excited to dive in and see what we can talk about to appreciate. You guys have me on this topic. I'm pretty passionate about and I think it doesn't just apply an elite sports but application of risk reduction strategies an outpatient or professional sports. Yeah and I think speaking for John. You know it's definitely been something on his professional. Cv trying to get people to apply the evidence into clinical practice and you know kind of the vision that has had for for years and years is trying to translate that even better and so. I think where I'd like to start Matt if we can. You know as really this idea about the setting of the sports elite sports world and obviously. I can imagine it can get pretty challenging when you're applying the research to practice in the League sports because it relies on you know a lot of different people. There's a lot of different people who are part of the team. Not only the practitioner an athlete. But you have the entire sporting structure so we're thinking about owners to general managers two athletic trainers. There's a lot of people who are engaged in the athletes every day. Work in care. So can you expand on some of the challenges you've encountered in relation to this absolutely? I think you touched on a little bit of it. The there's a lot of hands in the pot so from a front office you can have the GM the president. The coaching staff isn't just the head coach but his assistance down through player development staff strength and conditioning. Your medical staff in it just rolls on and on and then into the player's personal staff right because we're hired by the team but the players oftentimes will have their own strength coach in the offseason their own basketball trainers in the off season their own medical staffs in the off season so blending all of that together is is really challenging. I think having this conversation it's easy to mention. We get all the fun tools and gadgets to play with as far as our interventions whether it's unlimited access to like the F. R. units where we don't have to worry about fighting insurance for more visits. There's a lot of perks there but I would say that. Sometimes the treatment isn't the hardest part that it's actually managing of personalities in the people involved with it so that we all feel like we're doing what we think is best for the athlete but ultimately the product for the athlete is staying healthy and performing on the floor. So what strategies does each group have to best serve the athlete so that's that's really probably the most challenging part of applying can evidence in research into practice on top of that you don't know necessarily what the bias of maybe other practitioners of your team are towards and then other practitioners said the athletes hired to. You could have somebody that thinks completely opposite of your viewpoint. Yeah I mean I can only imagine. There's so many cooks in the kitchen so to speak so can you? Can you give us maybe an example of a specific example? Where you've had to like manage some of these things when it came to maybe applying the evidence for one of your athletes. Bessie can at least do i. I think I'd like without getting too specific. I think once you really think about our. How do we have the proper medical management discussions from kind of our high-performance team? And then our physician staff when an athlete may have an injury. Because we have you have guys get injured all the time. You can't totally prevent injury. But then oftentimes the players staff or the players personnel is very involved. Raise for their agent gets very is always very involved in. They should be in that process But I think times there are agents that their background may be legal or business and it's not necessarily medicine so they may be advocating for stuff that they've seen on ESPN or worked for another one of their athletes and may have been appropriate for that. Athletes may not be appropriate for this athletes trying to provide them with the evidence in the research for wine. Injection MAY BE APPROPRIATE OR WIA. Surgical intervention may be appropriate. Now are y you know. No major management is appropriate. Like so teaching people that is is really hard because the other one is for us. We can have really professional discussions. Make Oh Hey. Can you just shoot me over that research article in all Rita that we can talk about it? We can do that with people who aren't experienced in research and understand how to appraise research as I'd be like if they sent me a contract like I don't I have no idea how necessarily interpret some contract language so trying to educate them in putting in language. That is safe in friendly is. I'm not super challenging. Yeah these are dimensions that I never really realized in the sporting world. I think you get a lot of the kind of like glamour. You know working with these elite athletes that are really fun to work with and they're motivated dedicated but man. There are so many years to the amount of people that you have to kind of touch in order to old get things to work. And really seamless fashion. You know one thing. You brought up earlier matt that kind of piqued my interest. Was this idea behind. Injury Prevention. You know is kind of a topic that we were. We were thinking about diving into as well. And and you said you know while you're athletes get injured in Gosh when I look at any professional. Sporting elite sporting team. There's going to be injuries. I mean it happens so there's a lot of effort into preventing injuries. I mean. Can you really prevent this? I mean I know there's a lot of screening stuff out there but I mean. Tell me what your thoughts on that can. We really prevent injury in elite sports. Jetta there's no chance some people would probably try and argue that you know we're going to get there and we can do better and that's true. I. It's certainly something to strive for the pinnacle but I think reducing risk and understanding this kind of cut falls back to like having a research background that you really just playing with odds and percentages of you. Know what are we doing? And why the only way to truly prevent injury in elite sport for athletes not to play in. That just can't happen right. You can't have Lebron James just not play because you want to avoid him being injured for the entire year and then have played in the playoffs because it just creates a whole nother set of problems right because there is there is problems with under loading is in these settings as well so I think reducing risk is the best way to think about it and then understanding what are the trade offs with that so the easiest way to remove Rascasse just remove total exposures. But we can't have that in the setting of eighty two games. Plus playoffs preseason. Unfortunately not this year Olympics world championships. Like these guys have to play basketball so I think trying to manage some of the other without getting into specific injuries where there are specific risk reduction strategies. But what can we do as a group as a staff as a team including like focusing on sleep diet what other stressors? They may have in their life. What are these kind of more global strategies to reducing risk and then on an individual basis? Now you can dive. Into what more can you do for each athlete? Matt just as kind of a follow up to that question. You know one of the thoughts. I've always curious about. Is this whole notion of load management managing playing time for example in Games perhaps managing practice hours? What is the evidence around that whole concept that cumulative loading is ultimately related to some form of chronic stress related injury or? Is it just anecdotal at this point? I mean do we know that number playing hours and practice hours is even related to injury? Risk? This is opening a whole box and I like it. This is really a question. 'cause I think there's been so much media attention in publications about what is workload management. What is load management? You know one of your leading researchers here Tim Jab it looks at the acute chronic workload ratio granted. There is some maybe statistical flaws with that. And there's some other other high end researchers that will debate it I think the has face validity to it right. It makes sense that the concept for those. That aren't familiar is your acute load. So let's just say a one week total load. Whether that is objective loader an objective load is measured and compared to your previous four weeks. Three weeks maybe even six weeks and the ratio there of how much of you done over the last week compared to your previous three to six weeks may give you an indication of a potential for injury until it makes sense with face validity of just do way more than you have been doing. We all understand that that increases injured risk and then on the opposite end. If you do nothing at all you know there are the potential to go into a game in heaven injury because you haven't adapted to the load that you're going to be facing so there's sort of this sweet spot. Gavitt defines it as anything from kind of point. Eight to one point. Three arguments around those numbers are valid and worth having a totally different discussion as far as the overall body of evidence to support it. It's really sport specifics. Looking at Australian rules football basketball in other areas world necessarily the NBA soccer rugby. There's a bigger body of evidence for how to manage athletes across the season. Or How do you structure her? Preseason in-season practices to mitigate injury risk that said a lot of those sports play one maybe two games a week so it's easier to build a schedule around being ready or peaking over that period ization concept for a singular game every week and then they're sets of playoffs or their postseasons. I. It's a lot harder at three to four games a week. It becomes a lot more interesting. I think teams are messing around with it. Which is why you've seen some of this load management guys sitting on back to back. There is a little evidence to say that injury risk is higher on a back to back just whether it's travel or the demands for game. Two nights in a row is far as what is the cut point for throughout the year. I I don't think we have any idea. Do you need to sit twenty games? Do you need to sit a quarter of the season to have a decrease in injury risk? I have no idea. But then at the saint man it was not a lot of teams can afford starters sitting for a quarter of the year. I don't think we have those answers yet. Or is there a giant difference between thirty six minutes tonight in thirty eight minutes night across the course this season it is only two minutes but across eighty two games. Now you're playing a significant volume more total but we don't have any research truly to support it so I think that's where you're going to see more of the research evidence going coming out of the NBA specifically. I was a long winded answer. I'm sorry no it's super helpful. Appreciate THAT RESPONSE AS WE SHIFT GEARS. You know one of the things that comes to my mind you think about these professional athletes whether the NBA or any high level professional sport you know these are sort of freaks of nature from a sort of biological perspective and so when you look at the evidence which is oftentimes. Let's say done in recreational athletes or you know let's say college athletes or just ordinary moderately active individuals. How do you think about taking the evidence and sort of applying it to the elite athlete? I mean oftentimes. That is a big jump. From sort of generalize ability perspective so how do you think about that when you look at the evidence and whether or not it applies to to your players for example it's a hugely? It's one of the hardest things that we deal with touched on a little bit in the last answer. A lot of the professional sports research or elite. Sporting research is in other sports. There's very little cumulatively total research in basketball and the research that is in it is not specific to the NBA. Some of it's the N. B. L. in Australia Euroleague. Those groups also play under a different set of rules so now we have even more questions all right what we do try and find the basketball research in trying to apply it to the NBA. You know they have a different right there. Quarters and halves. That's different total game times different. The three point arc is a different distance away while it doesn't seem like a big deal if we're looking at research on say worked arrest ratio in professional basketball. Do we have more commercial? Timeouts are quarter. Times are different. All of that at some point has to matter now I don't again. I don't know what that cup point really is. I don't think anybody does. It's kind of be careful with the research we fall back personally. As a staff like our high-performance unit falls back on the research that we feel as strongest in his consistent across multiple populations so just global strengthening is is important. Right so the stronger. You are the more resilient you're going to be distress. And we find that frequently across different athletic groups whether that's recreational athletes to Kinda Saba league collegiate athletes to elite and professional athletes. So I think. What are the big home runs in every population? And how do we apply to our guys understanding that they're GONNA be differences? Think stepping away from basketball. There's really easy example So well-documented managing pitcher shoulders in baseball has to be different because they move different. Their their shoulder is structurally different than your sub elite recreational softball player who we may have some research on granted. There's a bigger. There's a bigger Olisa research now in baseball to how you manage that or you know. Hockey players have changes in hit morphology because of the stress they put under their system. So how do you apply? Say Add up your abductor ratio research from rugby to hockey players when their hips. Look totally different when we run into the same problems in basketball. If most of this research is in athletes under six feet taller under six to read I mean most of our athletes are well above six feet tall and then the taller. You get the farther on that bell curve height you move away from the norm so it is a real challenge. I think we're trying to to manage that by looking into the bigger the bigger data sets in what is always consistent or however usually consistent always is a strong word so matt you mentioned data said and that really leads into my next question and I'm just curious. To what extent do teams cooperate in sort of a big data sort of injury sort of reporting such that the greater good could be served by having more data points right versus obviously teams? You know sort of WanNa hold that information close to the vest I mean. Is there any any mechanism where teams kind of aggregate all of that data in some sort of a blinded way perhaps de identified so that maybe you know teen gets a sort of an information advantage but at the same time can take advantage of the data or does every team sort of live in a silo in wallet all off with sort of super top secret security such that it's never really shared across the NBA? Yeah I would say unfortunately as a as a research nerd it's it's number-two rate. It's that second of teams are very protective over. What they feel is their answer to addressing a lot of these problems in. It's hard sometimes to understand that because like you said there's there's definitely a greater good to be addressed if everybody's athletes are healthier than we get higher level competition. It's better for the players for everybody to be healthy. It's better for the league to for everybody to be healthy in performing at a high level but it just doesn't happen so we have like on an individual side. We try and keep good records of our data year after year hoping that you can build larger data sets across long-term now again when we say big data. It's a sample size of Fifty data points over several years which no means is big data but for the NBA. Where there's only thirty teams in fifteen to seventeen athletes on every team including the two contracts. All of a sudden fifty data points seems a lot bigger because of the percentage of your population. But it's really hard. I would love to think that in the future. We're going to have more of that. I think we're pretty open as a staff with other teams we try and keep a pretty open streaming communication and you know in other cities whether it's having coffee with other staffs or getting dinner with friends colleagues at some of the NBA conferences to swap ideas. But there's always a sense hesitation. It feels like on teams opening up to what they're really doing. Yeah no that makes a lot of sense and you know. I assume that's probably similar. Matt Across Professional Sports. Or would you say that there is a sport? That's like the the hallmark example. If we could just follow this sport we'd have better injury. Sort of data. Is that consistent across professional sports? It's hard for me to say having come from American soccer into basketball. I think you see last research coming out of American sports granted. It's getting better. There's more research being published in American sports. But I think your your standard is looking over it for me. Maybe some of the European soccer where they haven't academy structure for their youth athletes into their her developmental teams. So like they're you twenty twenty. Three's to senior team. So we have a pipeline of athletes coming through a lot of these teams have research arms to their facilities or to their teams and organizations. A big example is FC Barcelona who will house multiple professional sports under one roof and then have a physician team on site and a research team on site in higher end or united higher. Just a bigger staff across the board to support multiple teams in Multiple Academy teams to me. That seems really interesting grand. They're definitely downsides. I'm sure to to that structure but if we could do that in the NBA if you could eventually have it's not gonNA happen so for listeners. Might be kicking and screaming hearing this if you could maybe do something with the a structure where you had more. We could have the Denver Nuggets us. Thirteen fourteen fifteen excetera where we then have guys kind of come up through our pipeline builder bigger research group on how these athletes developed ultimately publishing more research out of the NBA. I think that would be. That would be really interesting now practical. I'm not sure where a lot of years away. We're still trying to pump out more research at this time we've got a few proposals research projects in the pipeline that will hopefully be able to get published soon. Now that's a that's super helpful. You Know Matt as you all know. We've got a lot of clinicians in the outpatient world that listened to the podcast and I guess I'm just curious. How do you see the distinction between injury prevention strategies in the NBA or professional sports verses Injury Prevention as it's applied in outpatient pt are there any paradigm of Injury Prevention? That sort of crossover. Both I mean. Obviously some element of load management you know might be one but are there specific injury prevention strategies that might work better in one or the other verses? Perhaps those that are ubiquitous in work in all settings absolutely I think we have like maybe some slow loading in the management in the tracking strategies are easier for awesome professional sports because except for now during the the hiatus were exposed are athletes not just like digitally like right now. But we're every single day we are in touch with our athletes and we're in the same space with them or flying on planes were in hotels when it comes to actually tracking what is happening on the floor or trying to provide you know maybe healthy lunches and dinners and breakfasts as we have a lot of control over that piece. It's easier to track that information when you're truly with somebody every single day on the outpatient side I think unfortunately sometimes you end up being very reactive because of just how injuries come into the clinic. Most people don't come in when they're healthy looking to prevent future injury now. It happens for sure. But for most clinicians. That's not the bulk of their population. It's usually post injury so I think for both settings it's what is the most updated research on specific injury types and the return to play a return to sport management to prevent recurrence even though that is the number one predictor of injuries previous injury. Like what can we do to limit that? So whether an acl that's proper quad and hamstring strength in HOP TESTING IN ANKLE INJURIES. Like hop testing profile single balance. I think we can do that. Well across all settings is. How do we take what we're seeing in front of us in trying to reduce the risk of recurrence? That to me I think is the big one for patient and at the same time just educating one that we can do we can all do across the board of Education on sleep. Nutrition stress management these other factors that sometimes seem unrelated to injury but the research proves time and time again that addressing. These concerns can reduce injury. Risk down the road. That's what I think. We also have to be careful to not maybe sometimes step out of our lane and maybe start trying to manage to many things but you can still educate patients on those strategies in gives them resources for the right people to find whether that's RFID or a a PhD psych to manage some of these other pieces of injury. Matt that's a Yes. Super Helpful and nor listeners are going to enjoy this conversation as we head to a close you know. I'm reminded by the fact that at least as of today the NBA's not playing and you know as a sports fan. I know I know I'm GONNA get some criticism from listeners. If at least don't ask you sort of what's GonNa Happen? I I mean I I you need to put your crystal ball on and tell me that we're the NBA's coming back may the first right. That's gotta be. Obviously I'm saying that ingests but What's the what's the crystal ball saying about what's going to happen with the rest of the season and I think I'm so far down the food chain here? It's hard. I wouldn't take anything I say with any any serious by I would follow loge on twitter. Because that's where we all get our best news. He super dialed in. I think we'll see the league comeback. I think there's a strong interest from the Players Association in from the League to try and figure out how to get the league back not just kind of personally for the US in the League to continue to generate revenue right. That's that's a huge driver in. I accept that I think there is also an understanding from the League office and the Players Association. That people are are fending for something. People want sports back. People want a distraction from kind of all the craziness that's going on in the world. I hope we can give that to people now. How that looks I would be. I can go out on a limb here and say I would be surprised if we have games with fans the rest of this year but hopefully the league in the Players Association and Government Officials. Health officials can figure out a way that weekend. We can have games that can be broadcast nationally without fans just to give people something some distracter from everything else that's going on in the world because ultimately we're in the entertainment industry and it'd be it feels like one way we can give back to the community now. I appreciate that perspective. I think we're all sort of hoping for the best. Perhaps preparing for the worst but being able to think about you know sporting events coming back as soon as possible. I think gives us all a little Glimmer of hope in what is You know otherwise a lot of bad or negative news out there so matt. Thanks so much for joining us as we close. Give us your calling card to folks connect with you or you out there. On Social Media folks want to get in touch with the allies. Know How that happens absolutely so. I'm not great on social media. I'm trying to be better right now because I have all too much free time on my hands as my wife would tell you that. I need things to do my instagram twitter handles the same. It's doc tuttle. Dpt So do cat ut. L. E. D. P. T. feel free to reach out on either of those platforms might e mails M. C. T. Seven six five at g mail. I try to respond to any emails all emails that come in. Sometimes I miss him. It happened so if I miss your email shoot me a follow up in a week or two and I'll try and get back to you but love having these discussions whether they're recorded or not so. Please reach out with any questions or thoughts awesome. Thanks so much Matt Mark. Thank you as always. And we look forward to Another episode soon. Thanks for joining us. Thanks guys appreciate it. We'll talk soon. See Matt Wow. What another great episode with Dr Matt Tuttle. Who's a physical therapist with the NBA's Denver Nuggets? It was really a an informative discussion talking about injury. Prevention within professional sports and how it does or doesn't relate to outpatient physical therapy and just some of the challenges around you know perhaps the sharing of data within professional sports and and how you make decisions about player playing time and load management and all the various factors that contribute to injury prevention and candidly whether injury prevention is even something you can do it all just given the given the high levels of physical activity and unexpected movements that occur in those sorts of things but a really fruitful discussion and even some commentary at the end on. What's going to happen with the rest of the NBA season in this cove in nineteen pandemic? So I know our listeners will enjoy and did enjoy this episode as always you can reach us at. Ein Team on social media as well as evidence in motion dot com for the blog. We continue to work really hard through this. Covert nineteen pandemic to keep you informed. Don't forget we've got during this time. Free weekly Webinars on Wednesday. So please participate in those. We've got lots of online content. That's available to you and so we hope you will dive in and by all means stay safe. Don't hesitate to reach out if there's anything we can do for you at the I. M. And we look forward to seeing you again soon on another episode thanks for listening to the. Em Clinical podcast. With Dr John Childs and Dr Mark Sheppard for more information on the podcast guests and the latest physical therapy visit. Www DOT evidence in motion dot com slash blog. If you liked this episode be sure to subscribe like rate and review on your favorite podcast directory.

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Clinical Podcast: Ruling In or Out Carpal Tunnel | Jenna Thacker

Evidence In Motion Clinical

34:09 min | 10 months ago

Clinical Podcast: Ruling In or Out Carpal Tunnel | Jenna Thacker

"Welcome to the clinical podcast. Your host Dr John Childs and Dr Mark Sheppard will be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be. Are you ready? Let's go welcome to the? Im CLINICAL PODCASTS. Where we talk with individuals within the healthcare field and beyond. Hi everyone my name is Mark Sheppard and today I am joined by the wonderful doctor. Jenna Thacker who is an occupational therapist by trade and also the program director of Advanced Han Therapy Certification Program? Jenna is also a clinician. Who treats then I should say. She's a certified hand therapist clinician. Who TREATS ADS PRO Rehab in Indiana Evansville to be exact and today really where we're GonNa be focusing our attention specifically because there's a lot to talk about when it comes to the hand as everybody can probably cringe remembering back on learning all the anatomy and by mechanics hand but we'll be focusing in on carpal tunnel syndrome? This is something that's so common in clinical practice whether we're treating someone who is suffering from it or seeing it in the list of things that people have had in the past so Jen. Welcome to the show. Super excited to talk to you today. Thank you I'm excited to talk with you guys and carpal tunnel. It's not every day that you get to have these deep discussions on carpal tunnel Not Very often just with patients right now. I think the listeners. I kind of chuckle. You know we were talking earlier. You know you're you're an occupational therapist and you came in to work with the I N as one of the first if not the first. Ot's to open up the world of OT. Yom that's been from the birth very P. T. centric so I think it's pretty cool because you've really opened her eyes into occupational therapists views of Rehab but more specifically you know focusing in on the hands so pretty cool to to have that story. Yeah it was great. It was a little bit of a challenge coming in as an ot because not everybody knows the difference and I will say that in the handrail. Were very physically oriented. But it's nice to Kinda man that gap a little bit that I think our practice has sometimes. Yeah on that note. I'm kind of curious from your perspective from an occupational therapist perspective when it comes to hand therapy what are you kinda see is like our role you know as a physical therapist in working collaboratively with the not because obviously they can come in in. C. A. P. T. For hand therapy just as similar as they could come to see not and I've worked with several hand therapists who are. Ot's as well and everybody kind of has their different culture within the organization. But how how do you see that work out? Like what are the lanes you know in our clinic? We have a fantastic clinic. We have a ton of Ot's we was out fifteen of us. A lot of us most of us are therapists and then we have twenty something. Pc's and we're all in the clinic together and it's really neat here because we don't have that separation you know we treat hands. Rpt's don't but you can't feel that separation so there so manual therapy. I think a lot better at some manual stuff are. Pt's do trigger point during the Lincoln we do not and their stuff like that we can use our PT's involved them in our hand therapy process so it's nice to kind of pull them in and work together. Sometimes if we're not really getting anywhere and then I think the same aspect for them there is. Sometimes they're treating next up in. They need some hand things or some of these situations they're like. Hey can you look at this or is there any splitting or anything like that? That using would benefit this patient so I think there's a really good way that we can work together to provide kind of both of our knowledge. It's the best for the patient. Yeah I mean that makes so much sense and I I loved point about you. Know the regional aspect. Because there's times where you know you may be treating someone who has symptoms or Perish Fiji's into you know the hand in the median distribution and you're thinking oh this person potentially could have carpal tunnel and then come to find out. Testing doesn't really reveal that it's maybe peripheral in nature may be stemming from the spine a bit more you know. It's always nice to have someone to go to and say. Hey can take a look at this. I think this may be going on and then vice versa from a PT standpoint. I don't I don't really specialize at all in splintering like if I were to split it. Probably look like taking a couple of sticks and stuff like putting around someone's wrist or whatever. I used to do that with her. Ot hand therapist say. Hey I think this person might need something here. Can you help me out? And they were just all the hand therapists were super helpful. On that. And the other thing I've ran into as well as patients who came to me with splints. That were prefabricated or custom fabricated for them in the past. And I really didn't know is does this need to be made new still effective so it's just great to have that collaborative environment where you kind of rely on each other. I think there needs to be more of it kind of sometimes I feel can be so delineated in certain clinics where it's like. Ot's only see this PT's only see this especially when it comes to the upper quarter and having that collaborative environment especially with that many therapists. I mean cheesy of pretty. Bustling clinic is really really encouraging New Year. So that's that's awesome Jenna. I agree I feel like there's been some competition almost between ot and PT. And honestly where at? I've never really felt that it just because that's how we work but you can kind of see it and I'm open that it's Kinda starting to bridge together a little bit more especially with Ot's covenant with PT's and all that kind of collaboration healthcare. I think it gives us the best outcomes or everybody in general. Yeah couldn't agree there. So let's kind of dive in now to carpal tunnel a little bit more depth and I think the best place to probably start out with is is really what we are looking for. When we're doing patient interviews so when you're coming in in evaluating someone with potential of having carpal tunnel what are some of the signs and symptoms that? Stick out to you when you're looking into this. Yeah oftentimes I always say that my patients history will pinpoint carpal tunnel pretty quickly. Most the time it's numbness and tingling in some pain a Lotta Times numbness and tingling in your thumb index long and then the radio side of the ring finger. Your pinky is usually not involved but most patients will come in and say. My whole hand goes numb. The common sign is I shake. It feels about her. That's the sign right there. Oftentimes these increase at night or when they're sleeping usually from prolong risk selection. And then if it's severe enough you can see some wasting of your thing are the padding on your Just from not getting that nerve innovations that musculature very good. And you know it's it's funny. You know you bring up the handshaking piece because an in this. I'm almost embarrassed to admit this but when I read that I remember thinking. Oh it's like physically like someone shaking someone else's hand. They just like felt that they had to do that. And then I realized after some reflection that it was actually you know actually shaking your hands to make it feel better. So it's interesting you bring up kind of the signs and symptoms related to where people feel numbness and tingling. Because I think I think sometimes in May maybe I'm you know have the wrong perception here that carpal tunnel pretty much gets over diagnosed for folks because they come in and you know. They complained to a practitioner saying that they have their whole hand Islam or they have numbness in their digits. How do you navigate that? Because I think it's tough when they come in thinking they have this. And then you find that. It's maybe in different parts of the hand I mean are there certain classifications of where those numbness. And Tingling is that makes you say this is probably not what you think it is or this is definitely so carpal tunnel versus you. Know a radio tunnel issue or something along those lines yeah carpal tunnel in just a common syndrome. In general Irene everybody has heard of carpal tunnel for the most part. So people come in. Their hand hurts their arm hurts. Anything hurts or tangles carpal tunnel. That's the first thought so often times you know. There's obviously provocative testing of your history. But we talk about provocative testing in the clinic Falen so that prolonged risk selection does that recreate their symptoms and I never asked them does that create numbness and tingling lady. Feel anything with that is. It doesn't guide them to say that a Tonelli's tappin over that carpal canal or compressing. That are both now for awhile. Unit recreate Sir Symptoms? A lot of times people say their whole hand just because usually the pinkies involved. You don't think about it so if I'm seeing somebody back I'll say the next time it goes on at European touch other fingers and see if there's a difference a lot of times there is if there is something in their pinkie. That's usually owner. Most time that's compressed as the elbow so if they're saying everything everywhere from their Pinkett everything is not been all kinds of look a little higher to all Tunnels says for that and kind of rule out those diagnoses and if it's on more on the back of their hand or of the back of their forearm than we're looking at more radial nerve and I've Kinda hits everything then we move up and I kind of says in screen out there net her cervical or shoulder anything just to make sure it's not coming from higher very interesting in when you say that. Are there things like that you're doing? Let's say for instance that the neck that you know help you do a quick screen to understand if it influences her symptoms yet. Generally Mike Quick Circle screen just because you know honestly in our clinic. I trade a little bit of neck but not near as much and this is kind of where that coach training into by quick cervical screen motion. I have a move every direction I asked him. If that bothers it recreates any symptoms at all. I sperling so little compression every direction. See that recreates are symptoms at all a little traction does that alleviate a regret anything and that's pretty much my quick and dirty serviceable screen if everything looks fine zero Than I'm Kinda like okay. I really don't think it's coming from higher if I'm like man. I'm not sure then. I usually snag. Pt's to hate you. Check out this neck for me and see if something's coming from there and then we can also use some monofilament testing stuff like that as not to kind of differentiate you know. Close Your eyes. Can you feel this compared to European tea in different areas to be honest? I don't use that very much but we can. Yeah that's really helpful and I know too that with carpal tunnel. There's some just inherent intrinsic risk factors for developing C. T. S. carpal tunnel. And some of those things. I've heard have been like obesity age even sex of the patient so I know that you know having a BMI that is within that obesity range and then I think the age limit is fifty. Typically that I've seen in the literature and then I think females are up to two to four times at risk for having C. T. S. or are these things that kind of resonate with you or are there other things you feel like go on your radar from maybe like an intrinsic factor. You know when you're doing the intake that says Maybe this is pointing me towards carpal tunnel. Generally those are the biggest any kind of inflammatory issues. In general can create some carpal tunnel type symptoms. But that's always challenging as opposed to whether it's like any arthritic or rheumatoid or something like that is it. Carlson are they have rheumatoid flare this creating some carpal tunnel syndrome. So that's always a challenging one and then you know the type of work do also. I mean I can tell you that. A lot of times people attended used their hands significantly while typing stuff like that will increase symptoms but more female. I would agree with that but either way. It's amazing to me how you can have somebody that has minimal if you look it doesn't. Mgm Even ultrasound. We have new imaging. Ultra Sinaga. I hear that actually image for carpal tunnel in five minutes which is Kinda Nice as opposed to just looking at that nerve compression but you can have some people that have mild carpal tunnel and they have these significant symptoms. And then you can have a seventy five year. Old Lady that has significant severe carpal tunnel. You can see Wasting Nar. And she's like I'm good doesn't bother me much so you know you never know all right everyone. I want to take a quick time out to tell you about an opportunity to learn the latest research on spinal manipulation paint science-education education. Lifestyle medicine and multidisciplinary care for complex patients and how to apply the research in your clinic. Sound like something for you. You can learn more about these topics and more jawans align conference which is taking place August twenty eighth through the Thirtieth in Dallas Texas this year. You won't want to miss. This year's topics and speakers are clinical podcast listeners. That means you get a special deal of five percent off when you use the code clinical podcasts at checkout when you register for the align conference you can find out all the information and register for the conference at a line conference dot com okay. Let's get back to the conversation if we shift gears now. Moving into more like physical tests and measures. I heard you mentioned failings which is probably one of the most popular or well known. I should say when it comes to you special testing for this type of thing. Can you describe what is the failings tests? What's the positioning and what we know about? You know the the ability for that test to be helpful for us in ruling in ruling out something like this Allen usually pretty good at determining carpal tunnel just because we decrease that space nerve has to run through your making the tendons that run through your carpal tunnel fatter and the near decreasing that space around that nerve. So really. It's in the grand scheme thing. It's prolong flexibility arrest. So most the time. If look it up or you look up. A failing test people are holding them back in their hands together with them with their risks seated inflection sitting that way that's uncomfortable sometimes anyways a lot of times I'll kind of modify it and just hold. Somebody's wrist inflection. For thirty seconds to a minute. Asmaa recreates their symptoms. So really all it is is some prolonged election. Gotcha yeah and you know. I've seen I just remember seeing those those pictures as well. You know when it comes to the positioning there and when you look at the literature for this type of thing I believe the Fallon's tests tends to be more of a sensitive test which you know if you're familiar with sensitivity and specificity tests that are highly sensitive for the listener out. There is better for ruling out a condition. So you know ingenieur mind somebody comes in assuming that you do a test like this in isolation at least do you feel better about ruling out. Does your experience a line with what the literature shows? I think with any provocative testing out to have more than one to say. I'M GONNA ruin a rollout but I can't say that if I am looking at carpal tunnel and I'm testing or its end. People present kind of like we talked about earlier with my whole hands. It hurts here. Goes up my arm. Something doesn't quite one hundred percent add up to carpal tunnel and my feelings negative. I do to know this native. I do a carpenter impressions negative that I'm like. Maybe we should look a little higher. Maybe we should dig into cervical we. We should dig into this more before we go straight towards that carpal tunnel diagnosis. Yeah and I know Rob Wayne or has a clinical prediction rule. That's been around for some time that that kind of supports what. You're thinking there geno where you just don't use one or two special tests to say yes or no it's really you're looking at a cluster of signs and symptoms. Obviously you know it's important to of think through that because I do find that this condition true carpal tunnel is is hard to diagnose. Because you know there's so many things that can cause Paris thesis into the arm. The neck you know can be a contributing factor. There's plenty of peripheral nerves. Coming from the break L. Plexus coming down that can get hung up in a multitude of different areas. And be sensitized. You know there's not a plastic or central sensitization that can play into some of these things. Neuropathy pain is definitely challenging in. I think when you really look at true carpal tunnel you know. There seems to be a cluster. There that really makes sense. I love that that thought you know of just not not hanging your hat on one or two things. Now from the cluster of other things. I've heard you talk about monofilament testing. You know sensory testing. I know to Nell. Sign is another one that's been described in the literature. And then something that's popped up that I've read about over the years is this Wrist ratio. Are you doing that in clinic or are you not? I usually don't not too much. We see quite a bit of them. We have three handouts. They're usually pretty good at picking up on some stuff. Earth they think is not generally I stay with my history. My provocative testing more than anything. And if I'm being honest we have all these tests. We have all these assessments. We have all this stuff that we can do. And yes that helps us but for me. The number one thing that gives me anything is what the patient is telling me so that history is the biggest thing biggest thing for me. This is one of those conditions where I think. There's a multitude of special tests out there Chad. Cook who's reported about you know. Sometimes special tests are not so special in you. Get somebody coming in who has endured -able neuropathic type of condition and you're in there doing everyone underneath the sun you know. Does that really help you? Get to the end goal of what the patient wants and that that is hey I wanna feel better so I I agree with you that you have to be really judicious in what you do and understand how your tables patient coming in. Meaning how how easy is it for their symptoms. Come on go away and ask yourself the question. Do I need to do all of this testing to really help me understand? If if this is going on and sometimes as I challenged the fellows I work with you know. Sometimes treatment is our best evaluated procedure. And so I definitely feel you there when you say look just because they're doesn't necessarily mean we have to every test under the sun so very good point. I think we could spend an hour doing testing for our tunnels I really wanted to in the grand scheme of things. I don't have the time. Yeah no no you. Don't you. Don't get very good reimbursement for that. And you know patients aren't GonNa want to sit there especially if you have a nervous irritated. Are they really going to choose their mess with it for that extended amount of time? Exactly it doesn't make sense in the patient's honestly leave ticked off because they're leaving worse than when they came are feeling worse when they came in and they're nervous angry. Exactly nobody likes you. Know when a nervous sensitisers it's GonNa let let the patient know to protect so you definitely don't like you test. The waters `table. I'm kind of a Geek when it comes to outcomes measures in really assessing for function. So what are the types of outcome measures? You know that are commonly used in this. Like I'm. I'm very familiar with the the Dash. Quick Dash but are there others out there that maybe are better for looking at those who come in who were suspecting may have carpal tunnel. Yeah so we give. Everybody was an upper extremity. Thing a quick dash that's are easy. Functional measurement of the beginning there's some specific for carpal tunnel. There's Boston carpal tunnel questionnaire. Which has been around for a little bit? Which is specific or article title? There's also something called the C. T. S. six which talks about the symptoms of carpal tunnel. Which is Kinda Neat? One of our surgeons in one of his students are actually doing a research study. And we're taking measurements on ultrasound guided verse open Carpal Tunnel Verse Techniques. Oh we're GONNA take measurements on that the two things we're using that functionally are quick dash in in the C. T. S. six. And that's kind of neat because that is six simple questions that just focuses on Karl tunnels booms. You don't have as much functional stuff in it. There's a little bit but that usually it's almost immediately after a surgery post op drops significantly. So that's kind of cool to see notes very helpful because obviously there's a lot of different outcome measures out there and and you know if you're just using ones that maybe aren't as specific to the condition. Sometimes I feel. You can't truly get a good grasp on you know functionally how they're doing so. I really appreciate the mention of the Boston. Carpal tunnel questionnaires. C. T. S. Six and others and just for the listeners benefit here to a huge advocate of clinical practice guidelines in our Wonderful Academy of Orthopedic Physical Therapy through the PTA has published recently. I believe this year a carpal tunnel clinical practice guideline. And if you go to the American Academy of Orthopedic Physical Therapy or I should say the Academy of Orthopedic Physical Therapy they. They have on their website access to this open access and they have a number of great resources there surrounding it. So if you if you wanted to dive in a little bit deeper into some of what we've talked about so far especially the outcome measure piece. They have some great data and talk about these measures that John has brought up so thanks Jennifer kind of diving in there. So you know. We talked about assessment and sinus symptoms. This point which is great. Good to kind of know what we're looking for. But how do we treat this thing? And I think what I've seen from the literature. Is You know. Hey night splints you gotta be on it so tell me what's up with the night splints like? I don't know how to do it so I'm looking. Eugene are like hey I need help with. This nights went thing. Yeah so nights letting is one of the number. One things that you'll get from almost anywhere especially treating carpal conservatively are risks. Flex irs are stronger than our ristic sensors in general in most of the time when we relaxed if we just completely let our hands relaxed. They're going to go forward. So we're going to be basically Test that prolonged flex in most of the time at some point when we're sleeping we hit that prolonged selection so the goal of nights one basically just a whole eurest in a neutral position. So we don't put that prolonged stress on that nerve. There's prefab ones that are over the counter. You'll see him. Everywhere I'm a big proponent of everyone we see long as Moshe Insurance has covered. Our customs launched their codes. I usually custom fabricate. They fit better. They feel better. They have a better basis than that metal. Stay that comes in prefab ones. So I'm a huge proponent of custom fabricated just because they tend to do better. I think that would matter to right because you know if it's not comfortable they're not gonNA wear right and there are some that. I've had a few patients that in one. They're like the one. I brought it Walmart. Those veteran okay where whatever works for you but I can't say that people come in. They have these. We have one in there like oh so much better Fit Must Time people with mild not significant symptoms that have not really had any treatment for their whole tunnel. Nights wants to do wonders even if it bothers them during the day just because we're not increasing that that prolonged compression on that nerve we sleep. Yeah it makes sense and you know it's just another hopefully reflection point here for any physical therapists who are not well-versed in splintering which I would say you know you're not getting a heck of that in. Pt School East. I didn't and I know the copy standards really. Don't have a heck of a lot of it focused on that and you know if you look at the clinical practice guidelines the primary interventions. You should be thinking about if there's anything that's listed there. They say neutral position risks. Ortho service for nightwear and to me. This is a prime example of where going to a hand therapists and saying hey. Can you help me with this? If they're at the clinic at least to show you or collaborate in a way where you can you can work together to make that happen but I mean I just want the listeners. To know how much evidence there is to support for this and true carpal tunnel and how effective it can be if done right and it sounds like you really are leaning on that customer aspect versus you know going to Walmart or a cvs or something like that to pick up. Those prefab ones yeah. We're we're very lucky. Are we work so close with our surgeons? Our surgeons appreciate what we do. We all day intimate Better I had the kind of funny. It has one of our surgeons. Who's not a hand surgeon? General Orthopedic Surgeon. His wife actually had a hand fracture. He gave her like this prefabs point in. She complained about it for about two weeks so he was like fine. Go there and we may one and she was like. It's so much better. I don't know why you don't do this with all your patience. Yeah as funny now. If we remove on from the splitting nights splint piece here like a lot of the research done for Carpal. Tunnel is very modalities driven at least from what? I've reviewed you know. My bias is the manual therapy kind of approach but quite honestly there really is a a lack of evidence to support manual therapy for this type of thing. There's some emerging literature but it really isn't like what we have for say low back or spine so tell me a little bit about your approach beyond using a night. Splint what are you thinking is best practice? Here when it comes to treating those with carpal tunnel way are pretty conservative with how much we see conservative Most of the time we split in or given some exercises which includes some gentle nerve gliding. Right nerve you angry when it gets stuck. So ideally get not move in will make it. Feel better tending guiding. Because you have your eight ten minutes that can run around where that nervous up through that we WANNA make sure. There's an INS are moving along that nerve of whether that be most the time exercise wise but as far as in the clinic as we can do some of that manually. If needed generally we see people splint give them exercises in. Say you try it. I'll see a couple of weeks in if it's getting better. Great you've seen we keep doing your thing. If it's not some other stuff we can try. And that's when I kinda jump into a little bit of modalities but the hard part with modalities and I think. Modalities for almost any diagnosis. Are they work for some people? But Not for others. I mean that's that's just with general almost any modality there is for the most part so I agree the same way. And you know I've used unconservative carpal tunnel and I had some people that are like this is wonderful. It feels the thousand times better. This isn't doing anything it just kinda depends. There's always places to Kinda hit and try. I can't say that in our clinic. Carpal tunnel release. It's a surgery so obviously people trying to avoid surgery as much as possible but it's a pretty simple surgery in the grand scheme of things and we get people moving pretty quick so I know our surgeons. A lot of times are like if you're not getting better. We'll do surgery so we don't have that boat. Luna time to kind of treat that but in my opinion planting and then exercises getting stuff moving in patient education patient education is the big one with risk positioning. Don't hang over the chair though hanging over the steering wheel stuff like that as far as changing positioning Yeah it's super interesting to hear that too like you know it's almost taking a minimalist treatment approach and you know really like I said I think the night splint has the best support for it probably because it's very helpful there but you know kind of looking at secondary interventions assistive technology whether it be different mouse or like you said adapting the work environment as best we can for folks were like you were saying earlier using their hands quite a bit probably makes a big difference there but yeah. I mean I think when you look at modalities it is kind of the wild west right and and you know in carpal tunnel. There's kind of conflicting evidence and really the the recommendations are not really that strong for for wanting to go that way a lot of the language says you know do a trial treatment of it and I wish we had more evidence and this is probably a call to those listening who are doing research to really start to dive into this more because it is so common but I think maybe why there isn't so much research is because maybe because the night splints and the other things are so effective to some degree. But I I happen to find that the the folks I've seen who continue to struggle with symptoms in their hand that come in and say they can't do stuff because they have carpal tunnel typically have other stuff going on. I wonder how much of that it is truly carpal tunnel or is this other stuff related to their conditions. Such as maybe the next more involved maybe they have a hypersensitive nervous system. That's causing Increase paint output. So you know. I think it's it's a challenging diagnosis. Because like I said earlier I can get over diagnosed in people who have hand symptoms and they don't really know what's going on so they give them a common diagnosis and it's easy for them to go at Walmart and get the splendid. Nellie seem like they're doing something for it so I don't know what your thoughts are there on on that but that's kind of my challenge here. I think there can even be some underlying carpal tunnel. That can be exacerbated by Coburn. Another symptoms diabetes is a big one imperfectly. Neuropathy and stuff like that right so we can diagnose his carpal tunnel but is it. Is it really the carpal tunnel? That's irritating you. Even if they do test provocative for Steph or is there some other stuff going on that we can come down mental? Make these symptoms feel better. It's challenge yeah. It's interesting you bring that up because I do think you know when you look at those intrinsic factors you know such is gender age those are factors that we can't you know you can't stop someone from aging or what gender they are but you know when you look at lifestyle things that are maybe around metabolic disorders cardiovascular disorders. It makes you think like are. They managing their condition well and is this carpal tunnel a results of poor management from a health and wellness standpoint. And you know it's almost like you have to take more of a global approach and say look you're having these symptoms because we're maybe you're not taking your medication or exercising eating properly and so when you say patient education you know it almost goes beyond the aspect of you know activity limitations in setup and more to just hey. Are you getting enough sleep? Are you eating eating a diet that is appropriate for you? And secondly are you getting the exercise you need especially if you have more of a sedentary job so it's just you know kind of Light Bulb. I that went off as we're we're tying this together for me but very interesting. Yeah a hundred percent and I mean. It's that whole that whole patient. That whole body that holistic kind of approach of education talking about Carlson on weakened Some of these symptoms. But what else can you do to make it better? I think end of that pain neuro science all that education stuff can come into play. Let's also very true. Well Jen. I think we've covered quite a bit in this this episode. I appreciate you coming on and talking about this common yet. Sometimes uncommon in certain worlds disorder. So I appreciate your time. Thank you so much. It was fun awesome it was great to discuss carpal tunnel today with Dr Jennifer Thacker. As you heard. There are multiple layers to this condition that need to be considered and I hope our discussion today was helpful for you as you bring this knowledge in reflection back into the clinic. I encourage you is well the checkout. Em's advanced hand therapy program if you're interested in taking a deeper dive into topics like this. The program is definitely a high end program. That goes into lot of topics to make you. Well-versed in addressing common conditions in paramount's and functional limitations related to the hand and upper quarter. So that is it for me and this episode for today as always thanks for listening into another episode of the N. Clinical Podcast. Thanks for listening to the. Em Clinical podcast with Dr John. Childs and Dr Mark Sheppard for more information on the podcast guests and the latest and physical therapy visit. Www DOT evidence in motion dot com slash blog. If you like this episode re should subscribe like rate and review on your favorite podcast directory.

carpal tunnel Jenna Thacker Mark Sheppard Neuropathy Jen Indiana Dr John Dr John Childs Carlson Walmart Fiji Dr Jennifer Thacker C. A. P. T. Pc program director Yom Mgm P. T.
Clinical Podcast: Treating the Thoracolumbar Junction for those with Hip Pain | Jeff Meadows

Evidence In Motion Clinical

17:34 min | 1 year ago

Clinical Podcast: Treating the Thoracolumbar Junction for those with Hip Pain | Jeff Meadows

"Welcome to the I am clinical podcast your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be are you ready. Let's go welcome to the clinical podcast where we talk with diverse individuals within the healthcare field and beyond I am mark. Shepherd and I am joined today by my co host as usual. Dr John Childs and we are both excited to talk with Dr Jeff Meadows who is a fellowship ship train P. T. coming out of Asheville North Carolina what a beautiful place to live in practice so jeff you had recently published a case hey series in the journal Orthopedic and Sports Physical Therapy or PT titled Short-term Response To the treatment targeting the Thoracic Lumbar junction in patients with hip pain and we will be discussing the details of that case series and Jeff. You know we're really excited to dive into this publication. You did and we're excited to have you on the show. Thank you mark John. Nice to be here and appreciate you having me glad for it and you know. I've been really excited about this because I think clinically you. You know these are things that we've seen before or we've had those patients with hip pain who just don't seem to get better with hip targeted treatments but before we really dive into some of the details of your publication. I just kind of want to get a little bit better idea for the listeners of where you practice and a little bit about your background okay. Thanks yeah as you mentioned. I I live in work in Asheville North Carolina great place to be is Suarez Hiking biking running all of that stuff I live in a very active community and into that that helps as well from the clinical side I work at anti fragile physical therapy in so now network clinic in we see a lot of spinal cases his runners athletes from Kedah one hundred Mile Mirror Ultra marathoner so it's a very enjoyable practice and working with an active community. That's great you know I've been down actually grew up pretty close to Ashville so I've been down there several times and just like this is like the optimal timing year right jeff wear like the leaves are GonNa be changing here in the next month or so you know in the fall time where he can really see some gorgeous scenes out that way so I imagine you're probably GonNa get out and do some hiking king or something along those lines right. Oh absolutely training for a rim Durham Durham Hike and Grand Canyon coming up and there's another couple outdoor races that I'm looking forward to in just not a better time year like you mentioned not too many places in the country that rival it so very very happy to be here. Dan I here that the beer down in your neck of the woods is also very good lots of breweries in your area right nationally. Yes absolutely so I'm doing a really good sell here on visiting Asheville if he can already tell like home. Prices are doing our best as we speak so I do have that effect on home prices. I guess all right Jeff so as as we look at your case series here again you're you're looking at Thoracic Lumbar junction junction and patients with hip pain so can you bring up in the Intro to your your case series you bring up the term T. L. Junction Syndrome and Ming Syndrome. Can you expand on what these exactly are. Are I mean these aren't things that pop off the top of our heads when we're thinking about hypotheses oh sure absolutely didn't recognize it myself until in the fellowship ship program in heard of these two terms in equities interchangeably main syndrome in. Teo Junctions drums so they were first described in the seventies. It was Dr Main who prescribed syndrome. That's why holds his name again. I think it's fairly under recognized. The junction is a source of symptoms. It can be in the the hit that it can also be in the groin cubic and it's actually less rare or it's more rare to have the symptoms in the spine in so you can also have a combination frequently are patients. It's not just one little focal spot in these patients are very much like that so it can be it really major ruling things up or down so jeff one of the questions. I wanted to ask before we get into. Some of the specifics is to talk a a little bit about the whole concept of regional interdependence. You know that's that's a concept. That's been batted around now within our community over the last guy call all at five to ten years at least and if you take regional interdependence to an extreme right you get this sense that you know you might be able to manipulate someone's neck and to influence great toe dysfunction or something silly like that right and you do have this extreme sense out there where some people treat areas that are long distance away from the primary source. You know so talk just a little bit about if you don't mind some of the mechanism mechanism behind why you would treat an area like the Thorndale Lumbar junction to manage someone that otherwise presumably has primary very hip dysfunction or is it one of these things where it's actually primary act issues that are referring to the hip so just speak a little bit about. I think the pause ability if you will of managing patients with this condition in the way that you described in your case series sure I think it would be more the latter of your comment. It's also described the spinal dorsal. Ramos mediated pay. We're looking for this to this can be an tation to the nerve at the junction in be within our hypothesis lists in our examination. We're GONNA look for familiar and comparable terrible symptoms when we're going through so in general if I could kinda backup in kind of go through the process again. It's not usually on top of my hypothesis. Lifts is going into an examination when somebody comes into the clinic in has a complaint at any one of those areas that I mentioned I think it's critical that come with a comprehensive you've differential list and then start with a comprehensive subjected in physical assessment as well so my process for me. I like to start with the body chart that that can be key with finding a pattern and also keeping the areas of complaint in a logical methods so the chief complaint because they're here for the hip so they want to look at their cat but they don't know potentially there. Some of the regional interdependence that you mentioned are there can be influenced from other structures so I I can't tell you probably had three or four patients this year that have had testicular or a pain in the bay area and you know that obviously I'm not held account fair says does not want a keen to me but when we would be on their hip or their spine and I asked the question having pain in the salary. It's interesting in how other things pop up that can eat with shoulder patient not playing that paint we just. WanNa make sure we're doing our due diligence yeah. No that's great well. Let's dive in just a little bit at the right up on your diagnostic. Process was really well done super thorough so curious about what you saw aw as the key factors in these patients that made you think about targeting the thorough lumbar junction. What is it that clues you into sort of. Look up the spine if you will we'll share so when the physical examination on his patients just to give clarity to the case there are three different patients. They were the right of has done three different patients with three different therapists. That's one of our challenges trying to be consistent with our patients but it did have a pattern in all of these patients had decreased in spile range of motion in that Teo junction it could be more workload. It could be more Columbia are three patients had a fairly negative cluster you know with the favor favor and the other head findings the muscle testing was normal but they did have a hypomobility. Te'o junction and then the key for us was there was familiar pain at that -til junction so not only the hypomobility decrease range emotion but we had our patients familiar fighting in finally is a kind of comes down to the test treat in re-test s. method and then that helps us that we would are assist lists and then what about the interventions that you used on these patients what were those specific interventions and talk a little bit about the rationale for the specific interventions that were used sure so our interventions with starring with manual therapy we we great progression of spinal mobilization including high velocity low amplitude in that we followed that up with mobility focused activities or exercises if you will and that was to reinforce therapy but also to regain some of the deficiencies in the range of motion of the spy so these they're all chosen to address our compare findings again going back to our range of motion and movement testing following our treatments so jeff in your right up you do a nice job of talking through some of the clinical reasoning aspects at least as much as you can in a publication and knowing your training and your background. I know I know that you are utilizing asterik signs and you mentioned comparable signs so I'd be interested to hear for the listeners benefit you know what are your understandings of. Asterix signs and how did you use them in this case especially when you're treating regionally to help guide whether you need to hang out there or should you go back to the hip. I think think on these cases we started actually at the hip looking for hip pain as that was the patient's chief complaint but when we start when we couldn't reproduce the patients familiar complain. I don't think we found our asterix. If you will in moving to the next segment do we find it in the lower lumbar spine. I think again the the answer was no and so then as you progress to the low-earth spine when we reproduced that hip pain or again like I said many of these recent cases had my clinic like that it is excellent for patient volume and then you can of course you're explaining the process to the patient Asia in letting them know I'm going to be evaluating several structures that can refer into that him or structure if that's been established as a complain so again commissioned once a few minutes ago the test to find that comparable Asterix entreat at so whether it's joint mobilization manipulation than re-test at in the range of motion improves in when he pushed on joint and they have their pain resolved or all extra diminished any no. That's that's really kind of key for for my practice. I think that's helpful. Hopefully for the listeners to hear because you know often times in these cases especially treating regionally you know it's hard to convince the patient y you're treating the spine you know when they have primary hip complaints so tell us what did you do or say to the patient to frame your interventions or your staff summit when they're like Jeff. You know it's my hitman. Did you hear what I told do. When I was telling you what was wrong with me right yet I think explaining the processes Sochi and and just you know most of my patients are reasonable about letting the examine multiple structures ones that set the framework for saying. I just WanNa see how everything is involved here. Sometimes this can contribute to hip or you pain the explaining the process. I think is the biggest piece of things. There's no better Brian than when you reproduce that commissioner pain during your assessment man let the patient never hate us. I think what's going on. This area in your upper. Back is actually contributing contributing to your deer hip while we try to give it a trial treatment and to see if that is better worse the same afterwards so kind of the process within the clinic and I think that's really helpful to hear you know because I think as a as a new clinician I remember really struggling huddling with this idea behind treating regionally and I used to get really nervous when he started getting as John mentioned earlier farther away from the area of complaints into maybe the spine I typically the patient kind of look at you funny and and there's no better by and then having those asterix signs as you were talking about earlier. Some of the complaints in the case ace series are having trouble walking or there was a person patient that you had who had issues with their golf swing and those are easily things you can replicate in the clinic to say they like Oh. Yes I have pain doing this. Wow you treated my back and my hip pain feels better with those motions. I mean there's no better confirmation there that you're heading in the right direction if you do it in a non-bias way so I really appreciated that in your case series year Lilly Jeff as we head towards a close one one of the things I'd appreciate your perspective on you know there's lots of clinicians out there that are interested in doing research and maybe publishing a case report or a case series so if you don't mind share some of your sort of lessons learned if you will in this process maybe some of the pitfalls clinicians are always. I know I get a lot of emails. Els About being interested in so folks like yourself. I think offer a lot to your peers and others who want to share these pearls that they're learning and in it's oftentimes oftentimes in these case series where insights ultimately lead to you know larger clinical trials and so you don't mind to share your words of wisdom and some of your lessons learned going through this process sure it was an absolutely rewarding process in the end. I mean this started early in my fellowship in it's been about four years now. Allen was so it was a long process. I was very thankful to have strong team said Peterson Tom Dinner had already gone through this process several times so that was is invaluable and then great support as well from Leslie Milligan John Depatment who share authorship on this so in the end. I hope we reached reached our goal to increase the awareness of the T. L. junction. As potential sources of pubic pain that a lot of clinicians may or may not be aware era so definitely would go through the process again would recommend it to anyone. That's either going through. Fellowship just wants to expand into new skill sets. Yes you know it's great to have an excellent team though as well. Jeff it's been great having you on the show really appreciate your time with us and we should the best of of luck and hope you have a great fall face has been great for me as well thanks John. Thanks and you guys have a great as well. Thanks Jeff. Wow what another terrific episode with Jeff Meadows and it's always fun to dive into some of these clinical all topics jeff having published case series on treating the T. L. junction for those that are patients few patients coming in with primary hip pain or main syndrome and so so it was enjoyable just to really talk about the whole concept of regional interdependence and just really being reminded as clinicians that oftentimes patients canary complaints may or may not be where the primary source of dysfunction is just hearing some of his rationale and probably most importantly just appreciating publication process. Jeff is an active fulltime clinician not an academic. There's so many clinicians out there that are interested in publishing and and hopefully his paper is a good marker of what's possible and so if you're under an active clinician out there who's interested in sharing your clinical insights on patients please reach out to folks like Jeff who've published before there's lots of opportunity to share and ultimately see some of those insights row into larger clinical trials ultimately influence a practice so so thanks to Jeff and his co authors what a great paper and was fun to hear the show as always you can reach us at emt on social media or out on the blog we certainly appreciate our listeners and look forward to another show again soon thanks for listening to the EM clinical podcast with Dr John Childs and Dr Mark Sheppard for more information on the podcast guests. It's and the latest and physical therapy visit. WWW DOT evidence in motion dot com slash blog. If you like this episode be sure to subscribe like rate and review on your favorite podcast directory

Jeff it Lilly Jeff Dr Jeff Meadows Dr John Childs Asheville Thoracic Lumbar junction junct North Carolina mark John John Depatment Dr Mark Shepherd T. L. Junction Syndrome T. L. junction Orthopedic and Sports Physical Thorndale Lumbar Dr Main Teo Junctions Columbia Ashville
Clinical Podcast: Career Advice for Students Part 2 | Tim Reynolds and Bryan Guzski

Evidence In Motion Clinical

18:44 min | 1 year ago

Clinical Podcast: Career Advice for Students Part 2 | Tim Reynolds and Bryan Guzski

"Welcome to the I am clinical podcast. Your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be. Are you ready. Let's go everyone. Welcome oh come back to the. Im Clinical podcast where we talk with diverse individuals within the health. Care Field. And beyond my name is Mark Sheppard and John Childs and I welcome you to the second second part of an earlier. PODCAST episode with Brian. Gutowski and Tim Reynolds. We are continuing on with our discussion. About what events were activities or life experiences that we have had both John and myself that define one's career and maybe defined our career if you missed the first it's part of our earlier discussion. Be sure to go back and check out that podcast says it will help build up some of the context and discussions that we will continue on on with in this episode so with that. Let's jump back into the discussion with Tim and Brian. So Marcus is what is an unusual habit that you you feel has greatly benefited youth throughout your educational and professional life. Yeah love this question and I don't know if it's so much a habit but it's I'll put a talent in quotation marks but I grew up kind of playing instruments and the first instrument. I really took a liking to was the drums and so my dad had this like cheap cheap maiden Japan like nineteen seventies drum. Set that I found like in her basement or attic or something when I was probably around eleven ten eleven years old and and you know I asked him I was like hey can can I pull this out. I just want to play with it. And got on their started beating around with it so anyway. I taught myself how to play drums by listening and and it took me years and years to do that but I I started getting better and better played in a couple bands throughout high school and in college and I soon picked up the guitar as well and kind of took a couple of lessons but the lessons weren't for me. I loved figuring it out listening to a song in my ear buds and trying to figure it out so I had the bare basics of foundation applied right it. So why does playing musical instrument compared to you know a habit or something that you apply education profession and I think what I've learned from playing music with other people has helped me one in healthcare being collaborative. When you're in a band you kind of have your lane right? You're playing an instrument. You're not playing guitar and the drums. Although some people can do that at the same time but most bands not right so you you have to stay in your lane gene but also build off of the people who are surrounding you and if you think about the Beatles are Earner von are foo fighters or somebody like that you know the best best musicians out there. You look look at them and it's like man. They are just so jeld. They practiced together. They work together. Know what the next person's GonNa do and when they do it you know that is solid team. They're collaborating rating to make sound sound beautiful right and so I learned how to work off of people in where to inject my ideas where to kind of add in in my little flavor but not steal the show right it was so awesome to be able to have friends and and come together to create something that just I drove me in having that piece there has been super helpful in the second piece when it comes to education. Being in a band has helped me be able to perform as an educator and one thing I think when I look at the people who who really keep you captivated. They're almost a performer of sorts. They set the mood dude. You go to a concert and you're just playing the same note or a couple of chords over and over again to the same sound same. Beat I mean you're going to like leave. The concert or fall asleep right eight when we teach we're kind of using a monotone voice doing the same thing over and over again reading from her slides or not engaging the crowd man. You're not okay. Keep anybody captivated. I don't care what you say but if you're up there like a performer. Engaging using different tones look tim. Flynn one of the best out there at doing doing an actual captivating speech or presentation just watching him. It's like man it's just he's like performing but he's like doing it like a musician. Vision and funny thing is Tim. Flynn is musician and so it just to me. It's helped me understand that you're up there and you're you're performing not like you're faking it but you have to captivate debate the audience use that skill set so to me. That was something that I think it odd thing that maybe as carried over into my career mark definitely saw a lot of that this weekend at Awesome I mean all you guys but I mean you especially the way you're introducing speakers An information I mean going through that case study that we went through you. You guys were just so captivating it's funny how you guys all kind of like we were saying earlier. Just bring it each each talk and kept everyone engaged. I mean there wasn't one minute rallies Alvin ALYSSA's captivated in focus the whole time. So yeah definitely a testament to what you were just saying. You know saw a lot of that this weekend so one more question here John. This last one is for you. We may have kind of answered it in the beginning so I do have a follow up question that if if we have time for like to ask but will start with this one one or bad recommendations you here in your profession or area of expertise. Yeah I think we've touched on this S. and just sort of emphasize again. I think it's a myth that you know you can do whatever you want to do. Genuinely believe Yada try to find a path breath that actually matches your skill sets in your talents. You know what you're gifted in doing so I think that's key. I think some of the you know to get specific acidic. I think this sort of idea you see this a lot has. There's a lot of folks consultants if you will. That are active on social media that are advising recent graduates that all you should go work for a corporation right. You know. They're just using you to make all this money. Go out start your own practice. You know insurance is going being away. cash-based is where it all is and that kind of stuff is I think personally has led a lot of people down some really really. I think misguided pads adds as I mentioned before almost all of those individuals have other jobs to help make ends meet and starting your own practice. It's a great thing but it's not forever potty and there's a lot of how you NBN a smaller part of a larger team that really embraces excellence in culture invest in your career and again it's not a it's not a one or the other. There's there's there's plenty of range for all of the above but I think you ought to be careful about you know taking too many of those risks too soon in your career. I can tell you at least my own kids. I would never encourage my kids to quit college or quit their jobs and go start a company. I think that's horrible advice. The one thousand that that make it get all the press in the media. But you know I can't say enough for Turtle SORTA wins the race. Slow and steady. And don't think you're gonNA get rich quick. It's the path to success as filled in littered word with lots of ups and downs in sleepless nights and failures along the way so it's not for the timid for sure. Thanks John so I gotTA SS question if we have a couple minutes. You alluded earlier to being an early riser. Back in the day when you're looking at your curriculum vita that Tim nizing found found somewhere. I mean the amount of projects and research obviously with evidence emotion. Just the amount of things that you you are doing ed were doing back in the day when you were up at three zero four. What did that morning routine? Look like I think that's a common theme that we hear from from leaders and definitely those leading larger organizations like to get up and get some things done before before the sun rises before there may be competitors up. So what would you say that. That looked like it was filled list list. You know kind of learning was filled with journey meditation the kind of a brief structure that morning. Yeah I think it usually for me always started with a a cup of coffee. I mean that was just sort of. That's where I go especially at three thirty in the morning. And then yes some amount of meditation prayer devotion time that sort of thing just to kind of get a sense sense that the world is bigger than sort of yourself if you will so that was always an integral part but pretty quickly getting into. I had a a for a long time. And I've been doing this a walking treadmill I I could walk for you guys probably five or six miles of for my kids ever even got up and so walking and working on my laptop and those sorts of things you know. It's uninterrupted interrupted time. You know your emails not going off. Your phone's not going off. So that's when I could write papers and do a lot of my heavy sorts of thinking kinds of things working being on projects so that once the day got up and everyone else was up and going. I could spend the bulk of my day really focusing on the relationship side of things I mean you you mentioned Agen Lot of hefty. CV in. I mean that is shared with a lot of other co-authors and teammates right. Who really came alongside me so I think part of being successful successful? It's not just working hard. There's a lot of people who work hard working. Hard is to me a sort of a necessary ingredient but it is not itself the secret sauce. You're not GonNa have success by just waking up at three thirty and working your brains off. You've you've ultimately have to have the ability to the part of a team and I think when at least when I did my PhD. At the University of Pittsburgh. I really learned to be a part of a team. I was surrounded by some of the smartest people I've ever met. I had some big doses of humility when I was interacting with some really world class people I felt really small But I found a way to sort of insert myself a really small way into some really significant can things that were happening from at that time research perspective and so I made myself -able to some really again. I didn't appreciate dicit time but made myself valuable to some really key leaders within the profession who are like one step removed from everyone else in the profession in. So Oh you know when I would stay in the lab till ten thirty eleven o'clock at night collecting data when all the other graduate students have gone home. That sort of pattern prompted did others to want to find opportunities for me to do other things and so I got involved. AP Ta and and various committees and really had the chance to start doing some teaching and continuing education and being a lab assistant for some really really prominent folks at the time and and I just took advantage of those opportunities not for any desire desire to get accolades but just it was feeding my desire to learn and one thing sort of led to another so I think it's ultimately a combination of hard work for sure that you've also so got to be able to function in the context of a team or you'll never accomplish anything you know significant ten year you have a lot block on on. I feel like right now. So you have a comment there. Yeah no I mean I I appreciate like Ryan said everything that you've accomplished mark you as well. I mean I I started burn both ends. The midnight oil between full-time Clinton working fulltime academia but seeing that the individuals like yourself started off in the same kind of format where you you dedicated a lot of your time to better advancement of yourself and and finding out what your what your passion was what. You're good at and trying to work through that I think it sort of resonates with me and I like I said I really appreciate that and then I gotta I gotTa follow up question real real quick for Mark John. So if you're in our shoes Brian in many issues in near accumulating this list of quote unquote leaders in the field. If you could sit down with one person pastor present and have dinner under with them within our profession who that person be who. I don't mind going I. This is somebody I actually was able to sit down and have dinner with so I don't know if this sort sort of even counts but Charles Giusto is someone who's practically the father of private practice back in the fifties having contracts independent contracts with hospitals was a real early leader in the profession. I think was you know was president of a PTA way back when was the founder of the foundation for for physical therapy or at least one of the one of the founders and so a true giant and it just really makes you appreciate that. The opportunities that we have have today are largely dependent upon those who paved the way going before us. And it's you know. Sometimes it's a cliche. You know that we stand on the shoulders shoulders of giants. But Wow when you actually interact with those giants and you have a chance to hear their stories. You realize it's not a cliche like there's just things we would not be able to do. Had people not gone before us and taken some incredible risks and so I remember having dinner with him shortly before for he passed away and he's looking at sort of what's happening in the profession now and the opportunities in private practice and the opportunities in academics and direct access and all the progress we've made and he's envious right because he's feeling like other people passed him up. You know and did more than he did. And I think that to to me is the hallmark of a leader in the profession. Is that when the people you lead actually go on to accomplish more than you did head then over the course of your lifetime. You've done your job as a leader. If the people that you're leading don't ultimately have bigger and better opportunities go sees those those opportunities and make you feel not feel small but Kinda look small relatively speaking. I'm not sure you've actually really done your job as a leader and I just I remember a really appreciating his perspective in just acknowledging that he simply didn't even have the same opportunity that we have but yet he helped create eight those opportunities at folks at least in our generation were able to take advantage of. That's awesome John and I think you know it's challenging. I think I have a hard time time pinpointing somebody but I think my choice and this is somebody I've had actually many many dinners with but Kinda right off John's point. I think Julie Whitman is somebody buddy who I just love spending time with and having dinner with because Julie to me just like John is to me our leaders that are true leaders who actually care about you as a human being and I think any person that you talk to WHO's interacted with Julie would say the same thing that she is just a genuine. Can you in good person. And she has taught me so much about being a good leader. That good leader isn't about just being competitive additive. A good leader isn't just about doing things that matter or making value in the world is it's about elevating people who are around you it's about challenging aging you. It's about telling you when you're not doing what you should be doing like when I failed my practical you know she was that for me all those areas and I can can say that I would not be where I am today if it wasn't for Julie because she opened up not just windows but she blasted the door open. Walls Open for me in many different ways and I would say John is done that Tim Flint has done. That and many other people have done that. But Julie really came alongside me early. On in my career specially going through fellowship training to really help me and give me some confidence and allow me to be involved in things that I never dreamed I would be able to be involved in you know. I've always always felt that she almost had a call arms for me now in my role within fellowship to do the same thing and I I really I hope you talked to people within the Belen College Program. I'm and ask them that. I was hopefully doing similar things. But that's my goal is to to strive to be like leaders. Who Look at you as a human I and ask themselves themselves? Like how can I make this person. Better in the ways they want to grow and maybe ways they never envisioned that they could grow and it's always a work in progress but man just talking to her and having you know those. Those pearls has been huge for me. I mean ten and I both went through residency together. We were a lot of her research as well as yours. John and Tim Flynn and a lot of the the names that we've talked about. And just amazing to see like how you guys have all worked together so much on these these common projects and an impacted our practice so so powerfully powerfully speaking personally my practice has changed by reading. Julie in your Sean Your Research. So I think that's awesome. I think has one of the goals and kind of objectives of our book is to expose again younger. Professionals and students to these awesome leaders thought leaders and people that have taken risks and kind of get their their perspective on life in Tim said earlier kind of what makes them tick so. This was awesome in this interview as ingrained in answers are will be hugely hugely valuable to to clinicians younger than ourselves. So and I mean even season clinicians Looking forward to continuing our interviews. Just WanNa say yeah. Thank you guys both for taking time with us today. An answering these thoughtfully in-intentionally. So thanks thank you anytime no happy to do it. Thanks for are reaching out and best of luck with the project. Thanks thank you guys. We hope you enjoyed the second part of her podcast with Tim and Brian. I want to thank both Tim. O'Brien and again for coming up with these questions and exploring these topics with both John and I work. They are doing to share. The wisdom from those within our profession is going to be awesome so be on the lookout for compiling with these different types of quotes in pearls of advice. I hope you guys listen to our podcast again and I look forward to our next conversation station here on the little podcast. Thanks for listening to the I. I am clinical podcast with Dr John. Childs and Dr Mark Sheppard for more information on the podcast guests and the latest in physical therapy visit visit. WWW DOT evidence in motion dot com slash blog. If you like this episode be sure to subscribe like rate in review on your favorite podcast directory.

Mark John Julie Whitman Brian Tim Dr John Childs Tim Flynn Mark Sheppard Tim Tim Reynolds private practice Japan Dr John Marcus Beatles Tim nizing Gutowski Dr Mark Shepherd NBN
Clinical Podcast: Cannabis within Healthcare | Jeff Konin

Evidence In Motion Clinical

30:23 min | 1 year ago

Clinical Podcast: Cannabis within Healthcare | Jeff Konin

"Welcome to the I am clinical podcast your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be are you ready. Let's go welcome to to the EM clinical podcasts where we talk with diverse individuals within the healthcare environment and beyond. I am joined today by my co host Dr John Childs today. We are talking with Dr Jeff Conan Jeff is a PT ATC by training and is currently the clinical professor and director of the doctor of Athletic Training Program at Florida International University Jeff has worked with a number of athletes all over the country. He's also been an uneducated for many years at several different institutions and just to give the listeners some context jeff and I go way back actually to when I was in undergraduate the program at James Madison University where Jeff really served as a mentor to me before I started pt schools so it's Great Jeff to have you back and to discuss an interesting interesting topic today so welcome to the show. Thank you mark John. It's a pleasure reenact especially with this case mark. Yeah awesome awesome to see how paths continuously tenuously Cross and gravy on the show and it's funny because I look back number at gm you and L. things change over the years. I remember when we were working together. You are really into the concussion kind of domain and and it's interesting to see now where your focus is within the topic of cannabis within healthcare of care so I'm really interested to see how did you get interested in this line of Education and interest so ironically it actually came from concussion and I was out west teaching a concussion workshop and one of the participants who is a physical therapists from San Francisco California Post posed a question and he said many of my patients smoke marijuana recreationally in. I'm curious what your thoughts are Jeff if I'm treating them and they have posted cussin' symptoms should I encourage them to stop smoking so that I can have a better accurate assessment of their memory Marie perhaps of their gaze of their balance and I thought to myself never had to come up in a question before but sure it made logical sense to me. You want to do everything you can answer. Get good accurate assessment thought I was off the hook there but he asked are two of his question and the question was would about those who don't smoke and they have post cussin' symptoms that relate to migraines anxiety difficulty falling staying asleep he said should I encourage them him to try a little bit of cannabis in the field. I wasn't as comfortable answering that question and I really had no foundational education background to answer the question so I promise it when I got back home I would look this up summit reconnect with him and I became fascinated and I started to look at literature so I shot him a note back. I wrote what a blog about this and the more I read the more I became more fascinated. I started getting more questions about it. Then dawned on me that medicinal marijuana marijuana is legal in thirty three states and CD cannabis is now becoming more and more accessible throughout this country and there's another world out there where it's being used so I just really got excited and fascinated to learn about this and learn about how it works and what the differences excellent and most importantly how does it impact what we do from a clinical care perspective of our patients and one thing led to another. I put in a couple of proposals to speak on the topic. Jordan have been accepted now. I'm receiving invitations to speak on the topic and educator on this topic. My goal is is to help the practitioner understand how this fits into the realm of care. If in fact it does at all that's interesting Jeff. I mean it's kind of a hot topic topic here you know candidates within healthcare and I'm kind of wondering have you had any like criticism of getting into this line within our profession and maybe the realm home of course I had criticism starting in my house for my family and so what has gotten into you. What are you doing. What are you up to and and when I talk to our colleagues majority of them are a little bit skeptical aunt. What I simply say is. Let me chat with you for about ten minutes in all all. I'M GONNA do is share with you. How I got into this and what I'm learning about it and trying to figure out what's happening around us because quite frankly it's his big elephant the room and most of only know what we know from our perceptions of growing up from our hearsay. CETERA ET CETERA and there's an awful lot of aces out there in fact you know what's really interesting to me is the population that seems the most interested in this. Are The elderly folks there on fixed incomes but they're really tired of using a dozen plus pills that are very expensive and they're talking to their neighbors. They're using Google in their figuring hang out ways to try things in granted. They're certainly placebo effects a lot of what we do but it can't be coincidence that so many of them are saying. I I feel better and I've been trying all these other approaches and I found something that's helped me so while an N. of one is really not high level. Oh evidence a lot of ones that you hear over and over and over again just had me thinking about what is actually happy and surely I'm not the only one in and yes I still have some critics and again. I'm not really promoting the use of any form of cannabis whether it be t h C C CBD ham boils. I'm educating so people understand why patients are looking into this and what the research shows and how we need to get involved in the biggest concern I have if we turn a blind eye to what's around us if our patients come in to clinical setting and save you a marker John. What do you think about CBD if you don't know or your answer is completely against it it my gut senses. Dave already looked into it they may in fact already using it and this is an issue of them with your trust and if they don't feel like corre board or you don't know enough about it. They're not going to tell you what they're doing. They're going to go back and Google Sophomore and asked to France neighbors and I think that it's important that we understand stand the light which we can speak to that. Here's the facts that are out there. In fact let's be proactive and let's have patient education information that we can provide to them and say a here's what you should know about this unhappy to answer your questions. If I don't know the answer I'll look it up and I'll get back with you but think about this. If you are commuting somewhat you WanNa know what medications are on. You want to know if they're seeing other practitioners and if you don't have this knowledge because if they're taking cannabis in a medicinal format they're seeking different physician more than likely so now they're getting care from multiple physicians. We know so. I think it's a trust issue. I think it's also an issue of our quality of care to have a comprehensive background knowing everything that can impact the patient's illness or injury that we're managing Jeff. This is is a really timely. I mean as an entrepreneur get pitched. That seemed like a day goes by something doesn't come across some deal network on investing in some cannabis cannabis related business so clearly this is an emerging area and even within our own profession. We're starting to talk about within physical therapy educational circles all about whether cannabis education should be included in the curriculum and as you probably know jeff from being actively involved in this discussion. The House of delegates actually considered a motion at the next meeting in Chicago for Abtei to develop materials physical therapists could use as resources for educating patients since about you know the use of cannabis related to healthcare now that motion I think was narrowly defeated but nonetheless at least the first time to my knowledge. I think especially on the docket so I guess my question is you know as you look across sort of healthcare and you'll look into. Let's say the physical therapy profession or athletic training. Where are we in this discussion. Are we progressive in the fact that we even had this on the docket or in other healthcare professions. They're widely talking about this and we're way behind as Rehab professionals and just give me your thoughts on sort of where we are in thinking about this issue in terms of being ahead or behind the curve. That's a great question and John. I was actually in the Gallery in Chicago when the discussion slash debate occurred in the house of delegates this was RC for C. Sixty seven dash nineteen in an actually did pass past fifty one to forty nine and it was really interesting dialogue back and fourth. I have to tell you I had to be restrained in this gallery because the motion wasn't about advocating at behalf again it was about putting a worker together to develop resources for members for cannabis. I was really mind boggled why we would be opposed to that and honestly as I listened. He was like Oh Qasem of WANNA travel speak about this individuals practicing in states where there's significant get access to this were at supports and said he look. It's not coming year. I see this with patients every day. It would be really really a fault if we had a body of our membership helped together. All the resources and then others were in states where perhaps they don't see this much or perhaps perhaps her personal beliefs are against this fought against it and so it came to a really narrow vote but it wants proof but in discussions afterwards. I had certain people it did feel like even though it was approved it was going to be a priority our agenda of developing these resources anytime zip. I have had only two of my proposals to speak on this topic not accepted what was for the upcoming combined sections meeting and what was for the upcoming Educational Leadership Conference both physical therapy now. Maybe they weren't well written abstracts attracts. Maybe they didn't fit into the theme of the meetings. I don't know but your question about where this fits into. The curriculum is a really fascinating one for me. It can it at the very beginning as we try to understand. The physiology anatomy of the Endo can happen weight system which is not very well studied and really is all a band around since the early nineties at guessing most of us went to school with a number of anatomy and physiology classes and don't remember sea. Is that our books or studying. I think this could possibly fit into physical agents. You know this could be topical is could be adjusted. Tincture is lots of different ways to put this in your body. I think perhaps maybe most importantly it can fit in the ethical legal classes that we have a lot of different places where this falls across the curriculum and I think it's a great I talked to out of disgust not to take over the curriculum out to dominate the curriculum but what you talk about learning across curve this happened at the very beginning that one's education all the way into their clock a practice because it's real and it's here and so I think when you pose the question are we behind. I think we're behind hind in understanding and educating in one of the reasons I was supportive of this is that it's not really easy to find good quality resources and the argument made against this. RC passing was that we are all individually capable of doing our own research and sharing this education with our patients. The argument for for was the SE. Les Speak With one voice. Let's have common factual educational materials. Perhaps educational links that we can send people to that are being updated because this is a fast in fact. It's the fastest growing industry you mentioned. Entra parochialism fastest growing industry United States and there are universities Anna Community College. I just learned for example Miami Dade Community College. They are starting full degrees in the concept of cannabis degroot gooseberries. You can specialize in the cultivation of agriculture of the plant itself you can focus into the healthcare setting you can focus into the business setting setting whether it be the tax laws or banking industries and so to a certain extent. Yes we are way behind but with that said. I'm not not an advocate of rushing and getting behind this one hundred percent because I think if we go fast too soon we WANNA be obviously be careful of our credibility. Which is why live is fully support factual information coming out with what voice from an association. That's good historical perspective there you know on where parts fit in within the really physical therapy and you know. I like your thoughts about how this could fit into the curriculum because I think you know as educator Educator Myself. You know there's always this idea behind curricular creep. You know I it always seems every every year. Isn't it that we're always always like this would be great to add in you. Just start getting almost like bombarded with areas and topics that can be added in whether it be dry needling or this the topic. We're talking about now or something else you know. It's just it always seems like it's something and so it's nice to hear that you don't feel like you have to basically rewrite your curriculum to fit this in because obviously it's a part of many different systems that cannabis you know relates to infects so it makes complete sense that it doesn't have to be a major component on it but we need something in order to start learning about it otherwise we're like you said patients are. GonNa come in and we're going to have our own bias or perceptions or things along those lines so just good points to bring up in curricular creep is real and it doesn't unfortunately a company things that we remove typically so we're constantly putting more and more into the curriculum as of now a two hour presentation can't really provide a good solid foundation for clinicians to understand doc what it is. It's happening around now. We can expand that to a full day workshop and really have people get caught up to speed as it relates to the laws yes for example because as I travel around and speak to individuals of different states also tailor the presentation to their state however it's important to understand understand that regardless of your own state law you need to be aware of your surroundings straight loss because if individual can travel two hours across the lion and have a better opportunity to access with looking looking for certainly they will so. It's really important to know even if it's not legal in any form in Iran state in their pockets of the country where it's not it will be naturally. We're seeing some really interesting things everywhere. State laws are overriding federal laws and I think one of the interesting things is going to be the next national election cycle e costs. Let me give you greg's apple. I alluded earlier to how the largest population that's pushing his seems to be the senior citizens in Florida where I am in the last election in two thousand sixteen the President won the state of Florida by about one hundred twenty or so thousand votes vote's not a lot of votes right soon after that our governor was elected in our commissioner of agriculture was elected both on on a grow cannabis platform there are now three hundred fifty or so thousand medical marijuana carb users Florida Florida in it is estimated by the next election. There will be about a half a million. If you're a anti cannabis running for president candidate handed it you will not with the State of Florida which is a swing state in a national election. That's how powerful this issue is right now. Just in this state the state you're seeing similar. Events of other states where banking laws are changing industry is changing in. There's job creation as a resulted this it really what's happening is this has moved so fast that the state government are simply trying to figure out ways to regulate number want which is a good idea from safety perspective but in all honesty exit number two because what's really interesting in this business right now is technically a majority of it is still illegal. You cannot markets for example. THC It's still a schedule want illegal drug in the United States. However are you still pay taxes so you're allowed to run a business but this'll wanting allowed to have a dispensary you cannot take tax write offs S. You cannot deposit your money in a bank because they are. FDIC shirt and they can't take illegal drug money but you pay taxes to the government so it's like the wild wild west right out every aspect of this but we can't slow this down. This is moving at a speed unlike anything anything we have ever seen before and ultimately the laws will catch up federal regulation will standardize a lot of what we see at which will be faced with just a slightly different statute in each state but the neighboring states if they're equivalent of their statutes you will see people flock from one state to the other and we're seeing saying that now with Florida. I'm sure Branson Arizona. We see a lot of snowbirds that come down and they're trying to figure out if you will how they can access some more reciprocity so that they can do whatever they do. In the state. They're coming from at just transferred across state lines or Florida truly fascinating to hear that perspective give in to switch gears a little bit here Jeff. You know I've heard these different terms being used. I mean you hear about CBD. There's hemp medical marijuana and obviously recreational marijuana. What are the differences between these because I think it's important. It seems like it's important to know what that is right. That's a great question so so I guess to start is understand that this is a plant we're talking about. It's not a drug unless it's made separately as an a synthetic for but it's an actual plant in the plant is grown in many places it can be grown in Colombia can be grown up Portland Oregon in so the plant a- as it grows can come in different force and what are the forms that engrossing is CD and CD is a non you've four component of the plant and the other side you'll see is the thc or the virtuous marijuana which does have the euphoric effect act and what are the greatest concerns about the THC nowadays particularly from a recreational perspective is that it's a lot stronger than it used to be so if you go back into the sixties seventies in advocates say well. There's really no reason why this can't be legal adult recreational use. We used to do it way back. Then Cetera et Cetera or the concerns medically right now is that the growth of the THC in the plant is significantly higher than ever used to be almost three times higher than it was huck aids ago itself itself is actually THC however it's an incredibly low dosage of TAC's point three percent point three percent of of marijuana's count it so it doesn't have a thc in it to create a fork effect in fact the farm bill that was passed in December of this past year was passed because hemp is at natural plant product that is used around the world at any other countries to develop things like from industrial-style paper various forms of Colognes at lotions rope natural gases and so what we found here United States was at there's there's an argument to separate him out of the rest of the plant particularly out of the THC capone and use that to create jobs allow allow farmers to have opportunities to grow and export these products in why this became where it is today was decades ago through the Nixon mm-hmm and the Reagan administrations there was an original we call drugs schedule classification in the classification marijuana as the global term was scheduled in the first classification schedule one that was alongside of heroin and LSD in so one of the reasons why we don't have a lot of good studies on this right now is we're not allowed to study marijuana just like we're not allowed to study. LSD or a heroin. It's not likely it's going to pass an institutional review. Board objects can write whatever the government has created pathway for this at so through a number of different applications fair amount of money to apply for these applications and a couple of years you can get approval through the government to you perform your studies if thc is involved with a significant amount of restrictions and typically it limited forms of the type of thc they have and and again as I mentioned if they have one grow planters university in this country that has federally approved grow plants and that's the issue that we usually studies but the ground in Mississippi versus Portland Oregon versus Columbia is completely different in that's a really important point because if somebody asked you this where are patients typically say quite frankly. This is what a lot physical therapist asked me to is. CBD good does it work that sequence me asking you do you like micro beer tastes snack many different products and there's actually studies that have shown where individuals have gone up and down the streets of communities where they've been selling cbd various stores and they pull those out and go testament elapsed they find out there's actually no. CB Dan those products whatsoever and you can see that type of situation all the way to everything from CBD infused beer to obviously CBD gummy as an out as their golf courses in Canada that encourage you to come there so that you can enjoy CBD at each hole Ashok. Our various parts of the country is a significant arguing a recruitment tool in early. One of the biggest opposition to this industry streep was the beer industry but they maxi not one eighty and now there are some of the biggest investors because they were concerned that the people found usage Dan either recreational or St D. that they would stay all the burs so instead they found a match if you will and now you see microbreweries with CBD coming up all over the country Jeff. This is really just a fascinating discussion and I know one. That'll be super interesting for our listeners and an issue that you know on kind of the leading edge of where we're heading in healthcare as we move towards a close I wanNA throw one little SORTA curveball and maybe take us back to quote unquote more traditional sort of Rehab but you obviously have a dual role of having been very actively involved in both physical therapy education an and athletic training education in dual credential than so you've seen over the many years the sort of the rivalries scope of practice issues all the sort of been fighting whatever you WANNA call it between tease. ATC's and you know most recently I think it was at the next conference the President of the Athletic Training Association as well as Sharon done the president of Ta got together and it seems that our professions are finally starting to realize we're not each other's enemies but perhaps we're actually colleagues in this whole pursuit of a less invasive non-surgical less Pharma less imaging sort of future of healthcare both of which pt and athletic trainers owners. I think fit perfectly into that strategy so my question is what are your thoughts on this. What I think is a renewed sense of collaboration between our professions and where. Where do you see it headed going forward? Why Gye certainly hope you're right on that. This isn't New Era Tori Lindley came out to Chicago and shared a stage took Sharon done and then Sharon actually came out to Las Vegas for the athletic training and shared a stage with Tori. I think on the national level the leaders are on the Saint Age and what's really going to be important is that at the state and local levels we see similar relationships developing in many places they already are developed upped but from a political standpoint I served for three years many years ago as a liaison between two organizations nationally and I probably a las a fair amount of friends from both sides because we were at each other's throats at that point in time in the truth of the mattress scope of practice perspective you know if you look at Asu the AP Ta for example the percentage of membership that actually work in the sport setting it overlap with athlete trainees what they do. It's not a large percentage pitch so many physical therapists that are active are not even aware of this. They don't even know who or what athletic trainers aren't what they do. This is a non issue for them but there's so so much that we can do together to share it particularly nowadays whether it relates from the beginning of the classroom setting with interprofessional education alway to interpersonal actors is an teamwork in the settings that I've been. It's always been a hallmark for me for everybody to work together and I really hope we're seeing a renewed relationship here. Because many any of us are either Dole credential or were very good friends with each other. We do a lot of similar things together both of the job setting anything outside the job setting and so I'm excited to see that it would be really nice. If we could show the patients don't care they don't understand but if we could show the rest of our healthcare communities that here's a way to work together other including at the lights statute level. Would we each these things to change. You know I know down here in Florida. Physical therapists are not able to drive Adl and it it was because of the acupuncture board in fact that fought that well you know it'd be nice to have support with each other there and have another organization stand behind you to see positive legislation legislation. Go through in an effort to improve your practice so I'm glad you brought that up. I'm certainly an advocate behind those relationships it all religions for that matter. I mean charcoal is to get the patient better. There are certain things that we do that none of us all in a technique if you will but we share some commonalities this is a great opportunity charity right out with two basic leaders to do away and stuff to the rest of us to follow a great perspective great wrap up there. Jeff and thanks again for your time today a day just going through what you know about cannabis and how it relates to health care particular in our kind of backyard with the Rehab professionals but we look forward to hopefully having you back on the show soon and thanks again for everything. Thank you gentlemen. I really appreciate the time of the opportunity great to have you jeff. Wow what a great episode with Dr Jeff Cohen who is a dual credentialed physical therapist athletic trainer and would really had a good time I think uncovering a new very progressive topic on the area of cannabis education it certainly being discussed within healthcare in general and weather and win it should be the included in healthcare education specifically we talked about the physical therapy profession and the recent passing albeit narrowly of the RC the motion to develop resources for AP TA to develop resources that therapists can use an educating their patients about medical. Marijuana and cannabis use discussed a lot of the You know misconceptions you know in any new area whether it's a new treatment technique or something like marijuana that has been sort of previously illegal well in many states and now becoming more legal and mainstream in just all the truth fact fiction around its use in its potential benefits and healthcare so jeff is certainly a very valuable valuable resource and I know our listeners will enjoy connecting with him online about the use of of cannabis in healthcare so as always you can find us on the blog the evidence in motion blog at EAE MTM is our social media handle whether it be facebook instagram or twitter we always appreciate state your feedback and mark and I are always open to ideas about a guest that we might have on the show so without further do thanks as always for listening and we look forward worked to having you again on the show thanks for listening to the EM clinical podcast ast with Dr John Childs and Dr Mark Sheppard for more information on the podcast guests and the latest and physical therapy visit. WWW W. dot evidence in motion dot com slash blog. If you like this episode be sure to subscribe like rate and review on your favorite podcast directory.

cannabis Dr Jeff Conan Jeff marijuana Florida United States Dr John Childs Google Jeff mark John John Florida International Universi President gm Chicago Portland James Madison University Oregon
Clinical Podcast: Serving in the US Public Health Service | Dr. Steven Spoonemore

Evidence In Motion Clinical

29:19 min | 1 year ago

Clinical Podcast: Serving in the US Public Health Service | Dr. Steven Spoonemore

"Welcome to the I am clinical podcast your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to be. Are you ready. Let's go Thanks for tuning into this episode of the clinical podcasts where we talk with diverse individuals within the healthcare clinical environment and beyond today. I'll be joined by Dr Steve Spoon Moore who is a physical therapist for the United States Public Health Service his journey and experiences as a PT are very unique and we ears thrilled Davenport of her show. Steve comes to us today from Alaska where it's Brighton earlier maybe dark and early. Steve and I'm willing to say it's a bit colder where you are than where I. Am is that fair to say it probably so it is definitely Brighton early. Man It is summertime in Alaska. It's lots and lots of sunshine share so so is it like pretty much like midday like in the regular states or like how how bright is it out there right now at six thirty in the morning. You know it's actually probably equivalent to what it would be other places. The son's been up for quite a while and it's it's nice and bright looking out the window with the the green leaves on the trees as partly cloudy outside side looks like a beautiful day. That's great to hear and Steve. I'm really excited for this show. Because every time we kinda hang out I always have just sucked into the stories you have and and I think your journey to where you are. Now is just so interesting. I I love hearing about it. So can you tell the listeners about your journey and what leads you to really lean towards the US public health services yeah sure so me just put up their first of all I am on active duty with the United States Public Health Service and so as such comments and things we discussed today are my opinion my opinion only they do not reflect the United States Public Health Service the Indian Health Service where I currently you work or the Southcentral Foundation the organization assigned to currently they don't represent the views of the Surgeon General Lor of anyone else there my own but that being said happy to share my my journey in back in two thousand in eight I went to a conference. APD Conference San Antonio Texas and my wife wife and I were walking through the gallery at lunchtime in saw big sign in the corner that said student loan repayment that was it that was it and so I said Hey let's go check that out and we met an individual who has made the booth there was doing some recruiting for the Indian Health Service and found out about the student loan repayment opportunity that they have which is breath a nominal and that was kind of the carrot that got us in that individual ended up someone who became a mentor of Mine Joe Strengths is his name he's a captain with US Public Health Service currently so I actually met him in person and as we begin to talk realized that there was some opportunities that I was interested in learning about exploring he added there was a vacancy open their ship rock to Mexico where he was located and so we applied for a commission came on board but the ship rock and was able to work under the tutelage and mentorship of Joe for quite a while and learning about his story and learning about the journey he went through through Fellowship through the Army Baylor Program really piqued my interest led me towards the fellowship during the ultimate we went through with with evidence emotion yeah. It's you know common theme on the show. We have mentorship in how that's shaped a lot of where we've come so Steve. Let me ask you a little bit more about the the student loan aspect of what got you into. US public health services like WHOA. How did that work out in like why was it so enticing hi sue for you very frugal and we came out of school with some debt and we're very interested in in eliminating repaying that debt it quickly the Indian Health Service and I believe these numbers are accurate but I would ask anyone. WHO's listened interested to look further into it and that's? IHS Dot Gov you can look up the webpage there and find the student loan repayment program but for a two year commitment you get approximately eighteen thousand dollars each year offered to your our commitment and the opportunity to continue on with that you send them the letter saying that you would like to continue to serve in the capacity where you are and if they agree agree than you can continue to extend that so over the course of a few years ago we were forced to have all of our student loan debt repaid and now we have no debt bow. That's that's amazing and you know. It's interesting too because you've you've worked in some pretty cool areas here. You are in Alaska and like you were stating earlier. Are you work for Indian. Health Services and I imagine in this is my perception is that these experiences working with these populations has really had to call oh on cultural cultural competence. So how has that played a role in your interactions when it comes to you know health behavior change or really just working king as a physical therapist working with the native American people and now with the Alaskan natives is I consider privilege that I have. I've personally learned a lot lot from my interactions with learning about the culture and the history that they have and you really have some matter of respect in and understanding that where I came from uh-huh and my background and my belief systems may be different than some of the individuals that I work with and so coming to understand their point of view understanding their beliefs and being sensitive to those is paramount in building that therapeutic alliance that we speak so much Shabazz as physical therapists right. It's really interesting so so what we're maybe some some things that you have learned in your process of working through these different types of practice settings. You know where their challenges or their like Major. Aha moments where you're like man. This is really helped me connect with my patient. He shouldn't here in front of me. You know there's been both I think one challenge that we face across the board within our healthcare system is the time based constraints aints that we put out there that are put out there the whether it's the insurance or simply the nature of the system in which working it's really coming to get to know people and to to get to know someone takes time and you have to allow people the opportunity to tell their story and so those those are challenging when you have a thirty minute appointment et slot or fifteen minute visit in a primary care setting that to really be able to understand someone's story understand their perspective where they're coming from it can be a challenge in that short amount of time and so you have to what I've found is really learn win. The tools that I have in the models is that you know that I've learned as a manual therapist when I need to go deep with that and when I need to pause and just sit back and listen and let the story unraveling this the story unravels then be able to pick up on one element and just work one element that day and be able to come back and get breast of the story in in future visits love that thought there you know where you you're doing everything that's needed no more and in sometimes our best therapy is is to listen and not just here but actually listen to what the patient is saying so that that really resonates with me and I'm wondering to you know I picture and I've heard from other therapists who work in Alaska. Obviously it's a you know very large area of land up there and is rural in many many areas in Alaska Alaska. Are you having patients who who fly in or come to town for a visit and are gone for a month. How do you structure around around that kind of approach when it comes to you know changing behavior and changing someone symptoms when they're only coming in. Maybe sporadically yeah and you know what's interesting working in Anchorage where I'm at now. I actually see much less of that than I did. When I worked on in ship rock for example which was was a little more remote when it came to people being able to access the clinic Intra leakier get. We do get folks that do fly in. They may be seen nobody by the Orthopedic Clinic and then you can see them for one day. You see them for two days. There there actually is a location where the patients have patient. Housing Center hotel basically right right on campus Liz yeah so the fly people in they have the primary care if they need to see the specialist we'll see them. They'll be there for few days. So are your often tap the Hey. What can you do to help guide this person before they go back to their village and then when they fly back in for their next follow up than you would? You would see them in follow up. So how do you interact with that is a lot of it is education. It's empowering the person to know what to look for what the typical progression would be helped trouble shoot. If something didn't go down the road that you expect it to go. What should they do about it giving them a lifeline your phone number and email address way to reach out to contact you contact the primary care physician often. There's no there's a small walk clinic. Perhaps in in their village where there's there's someone that comes into provide some interim care to most of these villages as as my understanding at least I'm still new enough up here that I'm learning all of the INS and outs of it but so I think that's that's the bottom line is it's a lot about education and about empowering people to know what to expect and how to go about small changes. I have an opportunity. That's actually going to open up by in June that I'll be working part time mm-hmm in our primary care sitting here at Southcentral Foundation which is we serve a population of about sixty thousand native Alaskans and I'll be working directly flee in primary care role but also as part of that interdisciplinary pain team. That's being created inform. We have a physiologist we have pain psychologist while physical therapists onboard have access to the pharmacist and to our social workers said to the other mental health and behavioral health components of the team and and we're still creating informed understand exactly how that's GonNa work but so have the opportunity to work forward in that team and be able to provide the individuals with chronic persistent persistent pain. You know some direct access to care and then worked also directly in the primary care. We did a pilot program. Last year we bought physical therapist episode over to work directly in that primary care setting and rather than being the city with a patient came in all you're going to see the physical therapist directly it still was that they touch base with the primary care provider in the primary care provider within tag you to come see them when they ask you to see them and then they would come in and see the person on the back end and at first. I was a little unsure thought you know I. I guess this is a acute injury. I feel confident that I like do it. What I've come to really respect about the way south central is approaching things is it maintains that continuity of care and it allows the the patients really you build a rapport with the primary care provider and have that entity be in place which I think is something that we're losing using integrator healthcare system is so few people have their doctor knows they have that point person that they can really call upon to manage take care and so. I think that's something that I'm excited about being here southcentral foundation working with them in within that kind of model. which is a little different in the past? It's been more. My mindset has been a little bit more of af it. Has You know this muscular-skeletal thing and then I want to be the person to see them. Directed succeed and I and I still believe that that's appropriate for us. We need to be there but at the same time we need a balance. The idea of helping people people have empowerment for their overall care and that comes through having that having a primary care provider that can manage quarterback the team so whatever the situation relation the scenario is where people work. I would just encourage us to as we look for with direct access as we look at you know making sure that we have a greater footprint in the healthcare care system that we don't do so at the detriment of of mismanaging the opportunity for people to really have a hall holistic of Hope Person Centered around them very well said and I think that's so important you know traditionally you think of some coming into your clinic at least weekly or twice a week he can it kind of has that traditional plan of care that you can implement and you can work steadily through that but your mind has to shift in these individuals Joel's. I imagine you know where you're where you're like. Look I'm immersed here in Anchorage for for two days or three days and then I gotta go back to my village and provide for for my family and and the the folks that I live with and be back for another month or maybe for another year so I love to hear how you're empowering people all and a lot of what you do it sounds like Steve is is a lot of just educating the patient on you know what they can do to to really increase their self efficacy and do you find that you're you're really having to create a lot of buy in at these visits is to have these individuals understand you know the importance of basically treating themselves versus relying on someone else to do something to them. Yeah that's a great question on finding here and again. This is a relatively limited number of individuals that I've worked with here in that in that capacity passively that often they're the folks who come to the clinic at least are pretty well on that pathway already so when you look at that readiness for change scale they're already already deciding that they are going to do something about it and my opinion is. I think that the Alaskan people people who live in Alaska are resourceful. I think you have to be with the environment. That's yeah I can only so yeah. I think that I would say in general that the folks are pretty well motivated you know and they're looking looking for ways to make things work and so if you can come to understand what they're living environment is like and what resources they do have and that's the fun thing about it that is you get to be creative. Just I will what what do you have and what is life like out. There will tell me about it. Let's see a weakened due to trouble. Shoot shoot things. That might be challenging for you and then. How can we create some really cool ways for you to do strength training. How can we get some some conditioning in within the the environment. Did you have yeah. I think that's what makes our job so much fun is that you can really dive in and almost experience at least mentally what your patient concer- are going through on a daily basis and I know some of my favorite cases. I'll deal with are ones that are unique and you kind of have to problem solve to figure out how to get your goals. Kohl's implemented in a way that will actually drive behavior change in part of that is making it easy right and so you know you can't you can't necessarily say we'll go to a gym when there's you you know not jim for one hundred miles two hundred miles away and I just love how you're using those problem solving skills that I would imagine kind of keeps. You invigorated when again you you. You have these people maybe on a rare basis but I would argue. You're probably doing it on a fair amount. If not everybody who comes in Oh absolutely yeah I mean every everybody that comes in. It's it's it's troubleshooting. It's it's coming up with unique in fun ways to make things work. I was just thinking about a gentleman that WHO's he works construction in an offsite area and need to do some conditioning you know and so he's really moving in a work camp. Essentially I mean they've. They've got a tent out there and they're. They're building this airport that they're building the remote area and so I need to do some condition. We needed to get your strong. While would you have laying around. We've got a lot of lumber laying around. There's certainly lots of big rocks. There's there's hammers and heavy duty things so so we started figuring out some you'll modified cross fit type of workouts where he could get some heavy reps in to really get the a strength back that he needs to build up so yeah. It's really cool to hear so if we switch gears a bit and your experience working king native American health services and then also being in Alaska I imagine that as part of the US public health services there's a large kind of primary primary care aspect of your job whether you're you're providing it as a therapist yourself or your integrated in with team so can you can you talk to some of what your practice setting looks like and how you're working as an inter professional team or even just providing primary care yourself as a therapist yeah and there's there's quite a bit of variability. I believe throughout the officers in the US public health service in the various areas where they're assigned. We work work primarily within the Indian Health Service Federal Bureau of Prisons. We have officers detailed within the Department of Defense working within the traumatic brain injury clinics that are there we have some folks at the National Institute of Health that that are in that realm and then there are other sprinkled throughout other agencies typically not patient care settings it so the Yumei experience comes more with the Indian Health Service and I've I've worked a couple of different avenues there one where I was in Arizona before it came up here and I was very small rural clinic sort of population of about three thousand people with two primary care providers three pharmacists assists some nurses alab myself I we had no imaging capabilities and so I really became the default oh the defect the musculoskeletal expert and so anybody that came in the clinic with musculoskeletal needs than I saw them and it may be that I saw them first and then they saw the the the provider they saw the provided they saw me it was kind of back and forth a little bit but that was my role and was an aide in clinical decision making it if we needed to stabilize something that looked like acute fracture and I would split it and we'd send him up for imaging or help determine if we needed to get imaging for something but through furrows into get them down for for other things so had an opportunity to do some of that it really be on the front lines and when I did that I came away with much greater respect for our primary care providers riders and for those working in the Emergency Department of urgent care that those clinical scenarios those folks that come through the clinic that you may be see as an outpatient referral basis Jason few days later that looks so cut and dry. It's it's a rotator cuff ten anthony or It's a knee sprain that they look really clean and dry a a few days later that first initial visit they're not always so straightforward and the waters the water's Muddier and I have a much greater respect for for for those working on that front line in the primary care setting and it's given me a greater appreciation had gotten me to dive deeper into that medical screening the differential diagnosis and being able to ensure that you're not missing something else that may be presenting that more common musculoskeletal presentation that we typically see yeah and speaking of interprofessional work. I know you've been involved with an opioid advisory committee within the US Public Health Services. Can you tell us a bit about what you're doing in that regard yes so we had a white paper that was done to the US a surgeon general behalf of the Therapist Professional Advisory Committee. That was well received. I believe in actually that that white paper is undergone some additional in revision and just been accepted for publication in the Journal of pain management as we look look forward to that coming out being able to share that with everyone but our our opinions and views is our as a as rehabilitation therapists in in how we can be helped for for the opioid problem that's creating and what were or some of the recommendations that you you put forward. was there anything that kind of were major highlights in that white paper. I wish I had a copy of sitting in front of me but the the main recommendations were really one of the things that we we identified was the lack of education within our healthcare system for our healthcare providers providers regarding pain and you know the average medical student. I believe it was received about one day equivalent what education or number seven hours something of that nature on what paint isn't mechanisms for pain and that was centered on the the gate control control theory and there's very little if any of what the International Association for pain identified as the best resources and recommendations for understanding pain there was very little to any of that curriculum that's within our medical schools within the training for primary care providers and then you take that downhill really transcends into other other healthcare providers as well so one of our recommendations was that we need to revamp the way reteach our healthcare professionals and subsequently how do we teach people. How do we teach teach patients about pain. What it is some other recommendations. Were you know bringing rehabilitation therapists physical therapists occupational therapists more directly in bringing us up that we felt that were very under utilized and we look the vast number of individuals with musculoskeletal type complaints plane or even dealing with chronic pain that may not be of that musculoskeletal nature took typically. You would think of where physical occupational therapist would get involved. There are still so many avenues and aspects that we could interface in assists with that patient so the third another recommendation we had was really looking big picture every `imbursement sements structures and the way that we reimburse for services and in our current healthcare system doesn't bode well for this new bio psycho oh social model and patient centered care yeah no don't even get started on my soapbox there but it's it's great to to see you at the seat at the table if you will in regard to that especially within within the US public health services and having that kind of go to the the surgeon general for for their you're kind of oversee and oversight and review that's very awesome to hear so Steve I kind of want to work on our closing question here and and and a lot of times when we when we think about wrapping up here I like to think of questions that are reflective or at least futuristic in nature so my my question here is surrounding this idea that being in the US public health services allows you obviously to take part in unique experiences as a physical Zigal therapist and I know just from working with you that you can be deployed to natural disaster areas on a moment's notice so what has been one experience variance or several experiences through the US public health services that is memorable to you or has been a lasting kind of experience against that has had you think about it often. That's a request pause for just a moment in what yeah take take. Take your time to Steve. If you need to just to think through something I would say two things kind of stand out one well three. Perhaps one one in a while ago two thousand ten I believe are the team that I deployed with had a training mission in Pineville Kentucky where we partner with another group called remote area medical and we provide we ran a clinic essentially for the weekend providing a basic medical care dental care their case management services to a number of individuals in that area of the country which the Pike Phil Kentucky is very low socio economic area in southern South Eastern Kentucky belief and so anyway we were there came up for week did some training as a team in put this massive clinic we treated thousands thousands of people in in two days and it was really impressive to see partnered with this other group that does this quite often just to learn how effective and how much we could get done in a short period of Time with a Well oiled machine and that's that was a great experience. I spent the first first day at you know my role. In in the deployment is actually as a logistics officer primarily and so I'm not necessarily providing patient care our but I'm behind the scenes awesome making sure that we have the equipment and supplies necessary for the team that that is providing care to do their job and so I spent the first day really in a non patient care role manning taking taking care of things and then the second day I found out one or the other therapists there was actually doing some some patient care and I ask permission. Would it be okay if I were to to to move. Laterally in the request became back down and said yes. You can be welcome to join him tomorrow. We won't need you to do it. You're doing the day before and so I did. I got to do you. The patient care the next day and that was a lot of fun. I really enjoyed that doing just basic musculoskeletal triage essentially for people coming through and a lot of what I do on a day-to-day basis now just providing fight indication of ice to people knowing that I was going to see them one time but giving them some sort of education some sort of advice some suggestions on how they could work through situations that they're dealing with the chronic low back pain the chronic knee osteoarthritis complaints in the benefits of stain moving. Stay active etc things. It's like that so that's that was an experience that I've I've reflect back on from time to time that I really enjoyed that training really got me interested in continuing to be part of our our our deployments with US Public Health Service. I did have the opportunity to deploy for Hurricane Maria to Puerto Rico and spent three weeks down there. You're in new witness firsthand some of the devastation that occurred there and again. I wasn't in a patient care role. I was in logistics role so my my job was to travel around to the different sites across the country and provide the supplies that they needed and then really pack up and move the warehouse. Get things move in and out of the warehouse else but I had opportunity to hear the stories of the providers that were there and see the very positive impact that we were able to make and be able to help how people get back on track and start to build themselves back up after that IMF devastating hurricane came through yeah and it's just it's cool to hear that because I think you know as as you know. There's not many opportunities for kind of similar experiences in just your everyday kind of health setting as a therapist in it's just need to be able to provide ride services like that to those in need and you know as a commissioned officer be able to you know have a leadership role. Maybe not so much in patient care but still providing eating useful resources to help in in times of need so I think it just goes to show the the breath of what you're able to do being within the US public health services so really appreciate your insights today. Steve and and and just allowing us a glimpse into your journey as well as your day to day life and some of your past experiences through through your careers p. t. so thanks again mark you can see the diverse patient population relation inexperienced doctor. Steve Spoon more has encountered in his role as a P. T. in the US public health services from getting his student loans paid off providing care here in rural areas and travelling to the far reaches of our country. You can see the breath of what his job encounters if you like this episode be sure to give us a review and follow blow us on the socials at am team and as always thanks again for listening to the clinical podcast thanks for listening to the EM clinical podcast with Dr John Childs and Dr Mark Sheppard for more information mation on the podcast guests and the latest in physical therapy visit. WWW DOT evidence in motion dot com slash blog aw if you like this episode be sure to subscribe like rate and review on your favorite podcast directory

US Public Health Services Dr Steve Spoon Moore Alaska Indian Health Service United States Public Health Se officer Southcentral Foundation US Anchorage Dr John Childs knee osteoarthritis Brighton Kohl Indian Health Service Federal
Clinical Podcast: The Importance of the Subjective Exam | Dr. Chris Dickerson

Evidence In Motion Clinical

35:39 min | 1 year ago

Clinical Podcast: The Importance of the Subjective Exam | Dr. Chris Dickerson

"Welcome to the I am clinical podcast. Your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be. Are you ready. Let's go welcome to the. Im clinical legal podcast where we talk with individuals within the healthcare field. And beyond my name is Mark Sheppard and I welcome you to the show today. I am joined by. Hi My good friend Dr Chris Dickerson. Chris is a fellow of the American Academy of Orthopedic Manual Physical Therapists and he also works with the Belen College Fellowship Program where he leads the virtual rounds. Course An- anybody who's taken. This course knows that it's the meat of the actual fellowship fellowship where we talk about clinical reasoning and applying the evidence in a way that is evidence formed and Chris and I've had many conversations that may or may not have taken place over Over a beer or two. And so this. This podcast is kind of birth from some of our conversations about the subjective exhume. And we'RE GONNA be talking about why this is one of the most important aspects. At least we think so of the patient encounter so Chris Excited to you Or maybe maybe not so excited to get some of her ramblings recorded year. Welcome to the show man base for having me Mark. I'm really excited here. Always enjoyed chatting with you and looking forward to this discussion. I think it should be enlightening awesome. Well you know Chris we can get on rants here but I think one of the things that we kinda hold in common uh-huh and this this perception or belief that we have behind the subjective exam so I think one of the first places I should ask you know where we are is. Why do you feel like the subjective exam is important? How important really is IT I? I've been in clinic. I remember. I did a rotation where the clinical instructor structure told me. You only need like ten minutes to do subjective exam and I remember he was. He was just hounding me for how long I would take too subjective exam so like why do we even have to spend time time on it and why is it important. Yeah you know I would argue. This objective examination is one of the things that really sets us apart from all the other healthcare professions sessions. I don't want to speak for every other health care provider in America. But I know if we look at overarching trends. If you sit in office with an orthopedics thanks orthopedic surgeon. That subjective examination is probably going like three or four minutes because it has two or three things zippy offer look at a picture that doesn't talk and make decisions from their same thing when you go to Family Care Practitioners Lot chiropractors. Most folks aren't really sitting down and taking the time to hear the patients out and I don't know if every other health care provider would necessarily thoroughly agree with that but I think our patients would and the reason I think that our patients would is because when we finally get him in and we start asking them to tell tell their story. It's almost like we're opening the floodgates. Finally they're getting a chance to let all this stuff out. 'cause nobody's doing so far they've seen all the people who got to us right and they never chance to really tell their stories and they don't like they've been heard so I think this objective examination. The Nation in my opinion really sets good physical therapist apart from all the other healthcare providers that share this arena. Yeah and and I mean and you know part of it too is and you hear this time and time again. Is that as physical therapists occupational therapists or being in our profession. Where you're in the Rehab professional environment? We get a lot of time with with our with our patients and you know you you look at some of these surgeons and other physicians in such. You know they're they're on like you know maybe ten minutes for for evaluations and things along those lines but you know we have a unique opportunity. I think to really have that time to build that alliance and and really do it through a sound patient interview. So let me ask you this Chris. What are some of the things that you feel like are essential to ask during during the patient interview or subjective exam what sets us aside from other practitioners at really makes it sound for us to go forward and and our reasoning model? So I think what's really essential mark is. We've really got to understand the symptom behavior and we've got it understand it in such a way that it helps us generate hypotheses and then start to refine those hypotheses and so I think this symptom behavior really does matter and I'll go one step further and say what we really need. We need to get that symptom behavior at the front end of this objective examination. So often I see that that. Come in the middle or towards the end of the subjective examination and I think that's a common a common error that I see in a lot of subjective examinations and don't really go well is it's not necessarily the folks are trying to gather the information that folks are gathering the information in order that's is less than optimal for our clinical reasoning process. If that makes any sense yeah now when you say symptom behavior can you define that right right. So here's an I think these have to go in a specific order. I think one of the first things you have to establish when you start your casting wide net of hypotheses that you hope to refine a little bit during your subjective examination a little bit more during your objective examination and a little bit more with your trowel treatment Sleepiq if you're gonNA cast at initial wide net. I think we have to start with. Where exactly are these symptoms located on the patient's body and of almost equal importance? Where are there no symptoms so we have to figure out exactly where the symptoms are are not right and so in fellowship? We would call all that clearing the body chart but I would argue. That's GonNa happen really really fast. Yeah a lot of sense and I kind of liken it to you know defining the map you know where you're going and how are you going to get there really is determined by what map you're working on and so that's not cleared up early. You know you're you could be confused. Used on exactly what questions May need to ask and so you know. We're kind of talking Chris from a lens of you know maybe the orthopedic driven patient I mean do you. Do you have any thoughts on how this may change if you were in like a skilled nursing facility where you're looking more on functional deficits and other types of things that maybe aren't as common in an orthopedic driven outpatient private practice so I wouldn't say that I'm going to be in the clinical expert or the not am not a neuro clinical specialists. I'm not a geriatric clinical specialist. So I can't tell you every single way that a a patient with Parkinson's disease or a you know a dense stroke by present. I would imagine that subjective Kazak nations probably going to go a little bit different especially if they're phases Eso. I guess I'm during this more like I'm thinking more along the lines of what we see in our scattered outpatient private practice setting or or outpatient hospital based Setting where folks are walking in. They've got some sort of chief complaint or or a handful of chief complaints as the case may be and they've either I've been you know. Direct access showed up at your clinic or somebody referred them for physical therapy Hugh that in that in that setting Gotcha and so are there. Do you feel like there's commonalities. Though between like every patient interview slash subjective exams should would have these types of questions. Maybe upfront or even in the whole thing itself any thoughts there. I would say if we're good across crossed boundaries and go orthopedic to neurologic or especially like an Aq- or inpatient neurological sitting I would say they're still some commonalities allman. Alex you have to have Right. You've got to figure out what the patient's goals are. You gotta figure out what's functional for the patient and you have to figure out what resources as they have available but you're talking about somebody who may have Parkinson's disease one not gonna ask them to identify their area of symptoms may not the pain may not be their chief complaint. They've got this. You know this shuffling gait and this intention tremor that they're struggling with right. Yeah I mean it just goes to show. Oh how. There's there's a slight or maybe more significant variability in how subjective exam is done so I think I think that's really important for people to understand. Dan is you know every every patient will will dictate assert a line of inquiry or questioning You have to match that there And I think you know if we go back to. Let's say kind of being in your outpatient environment like Chris if you could define or or put your like top three or four things that you're like. This is a must in every patient interview for questioning. We've talked Kinda right now about the early ability for you you to define the symptom behavior. What are some other things that you're like man? If they're not there then you're going to be lost when it comes to physical exam so one of the things things that I find most frustrating to watch and I watch a lot of subjective exams between entering doing mentorship with students students on their internships doing mentoring for orthopedic residents doing mentoring through with a fellows training. I spent a lot of time sitting back and watching watching subjective examinations in of course with fellow virtual rounds. I watched tons of subjective examinations and sitting on the sidelines of watching a subjective examination. The Nation gives you a very unique perspective. Because you're not actually there in the heat of the moment trying to come up with all these hypotheses and still develop rapport. You're with a patient and worrying about your body language and all those things I'm on my how juror on a stool on the other side of the room. Just observing gives you a unique perspective. But here's one of the things that I think we've got to get people pass. Do not sit down with a patient. Who just fat fifteen fifteen minutes? And you're waiting room filling out forms about all the questions of all things and visit them down and say so. How can I help you off automatic guides like yours too? So you're telling me like for me to watch. I'm liking it you. I mean it's not rude per se. I mean it's not an abrasive thinks if I come over to your house and we're not an I not been there before and you open the door you'll yeah come on in and you're you you invited me to your house for a party and you only on end. I've got to figure it out from there. How about hey come on and you can hang your coat here era? Everybody's in the back or they're in the kitchen. They're they're playing cards or there. There's appetizers over here. Are The restrooms down the hall of you need welcome. This is is your party. Welcomed the person in they don't know this is not their dance. You know it's not a solo act. So what I really wish folks would do and Mrs in that four habits model that we've been harbored on people about for goodness knows how many years but one of the things the top things that four habits model it you know. It says the invest in the beginning in the beginning. You're supposed to plan the visit with a patient right. I'm not mistaken on. That says it on the piece of paper Yes eurocrats take that first thirty to sixty seconds and say. Hey My name's Chris. I'd love to take a few minutes and just chat with Jio little bit so that I could get a better understanding of how your symptoms are behaving and how they're impacting you. And then hopefully you and I put our heads together and come up with a great game plan as to how how. We're going to help you out about that. Does that sound reasonable. And of course Jon is GonNa say yeah. That sounds reasonable. And you're so so that I can get added this information in the way that seems helped me the most. We're going to go about things in a specific order. So if you don't mind I'd love to start by chatting with you about specifically where on your body you're having these symptoms and I'm GonNa get oddly specific with that because really exactly. Identifying symptomatic area may help me figure figure out what structures are involved or not or it may help me figure out what interventions are most likely to help you after we got a really good idea of. Where are your symptoms are? I'd love to ask you about the behavior of your symptoms and that might be. How bad do they get? How low down to the symptoms get what makes them langree? What makes them feel better? How long does it take to feel better? How long does it take to get angry? Those sorts of questions really good idea of where your symptoms are worked and how your symptoms are behaving then. I'd like to have a good conversation about the history of these symptoms. I WANNA win. This started how this started. Who you've seen what you've tried? What the folks have said? I Really WanNa know the whole background behind this. Does that sound all right and Janet in it for the first time is thinking. Oh my goodness somebody's GonNa let me tell my story and what's so magical mark. I think about taking the sixty to ninety seconds at the beginning of planning visit with a patient is they've already seen providers X Y and Z. And they've never got the chance to tell their story they really haven't got a chance to have the monologue and get it all off their chest. Because everybody's got these short treatment windows or short evaluation windows and so they're kind of getting redirected or interrupted after about a minute navy Max and they don't feel like ever get it out so when they finally get in you there with you in the physical therapist so often. If if you don't plan to visit you're probably going to experience something like this quite frequently Well would you stand up up and turn around and show me where on your back. You're experiencing these symptoms Janet's going to say oh well yeah you see it all started back when I it and you're going. That's not what I asked it. All right you know you might say so Janet on a scale of zero to ten then. How severe symptoms get worse? And she's GonNa say we'll in nineteen twenty six and she's GonNa keep going she's GonNa keep trying to tell the story because no one's ever her letter do it before so she's GonNa try to that story in any day place. She can anytime she gets the microphone. She's GonNa WanNa tell that story. So I think you can eat those fears by the very beginning. Say Hey listen. We've got to get this information in a specific order because I think it matters and I think it matters a whole lot but no matter what trust that you are going to get this chance to tell your story. And as soon as they understand that they're able to answer questions a lot more directly and the whole data collection process becomes a whole heck of a lot more efficient and we see it over and over and over again when we can get our fellows in training or a residents in training or even our student interns to adopt that model. Plan the visit visit with a patient. I let them know what to expect. And then proceed with your subjective examination things just smooth ride on out over and over and it over now. Nothing's one hundred percent perfect. That helps a law most of the time. Yeah and it's funny because I think I could say my even for myself when when teaching entry level all students that there's this focus on using open ended questions and I think one of the the easiest that are taught to students and even residents and fellows this is. How can I help you today? Great Open ended question. But I so agree with you like the the one thing that really grinds my gears clinically and and it really came to light when I was filling out paperwork myself but you know we're we had these huge intake forms. I mean every clinic. I go to. It's like a frigging novel right and and some of them are are really you know helpful. I've seen some clinical intake forms that have excellent information on them and and the funny thing is that therapist purpose takes it and looks at a couple of things put to the side and they asked the same question that are on the intake form. It's like do they. Did the hard work for you. Why are you not ask like why? Are you not clarifying things in. Why are you asking them why they're here? They just wrote your their their whole life story on that she'd paper so I love the idea you know is is is setting you know setting the the the lay of the land you know what's the plan and and making sure that the the patients on board I think Chris you and I see this a lot with with with fellowship related. Discussions is a lot of a lot of fellows in training. Get nervous about asking questions and the number one is say residents to but the number one is this whole idea behind regional interdependence right I have shoulder pain. I'm really nervous to ask about the patient's neck because they said they've never had neck pain or blah blah blah. It's like well. Do you want to take their word for you. WanNa ask them and so I think in my mind if you if you paint the picture of why you might be asking these questions since I mean do you feel like that helps kind of open up that that vision for you know. I'm going to do a really thorough interview. Yeah I absolutely we do. I hate using the word checklist. Because it's gotten such a bad rap right so you say people are saying you need to avoid this checklist mentality. checklists exists for a reason. There's a reason checklist exists. And that's that's so that people who have complex processes don't don't Miss Critical steps. That's that's the thing if I'm an airplane it's going down please. Please follow the checklist dopes. It's coming back to twenty-six ahead. What do you think we ought to do? checklists dude so I check let's get this bad rep and people always say tweeted. A boy this checklist mentality and what we see people trying to be so conversational with their subject of interview and that's gray gray and they think they're building patient report and maybe sometimes they are but then they get to the object of examination and it looks the same every freaking time nine questions. They haven't got any good data. They haven't collected any useful data. The refined their hypotheses. So they go to the objective examiners and they have a checklist object of examination. I were far far rather see a situation where for every subject of examination had at least a common frameworks. Now you should spend a lot of timing conversational and I would argue that following. Some some sort of a checklist pattern allows you to build more rapport with the patient. Because you can stop and chat about any other thing they bring up or you could go law on these tangents because you know you're not gonna get off track because as soon as you come back. You're right back to the checklist and you're going through it. In a specific order I would much rather see a subject of examination that follows a similar framework with almost every single patient and an object of examination. Asian that is extremely unique and specific to that patient based on the subject of examination. Otherwise what's the purpose right. Why if we're GONNA do the same objective examination every time and then just have this casual lazy a fair conversation with our patients before that why not do simultaneously simultaneously? Why not just do the same objective examination with everybody? That has low back pain and have that discussion while you're doing. Yeah it's scraped point and I think you know going back to that mention you know where I said. I had a clinical instructor who basically said you need ten minutes for a subjective exam on every patient. That's essentially what was happening. Is You know He. He did the same tests on every person every time and not to go down a rabbit hole but basically the suffering from confirmation by his life to agree but It's it's just so interesting to me and and as I think about this to you. Know the checklist piece does get a lot of data attention and we say it's too cookie cutter and things along those lines. But I will tell you my patient interviews got immensely better when I actually actually created a checklist for myself and use that as my roadmap to get from point A. to Point B. and really where I was going I wanNa have off some good hypotheses that will drive a physical exam that matches the idea that needs to rule up rule down my my primary and competing hypotheses and if I had that there and that road map and felt like I did a good good subjective exam. I found that my physical exam was so much better. So let me ask you this Chris as you went through fellowship yourself. Did you see the amount of time you take in the actual evaluation of process process. Did that change as far as like putting time on the patient interview and the physical exam. 'cause I know it did for me. Did you see any differences there. What I would I would say is that as I went through fellowship and as I got more dialed in with my subject of examination and really started to understand why why I was asking the questions might object of examination actually got shorter with most folks most of the time so I'm more efficient and I'm spending less time on my objective examination? I'm not actually spending more time in my subject of examination. I'm I'm just spending time in my subject nation saw. The question becomes a little Chris. If you're doing this objective examination for the same amount of time and your objective examination got shorter. What are you doing with the rest of your time will in treating patients mark treating that patient? Now I've got enough time in the back end where I am not a deer in the headlights. If my first trial treatment is a complete dud because sometimes it is right despite despite a great subject examination integrate objective damnation. You can swing and miss on that first trial treatment and so if I do swing and miss on that I admit I've got plenty of time to cover my tracks called things back down and try again or would I also do is. I've got a lot more time to spend on that initial exercise prescription. I can't tell you how many times I've watched this like Exhaustive objective examination where. They're testing things that I don't even know what they're trying to rule out or rule in or rule up or rule rule down. It seems like they're just doing things for the sake of doing things. And then all of a sudden they got five minutes left at the end and they're like okay and so let me show you pelvic tilts real quick. I am just rocking back and forth a handful of times and send them out the door bikes. That person's GonNa go home and do that. Exercise The unit dot sell that you did not justify that you do not match that to any interventions unanue did not match that to any Objective examination findings. You didn't dose it medicine. You just kind of went Williams that do this sometimes no way. That person feels like that was the best exercise for them. No way they're doing that so you know. I spent the same amount of time on my subjective examination. I just spend that time better. I spend less time on my objective examination. Because I don't have to do as many things because I've really ask the right questions in the right order in man. I can't specify how much that order matters. But I've got the right information in the right order this subject examination which means I already narrowed down my hypotheses pretty well so it doesn't take me as long as the object of examination to reach that tre- treatment threshold an increase. My confidence that I've chosen the right intervention or treatment track for that the patient and then I spent a whole heck of a lot more time with trial treatment and home program prescription and and I think it's interesting because the more I I talked to you folks who've gone through advanced training particular fellowship. Obviously my Lens but you know I can see myself i. I used to spend spend a lot more time on the physical exam than I did. The patient interview and that that almost flip flopped and again I would say a more efficient and it's not that I'm spending ending forty minutes on a subject of exam you know but I am. I am taking the time to ask the right questions because I think you said it best you you know Chris. You'RE NOT GONNA get it right every time and and if I did a really good job with questioning upfront and ask questions that really helped me solidify hypotheses. If if I'm going down the wrong path and a new should know that fairly quickly I can come back and no okay I asked. I know for sure that I've rule rule down the cervical spine in this person. So let me go back and see some other competing hypotheses that may be going on in nine times out of ten you go to the next one in line and say oh well you know the harass spine was was more of a driver in their symptoms than I was expecting when I was looking at the shoulder between between visits one and three. You can iron that out instead of having what happens to many people in this new Grad I suffered from this. is you go in you. Do your standard subjective objective exam that you You typed up when you were in school and got a hundred on it but when you get into the when you get into clinical practice it just you know doesn't always catch everything you need and then you know visit to three when you're not making changes are five six depending on where it is you go back to square one and start your evaluation action over again. And there's nothing that ticks off a patient than them taking now time you start like your you make. It seem like you're starting from scratch again. I want to be able to go back certain questions that I know that I need to deeper dive in instead of starting from scratch so definitely interesting perspective there so as as we wrap this thing up Chris I think as people may be listening they might be saying well. I wonder where I could get more information on on areas for me to glean more about the subjective exam. So I don't know if you have any any resources beyond just going through fellowship training Obviously not everybody will want to go through that but are there some some readings the articles or websites or things that you were like man. This was really helpful in me just expanding my my breath of knowledge on the patient interview. Yeah so I think there was a handful of things marks. It really helped me pull it all together Tom. I would say going through the The MAITLAND's vertebral manipulation and and his chapters on this objective examination. I thought that was really good information. I don't buy into absolutely everything I don't. I'm not following that as though it's a gospel but there's great tidbits in there. I love the four habits model and then you know so the not to get back. I really I shouldn't even use this word but I read a book called the checklist manifesto. That just made so much more sense. And I don't know I don't know if it's because drew with the subject of examination took me each so much trial and error to get better and efficient and the same time watching other residents in entry level students and fellows have have the same struggles but when I read that book I was like this guy as cleanly laid out the case for using a bit of a checklist. Approach when we go through these things right and I think one of the greatest points to take home is using a checklist approach. So that you're getting specific information in a specific order isn't meant to take the proverbial rains out of the hands of a provider it's not robotic and it's not scripted. It it should be at all if you hear checklist and you think script. You're doing it wrong. Sorry the Arar. The checklist is a framework and ensures that you're getting specific pieces of information in a specific order. But you can stop anywhere along there and show your empathy put a hand on a patient talk about something else. They brought up or ask a couple follow up questions about about a piece of information they offered. That doesn't necessarily pertain N. You're safe to do that because you always know where you need to come back because you do. Have this checklist of all on. I would argue. That following checklist allows you to build better patient report because instead of struggling trying to keep the patient on track attack or just sitting back casually letting the patient drive this ship. They have no idea where they're going. You can stop and have those personal moments with your patient without fear of ever getting off track and the patient is able to see from the minute you start questioning till the minute you finish questioning the data collection process and that you are a healthcare provider that is meticulous and very interested in in getting things right and I think our patients perceive things about us as healthcare providers immediately in that first initial encounter encounter that significantly influence our outcomes that day visit six at visit twelve or the next time they come in for or a brand new injury. And I think patients subconsciously or consciously figure out that the way you go about all things is kind of the way you're GonNa go about everything. I still when they see you. Just meticulously trying to gather this information and being very specific doc about their symptoms in their story and their behavior and how this is influencing their life. They're thinking man. This guy doesn't miss anything being mean he is. He is dialed in. So that when you've gone through your object of examination and you get your like. Yeah we're GONNA DO PELVIC TILTS. They're thinking this has gotta be the right intervention for me. This guy hasn't missed a thing. He was so specific about his data collection. This exercises has got to be tailored specifically for me I think Larry Benz once did a talk. I heard he talked about priming. And he used an example where they took a bunch of people in Split into two groups and all the people were told that they were gonNA answer a bunch of questions. Those questions would be fed into a computer system that was going to spit out a personality profile. And maybe half the people answered by a fifty question questionnaire and the other half of the people answered a one hundred question questionnaire and then they fed all these the answer sheets into the software system in a spit out a personality profile people were given their own personality profile. Asked to rank that on a lighter scale L.. Going from like very much disagreed very very much agree an art. How much their personality profile matched their true perception of their personality? Finale and the people who got one hundred question questionnaire agreed significantly more with the computer generated personality profile profile than did the people who got the fifty question questioning. And the kicker of the whole story Larry was telling us that everybody got the same personality profile and it was just a horoscopes. That was cut out of that day's paper the right thing is it may not matter as much what you do if the people feel like. It's tailored tailored specific for them. And and I think that maybe by doing a very thorough subjective examination and treating it like it truly is a data collection selection process. You may actually be priding your patient to increase their expectations of the interventions that you're going to deliver later on that day and in subsequent treatment sessions and I think that if you could increase their expectations your outcomes are going to go up tremendously. I think expectations you know Jeff more always says that expectations are the foundation. That outcomes are built upon right wind wind up that early by demonstrating that this is a data collection process. It's all about that patient and we're very very interested in getting it right right. Love it man Chris. I appreciate your thoughts here. couldn't have said it any better myself but as a been a blast and we'll definitely have to have you back on the show to to talk about some of your other soapbox moments that we probably have discussed timer to have to do you. Well I don't think it takes much time to hear the passion behind Chris's voice here about getting the patient interview right. You heard how important it it was to be systematic. Follow four habits model and rely on a checklist to make sure you got everything you needed. In order to establish your hypotheses the season really planned for a solid plan of care definitely Things have improved by own process of interviewing patients that come into the clinic as always. Thanks for listening in and be sure to tune in again for the next episode of the clinical podcast Thanks for listening to the. Im Clinical podcast. With Dr John Childs and Dr Mark Sheppard for more information on the podcast guests and the latest in physical therapy visit. WWW DOT evidence in motion dot com slash blog. Look if you like this episode be sure to subscribe like rate and review on your favorite podcast directory Eh.

Dr Chris Dickerson Mark Sheppard clinical instructor Chris Excited Dr John Childs America American Academy of Orthopedic intention tremor Belen College Fellowship Janet Larry Benz private practice Parkinson's disease Dr Mark Shepherd Parkinson Alex
Clinical Podcast: Using OSPRO in Your Clinic | Trevor Lentz

Evidence In Motion Clinical

32:36 min | 1 year ago

Clinical Podcast: Using OSPRO in Your Clinic | Trevor Lentz

"Welcome to the IAE AM clinical podcast. Your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be. Are you ready. Let's go welcome to the San. I am critical podcasts where we talk with diverse individuals within the health care field and beyond my name is Mark Shepherd. I welcome you to yet another show the IM local podcasts. I am joined today by my co host. Dr John Childs as usual and we will be speaking with Dr Trevor Lenz. Trevor is a part of the musculoskeletal research therapeutic area within the Department of Orthopedic Surgery at Duke University and has done a fair bit of research I would say. On the factors that occur that relate to health care utilization and outcomes and really we're GONNA dive in in this particular discussion in his travelers work specifically with tools. That look yellow flags and I think what you'll get from. This show would be really great because I've been utilizing this tool for the past several years Julie help efficiently assess for yellow flags so trevor really excited to have you on on the show. Thanks for being part of our talk today. Yeah thank you you so much for having me on. I'm really looking for the discussion awesome trevor. Well thanks again for the work. You've done on the Oscar Crow so I'm GonNa just dive in right now. I've always referred to this as the ostrow. But can you tell us exactly what it stands for and what it is really. How did you get into like developing a tool? Who'll like this specifically for yellow flags? Yeah sure the pro. It stands for optimal screening for prediction furlough of outcomes referral and outcomes. Which is why why we shorten it to us bro of a bit of a mouthful? It's actually I back up just a little bit in About the how and why it was developed in a May give listeners. There's a better sense of what this is all about. And what it's used for so this was originally conceived back in. I guess you're on twenty thirteen when some colleagues of mine at the University of Florida. St George have been checked by Lasky George Put together this proposal to the time was the orthopedic Section Eight. PT Now the Academy Awards to be physical therapy. The goal of this project was to develop screening tools to be utilized in Outpatient Orthopedic Physical Therapy Settings and this particular grant that we've funded to develop these tools really two different parts. The first was to develop a clinical research network and which which is optime here the the acronym opt in which is the orthopedic physical therapy investigators our and the actual project itself itself that was developed through that network was called Ausra so the pro tools that we developed were the yellow flag which will talk about a little bit today and then also the review view of systems tool which is sort of a completely different thing. It's focused on what we traditionally think of as red flags screening. And so. Maybe a topic for a future podcasts. God casts at that sort of good differentiation. Here early on that what will be talking about. Today is the ASPRO yellow flag assessment to not the ASPRO review of systems tool the a yellow flag tool was developed with this idea in mind that we knew that psychological distress was really important in the clinical encounter. Something that we probably don't evaluate often enough and one of the reasons was because of all of the different psychological characteristics that are out there that we know can impact impact outcomes. And when you think about trying to evaluate all of these different characteristics it's quite overwhelming to think about the number of tools that you might have to use and and score and interpret and so there was really just a very practical clinical reason that we wanted to develop something that would make this a lot more efficient and much easier. You're an one one of the things that I hear a lot of people ask me or tell me is. Is that while you were talking about the sort of overabundance of psychological tools who is why now are you developing this additional tool that makes things more complicated and really the the goal behind. This was to make it a lot easier and in fact. The general idea of this tool is that you will be able to administer it to your patients and by using a tool. It's seventeen items long. You can get some really accurate score estimates for eleven different full length psychological questionnaires and so rather than having to administer after a number of these different individual questionnaires. You can administer just this one only seventeen items it will tell you with with a high degree of certainty. What patient would have scored score? Had they filled out questionnaires. And so the the questionnaires that estimates their their variety of different ones. You can sort of read through them in the in the development paper but their common tools. The tempio Phobia the fear avoidance beliefs questionnaire the peach to nine which evaluates depression their questioners for rings -IETY in anger self efficacy for rehabilitation pain self efficacy chronic pain acceptance. And so with this questionnaire. Now you can really. It's pretty accurately in in concisely identify. What a patient would score in how they're functioning on all of these different psychological questionnaires and in talking with with clinicians in mark? Maybe you have some of your personal insight in this. Is that people really like it. And it's because it makes it. It's very efficient to use. It's very easy to use. Did something that again doesn't require your patients staff to sit there for a very long time and these questions. It is a matter of fact when I was up and develop this. You know I I. I sat down with these these patients as they were filling out all of these different westerners it would take sometimes up to two hours. Yeah for them to fill these things out. And and so you know by reducing that to maybe two or three minutes that makes a meaningful improvement. You know certainly in my clinical experience on the ability to violate strasse ask so that In nutshell is what this tool dies and we can dig into the details a little bit more if you'd like. Yeah that's great background there because I think what the listeners need to take home here is the tool the odds per YIF yellow flag screening tool is so affected that it can actually correlate in predict predict. What all these different instruments do? I think from clinician standpoint. You hit the nail on the head there in the sense that you know you're saving time in in the Long long-runner what patients have to do on those we give them enough paperwork to fill out come in for their initial evaluations. And the other cool thing that I've been utilizing ahead of time if I can. Is this tool that was actually built in the Academy of Orthopedic Physical Therapy Their website. They have a scoring feature or you can actually put it into their website. The actual ironies in and actually calculates all of those different scores for the other measures that you guys have look to link at to me so helpful because you know with all the literature. That's out there that shows that certain cut scores on the fat Q.. Or T. S. K.. Eh You know doing this measure I can look at it. Now say okay based on this. You know they're meeting this criteria for these clusters. Are there this elevated or decrease increased risk for going on assisting or something along those lines in. It's just great to use one tool to do that in so with that in mind in Trevor House. How's the score in? What does it mean to you as someone who's helped develop this tool? What should US clinicians be thinking? Maybe one of the Nice things about the Ill flag assessment tool which sometimes can also be challenging and somewhat daunting for people that want to use it as there are variety of different options for scoring and again. That's there's something that's a little bit unique. You know. Most questionnaires particularly psychological questionnaires. It's pretty straightforward you. Add them up at yet the items and that's your score and this is a little a bit unique so what it can do in a very alluded to this. A little bit is that it can't estimate scores on the full length psychological questionnaire so for instance it it would estimate eight that a patient might score a twenty two on the T. S. K.. Eleven or a nine on the fear win beliefs questionnaire or something like that the other thing that it can do though is that it can also identify what we call yellow flags in yellow flags. I I think most listeners may be familiar with with those or at least of of those and really it's just an indicator for psychological distress and so the way that we've defined yellow flags is that their score estimates again we're taking taking those score estimates that the Osprey identifies and if those score estimates if they fall in the top twenty five twenty fifth percentile top twenty five percent of the population so for instance. If let's just say that the cut off for the top twenty five percent of Tsa K.. Eleven scores for instance. Say It's thirty five. What it would do is it would identify if a patient has fallen into that? Top twenty five percent or above thirty five and it would it would give us a flag a yellow flag. Yes it would say yes. This person is scoring top twenty five percent of patients that typically come through outpatient orthopedic physical therapy for knee shoulder la back or neck pain. What's really nice about that is that it's very quick? And easy way to look for where your patient might have some psychological characteristics that are of concern. And so you know part of the feedback that we got was that well. It's okay that it can tell me that a patient scored a twenty two. Tsa Eleven but what does that mean you know is important is not important. How do I make decisions based on that number and so this does is by having the sort of second way of scoring it can give us a very quick and easy way to look across the different scores and say okay? They have a yellow flag for depression. That have yellow flag. Bring Zaidi to have yellow flag for Phobia on in all those questionnaires. They scored in the top twenty five percentile and so then that provides a little bit quicker and easier way. More actionable may be way to identify defy where we would need to address. Them's in in our clinical practice. If you read through the development of the flag tool you'll see in the in the very back of the development paper there are a variety of different equations that this tool uses to identify estimate what the the scores would be end it can be pretty challenging to look at her or interpreting so mark as you mentioned we worked with the the Academy Awards be physical therapy to develop this online tool that makes this very complex equations very simple to use clinicians a quick shot same wound his team at the University of Florida. Who really who developed a lot of these statistical analysis analysis to develop? This really helped us to figure out what is the convenient way for politicians to be able to use information and together with the academy me would develop this website and so encourage in listeners to go to it it kind of makes a somewhat abstract concept a little bit more concrete in that you on the left hand side of the of the page. Couldn't all of the different item responses and then on the right hand side. It'll split up the estimate of the eleven different questionnaires in. It'll tell you whether or not that estimate puts them in the highest score tile for the yellow flag so again something that you can take and use pretty easy to use takes a few minutes to fill out. It's also you can print went directly from the site so if you need to upload into the HR less something that you can do as well and incidentally it is something that we have incorporated here in our HR Duke where it does all these calculations in the background. So clinicians can can insert that directly into epic in the in the provides that feedback for them as far is there number of yellow flags and their score estimates as well trevor. One of the questions I have. I'm trying to get a sense. For how generalize -able this instrument in is you know sort of across different neuro musculoskeletal conditions a making the assumption that it is diagnoses. Sort of agnostic. It's region agnostic. Mystic allow these instruments are sometimes the psychometric properties early develop more around the spine or more around the extremities so give me a sense for win. Inclinations should use this instrument and is it appropriate really for all patients and if so is this something that is used purely for prognosis noses in the sense of estimating kind of nine recovery if you will and perhaps you know based on a certain cutoff score we're going to refer out or or is there any element of this score sort of changing over time and being used as a measure of outcome itself. So I'm just trying to get a sense for you know the clinician mission in out an average quote unquote outpatient setting. How do I use it? And you mentioned it's incorporated into it. Sounds like dukes electronic medical record is this instrument has it been adopted to the point where it's widely available in other sort of electronic health systems. You know you think about duplicate data entry and you know paper having having uploaded and all of that so like how available is this tool to commercial. EMR's like web PT. The another big players out there. Yeah so I'll take each of those kind of one by one. The first regarding win it can be used or when it when it should be used used. I'll give you the the Scientific Secombe attrition answer to that and then I'll tell you what we really think when we developed. It was a population of again again. Outpatient physical therapy upon initial evaluation spine spine pain neck pain knee and shoulder. And so that you know I think compass services the vast majority of individuals will probably see an outpatient orthopedic physical therapy you know. These questionnaires that the parent questionnaire so impeach Cunanan for instance you know. They're used across a variety of patient populations in so we feel that even though the development and validation of this was initially within within the spine in extremities we feel like it. It probably applies across a wide variety of of patient populations you know there may be specific. Ones Horns were we. We have an exactly done a lot of the the psychometric analysis of it yet. For instance you know things like regional pain syndrome and things like that so so you know you may end up wanting to use caution for some of the more widespread chronic pain conditions. But you know we think for the vast majority of individuals that are coming through your door In an outpatient setting this is something that is going to be apple and can be used because you know. Keep in mind all we're doing. Here's where estimating scores were using using it to estimate these fully questionnaire scores. How well it predicts outcomes may vary a little bit and there is a lot of literature out there to look at things like depression anxiety your witness beliefs in how well those constructs in and of themselves predict outcomes for these different patient populations I think as far as prognosis monitoring or looking at that is an outcome? Measure the initial reason for developing this was for screening purposes so identifying those individuals that might be most appropriate for psychometric informed treatment particularly early on Or those individuals that may even be appropriate for referral out for more. I guess specific psychological treatment treatment. And so we do think that in in many ways can be used as a screening would there are. We have done some work around prognosis in looking at how Even if we just add up all of the the item scores and look at that number as a prognostic indicator for outcomes. We've found that it's associated with a variety of of different clinically relevant outcomes and that would include things like pain intensity a year out from from physical therapy initial evaluation disability ability physical and mental health status persistent pain. We've also found that if we look at change over time and the accuracy using it as a sort of a treatment monitoring tool tool than it also can tell us a lot as well we. We looked at it in the first four weeks of physical therapy in found that change in aspro score over time predicted somebody's level of pain. Intensity in their level of disability also found that it helps us understand those individuals that were higher risk for going on to have surgery which I think you know particularly in the value based environment right now where were moving toward you know pay for performance in away from some of the things like fee for service being able to predict healthcare utilization is really critical. And so it's not only just these traditional outcomes it can predict but also some of the the utilization Azazel outcomes. That are working as well. I think when you're last points was about availability and availability you know. This was published initially back in two thousand sixteen and it is a available through Janus PT. Our understanding is that the embargo has come off of that so it is something that can be widely used and we've tried to encourage urge that that is you know we we do want just to get out there and to a variety of health systems for people to trial it people to try to understand where it's the most beneficial understand where maybe it doesn't tell us as much as we want an in how we can improve our ability to use that in clinic to make really relevant important clinical decisions and we do have some examples as I mentioned cal system is is one of them that they were trying to incorporate it into the system at the University of Florida. I believe there are also looking at trying this out in the military health system as well and so there have been some examples of early uptake take of the tool and we certainly get emails. Pretty regularly about individuals that are using this Practice in asking about interpret things. How how they might be able to to use it to improve their clinical decision making so plenty of examples of it being used and I think we're starting to see a little more more widespread uptake of it? I think these things as you know. Take Time woman tation. Yeah no doubt and I guess the next you know sort of you know question would be around. How do you interact with the patient? Sort of based on the results I mean. Is this an instrument. Where if you're performing an initial evaluation evaluation you're addressing the score on this instrument with the patient and sharing the score or is this really operating more under the surface From the patient's patient's perspective and you know you're certainly making some judgements about whether they need some psychologically informed treatment versus you know referral out or how much of the specifics knicks. Are you talking to the patient about their score on the instrument itself yeah. I think that that's a good question. I think it's you know in some ways it's case by case I do do think though in in some of my own experience using tools into light psychological assessment tools like this often times you would use it to really open up a conversation in these things sometimes can be a little bit difficult to discuss. But you know I think the first question that you have to answer is whether or not the patient. Is You know scoring high enough. Or if their scores warrant discussion to begin with and that oftentimes we've talked a little bit about using those yellow flags as sort of yes no indicator. Although it's it's not always that easy or that simple but it's just making the decision about whether or not you know. This is something to address with the patient. Say you know I I tend to use. Is that information a little bit in the background but also have them help them to understand that you know. This isn't something that we're just kind of sense about them that there are some validated measures out. There that are helpful to us to understand where or win psychological characteristics might be impacting. Somebody's ability to get better. And I think you know having that conversation with the patient that another variety of different things occur. Impact your prognosis. It can be something Like for strength or arrange emotion or it can be chronicity of pain or can be a variety of different things. One of those being how you think and how you feel about pain and so there are ways that we can evaluate that and you know on on a couple of these different evaluation measures that we have. It indicates that there may be some things that would be helpful for us to talk about. And then you can kind of open up the discussion regarding either some of the responses or maybe just have a little bit more open discussion with them about how they're feeling regarding their error prognosis in their capacity to get better their self efficacy for managing pain. And so that's how I see. The using some of this information to broach those difficult subject sometimes with patient even when you administer it to them sometimes it can be helpful to let them know ahead of time that you know. Hey these things are are there to really try to help me help you and so encourage you to you. Know to be open and honest about how you feel about these things that you're that you're answering because some of them can be very difficult goal for patients to answer particularly when it comes to things like depression. It's important for them to understand that sort of the the rationale behind doing all of this and let them now that this is something. That's there for to help you. I like that you know that idea of using it as a gateway to start a discussion. Yeah I think clinically. That's how I've approached using because it's subjective writing. It's what the patient filled out. It's not your assumptions or your thoughts. Aw on something qualitatively that was said and it really helps come back to look at where we are their beliefs or their expectations in it helps me you just have those conversations to open the door there were so it becomes much more data driven if you will and I think the patients respect that in a way that they can say you know I know where this person is coming from. They're not just pulling out of there. You know you know where to try to talk to me about something saying I'm crazy or it's all my ahead right. It's it's good to have that Dan Yan. I often hear when you talk to patients that one of the major complaints is that feel like they were listen into enough or there wasn't this delving into their their condition enough in. I think this again really helps to sort of get did. The crux of what oftentimes is leading the quite a bit of disability and distress in people's lives. And so so it really helps set therapeutic article lions in it helps you to develop a relationship a close relationship with your patients so that you know they entrust in you you know what might be contributing contributing to some of their pain. One of the things I mention is that this is a screening tool and so like just about any other screening tools that are out there air. You know it's really designed to fairly sensitive to catch you know those individuals that might have high levels of psychological distress. We have suggested as part of this screening sort of two stage process in that is if they screen high on on some of these characteristics one of the options that you have is that you can go back. I can do a further deeper dive by using the full length questionnaires in it sounds kind of counter intuitive. But one of the things at that allows you to do you know say for instance. They screened positive early to have a yellow flag are screen very high on on depression. One of the things that you can do is go back doc. In administer the full length beach nine for instance and and what that does is it allows you to kind of dig in figure out. What exactly it is that? They're it you know why they're screening so high you know because the actual individual questions themselves can sometimes tell you about a lot about how people are thinking Particularly relevant to physical therapy practices. You know things that we can intervene on directly in that ends up being things like self advocacy in pain coping. And so if you were to go in administer the foaling save pain of efficacy questionnaire or or Tampa scale for Phobia then it might clue you in in onto what exactly the patients are afraid of. And how they're thinking and so you know the screening is just to catch them and then oftentimes it. It requires either a discussion with them. Like we've been talking about or you know there. There are more objective ways to go about evaluating them beyond just the screening process. So that that's another option for Winstons is how to use this this tool in decision-making yeah I think that's a really a good point too and actually something. I didn't really consider the tool. And and I kind of liken it you know when we're doing a physical exam you're not generally starting out doing a A very specific manual muscle tests as the very first thing you do. You'RE GONNA look at function. I in observing. Watch them right and so you're looking at. Ah are there in large deviations in their ability to perform some type of functional activity that will guide me to say I need to look further at the shoulders. If Egli Mobility Mobility were look at hip strain and I really liked that because here it's almost you're almost saving the clinician time instead of doing eleven different questionnaires assessing similar type of outcome. You now you can see okay. Which one do I really need to hone in on that will actually give me impaired psychosocial all state that the patient avian so really pertinent information? I think really helpful S- of so. Thanks for that to be there. I think it's you know what we hope. Is that by making being this more efficient and more convenient that clinicians will see this as as really routine part of their examined in the same way that you would evaluate strength and range of motion. It's ability and reflexes and a lot of the other things that you might try to assess on a routine basis with with patients but you know again giving an efficient option blue so you know trevor as we draw towards a close you know maybe give you a chance to acknowledge some of the other folks that were involved in its development. I heard you mention Sam Wu's name earlier earlier trevor. I don't know how much you know. But I worked pretty closely with Sam on our Provincial low back pain steady way back in the day that I did with Steve George Assuming Steve is probably involved in this somewhere at at least would be my guess give us Kind of some pats on the back and sort of how this sort of originally came about and who was involved absolutely this was developed and originally conceived by our group at the University of Florida. Steve George being the principal investigator on this. I mentioned a little bit earlier. But Jason Bennett Jack. Over the last few years superior a number of colleagues at the University of Florida that helped to develop the project. We also part of this. We had a development cohort. Art That was conducted were data collection were conducted primarily in Gainesville Florida and Jacksonville Florida at Brooks rehabilitation didn't and so A number of clinicians. They're far too many to name but really were instrumental in helping us to collect these data. This would not be possible without their contributions. And and as part of the validation study we had a number of sites around the country that integrate about nine sites throughout the country that we're we're collecting data data and all of those individuals acknowledged in our publications but again with not something that we would have been able to do without a number of individuals. Helping us Out Clinicians administrators and people really buying into the importance of project. Like this Samu. As ad mentioned you know He. He did sort of work. The magic background. Not only on on this paper and on this tool but also the review systems tool and had a group with him that really did some great statistical work work that is well beyond my comprehension in many ways but made this work and worked really closely with us to make sure that it was something that was digestible symbol for those that may not be familiar with a lot of the statistical techniques. I'm sure that there are a number of individuals that I am excluding and I'll think of them as soon as we we've finished the podcast but absolutely this is a really a team left and would not have been possible without their assistance. Who Great Will Trevor? It's really been a privilege is to have you on the show today. I know this'll be You know it's an important topic for a lot of our clinicians who are certainly interested in identifying patients that are at risk for chronic pain and non on recovery and you know making decisions about referral and psychologically informed treatment so trevor. Thanks a ton for your work and Really looking forward to seeing being how this plays out for our listeners might want to reach out to you. What's the best way to contact you if if you're on social media may be any social media handles you might have mail addresses probably the easiest way to get a hold of me and it's just my first name dot last name? Edu So it's At Edu the twitter handle is trevor. Liens P. T. A.. Few give me a shout out on social media and then just a quick shameless plug we will be presenting some hospital related information in some stuff. That's actually really clinically useful in hopefully will help people understand how to better use this tool that combined sections meeting coming up in few weeks. CSM Twenty twenty twenty. There will be some programming there that will hopefully provide a little bit more insight on on the pro awesome. Thanks appreciate you joining us on the show. Great thank you very very much. I appreciate being here. Wow what a great episode with Dr Trevor. Lense who's on Faculty Duke University Really just the whole discussion around the ASPRO as an instrument to screen for patients who may be at risk for chronicity and perhaps psychological issues that might necessitate tape referral or psychologically informed treatment. You know as clinicians I know were inundated with all sorts of you know instruments that supposed you're supposed to complete and if you completed all of them you know the patient would be in the waiting room for two hours. Filling out all the screening questionnaire so an instrument like the pro that you know summarizes a lot of the different domains of psychological issues is really clinically practical. So hopefully our listeners can appreciate now. The potential role of this instrument spend. Oh you know well developed. I'm sure there's more research to be done. But the ability to identify those patients who are at risk is such an important part of clinical practice in this instrument tremendous Really clinically practical tool. That's pretty easy to use. Our listeners will enjoy getting familiar with the instrument if they're not already and testing it out in their clinical Michael practice as always you can reach us at E- I M team on various social media channels Certainly the blog were active. We're just on the other side of our one. Brand launched so We're super excited and really looking forward to a fantastic already I am. I know we'll have a big presence combined sections meeting so by all means come out and visit us at. CSM really looking forward to seeing. Everyone can't say thanks enough for your listening as always his own mark and I are grateful for your loyalty happy to entertain ideas for future guests. So certainly pass those along to mark and I if you have any ideas on and guests so without further ado thanks for listening. And we'll see again on a future show Thanks for listening to the. Em Clinical podcast. With Dr John Childs and Dr Mark Sheppard for more information on the podcast guests and the latest and physical therapy visit. WWW DOT evidence in motion dot com slash blog. If you like this episode be sure. Subscribe to rate and review on your favorite podcast directory

Dr Trevor University of Florida Dr John Childs Academy Awards Mark Shepherd neck pain Outpatient Orthopedic Physical Dr Trevor Lenz Academy of Orthopedic Physical Duke University Lasky George ostrow Oscar Crow US San Julie
Clinical Podcast: Being a PT in Federal Prison | Dr. Jessica Feda

Evidence In Motion Clinical

36:03 min | 1 year ago

Clinical Podcast: Being a PT in Federal Prison | Dr. Jessica Feda

"Welcome to the I am clinical podcast your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be. Are you ready. Let's go all right. My name is Mark Sheppard and today on the clinical podcast. I am joined by Dr Jessica Fateh who is a PT within the United States Public Health Service as some of you may know pt in the US Public Health Service provides services in many different areas of need but just found her way into treating those patients concerned with thin the Federal Bureau of Prisons. What an interesting setting to be in unfortunately for this session. I do not have my co-host. Dr John Childs as he is tied up with an anti anti couldn't get out of jail. I am excited to be joined by you. I also for those listeners who don't know had the privilege of working with jess closely as she is part art of training. I should say of the Ballon College or physical therapy fellowship. Just welcome to the show. Well thanks mark. It's an honor to be here today and thanks for so much for asking me. Thanks going to be a lot of fun hanging out with you today on the podcast what we're excited to have you so not that long ago. Colonel Colonel Jason Silver now and commander Steve Spoon more were on this podcast and like them. I have a similar exciting disclaimer based on my military in agency responsibilities what he's I am an active duty United States Public Health Service officer assigned with the Federal Bureau prison so here's my disclaimer everything I talk about with you today. Encompasses my personal opinions and commentary it does not reflect the official policy or position of the office of the Surgeon General United States Public Health Service the Federal Bureau imprisons or the Department of Justice so how's that for a great informal start that sounds pretty good pretty soon disclaimer now just and I appreciate you you start us off there but now let's get into the nitty gritty here as you mentioned before you talked recently with Dr Steve Spoon Maher who is also a physical therapist the US Public Health Service. You talked about his experience within the service in how he found his way into this line of business as a physical therapist so I'm really curious various. How did you decide that working in the US public health services was something you wanted to do and more specifically. How did you get into the correctional setting mark. That's a great question I I became a physical therapist because I had always wanted to be a marine biologist. I wanted to perform cancer related or behavioral research with sharks however when it came time to apply to undergraduate programs I've realized my dreams of performing research on sharks Tarek Schism very difficult at with a low behold of success so ever pragmatic. I reviewed the top ten. Most higher positions and physical therapy was on the top of the list. I possessed a long standing interest in healthcare and I decided physical therapy. It'd be a good profession to pursue and I had the Great Fortune Nineteen ninety-six of spraining my acl and MCI Awhile Downhill skiing the physical therapy that I received after my acl reconstruction construction actually further ignited my interest in the profession from there I took a serendipitous path I met my now husband in college and we both had graduate school pursuits so when we looked ahead neuro perspective loans we knew they'd be in the six figures and this is filled daunting especially just starting out so one day while flipping through a PTA's guide to physical therapy programs. I saw Baylor University and in small print below it stated free tuition why had to call and check this out further so I called the university and they were SMART -taining my contact information I when I asked about the free tuition options relayed that the physical therapy program was a collaborative effort between the military and Baylor University versity the military orchestrates a program and Baylor confers the degree they asked me if I'd be interested in speaking with a healthcare recruiter and I respectfully rightfully declined with my limited knowledge and honestly PREDISPO- stereotypes regarding the military. I didn't think it was for me. However are they already had my contact information and soon captain. Amy Trevino was contacting me about the United States Army Baylor Program and physical therapy happy. I continued to hold the opinion that I wasn't right for the military nor was the military right for me and she continued to send me information regarding the elements comments of the curriculum the strong standing amongst pt schools I think at the time they were ranked eleven in the nation and they've continued to climb from there so finally it was getting time that was close to the time that they needed to make a decision and Miami Future. Now husband was pushing me to consider the military has great means to decrease. Our graduate school costs Captain Trevino she he contacted me to see if I'd be willing to fly to San Antonio see the program for myself and conduct an interview and I was floored. I really wanted to go but but my family stepped in and they weren't thrilled about me missing a family reunion to look into the military so I didn't know and instead Captain Trevino flew to Fargo North North Dakota the area in which I was going to college and when she walked in all of my misguided beliefs regarding the military fell to the wayside. She was fatigue around my size. We had a lot in common as she was an avid runner too. She enjoyed many of the same hobbies I did. She graduated from the PT Program Three Years Prior and was able to provide finite details regarding the program so we conducted the interview on the spy. I decided to complete the application for the program. When completing application there was a location on the form in which you checked which service you wanted to join. I decided to call the program to determine how many students slots available for which service and I'm glad I did because I learned they only had army slots available at the the time and that's how I chose to join the army and it turned out one of the best decisions I ever made as you likely know physical therapy originated created in the US army within the United States in nineteen twenty two with Mary Mcmillan and her reconstructions during World War. One at the Walter Reed General Traumatic Hospital and nineteen seventy two the army was in dire shortage of orthopedic surgeons and physical therapists stepped up into the musculoskeletal direct access role as physician extenders and they've continued their direct access rollover sense that education training and autonomy as a P. T. in the army was eminent eminent. I soon found myself immersed in a phenomenal learning environment surrounded by progressive forward thinking physical therapists working collaboratively between the Army Army Air Force Navy and the Public Health Service so in two thousand four the Public Health Service started calling Commander Eric Payne who I yeah I knew from a prior clinical affiliation four years earlier convinced me to consider an interservice transfer with an assignment with the Federal Bureau prisons and I knew that he'd be a phenomenal mentor and the Public Health Service also had an array of progressive physical therapists with similar expanded practice privileges just as the army so I went from serving soldiers which I knew in logged to serving the underserved and finding new calling and today I've served Irv nearly twenty one years between the army and the US public health service and looking back. I'm grateful for the phenomenal career of had to date providing physical therapy in an autonomous collaborative environment alongside of strong clinicians in an atmosphere of true interprofessional communications import so sometimes sometimes I think we make decisions that are well planned and orchestrated and sometimes we simply lockout opening the door when opportunity knocks is serendipitous lucked now yeah. I love that story. It's funny how you went from wanting to work with sharks to being in the army and then finding yourself as a P. T. in the Federal Bureau of Correction in prisons and awesome your stories into here where people kind of found their way and is this much planning as we like to to do to just get everything right. Sometimes fate just has it in the we need the right people who really light a fire under us and I really appreciate each sharing your journey to get where you are because I think it's a unique path that you've gone on an even with Dr Spoon more. I just love hearing your perspectives just because areas you guys practice. ACTES are just so interesting in I think one thing that seems kind of mysterious about the United States Public Health Service is that you're an officer Sir of the US public health services and not many people know are really understand that you can have rank here. Can you tell us more about what this means within the US public health services and how does compare maybe to like military of sorts yeah sure thing. I would be happy to talk a little more about the public health service as I believe this service is one of the best kept secrets amongst uniform services and I would love to no longer be a secret but a service everyone recognizes although relatively unheard of the Public Health Service which is also known as a commission core it originated in seventeen ninety eight under the purview of the second President President John Adams senior it originated as a sea-based service dedicated to the medical care of our Sailors Merchant Marines as an originally originally sea bass service the Public Health Service utilizes the same ring systems as the other Marine base services such as the Navy and the Coast Guard where we're different is urging general as our commanding officer the Public Health Service originally began with a small core of strictly physicians decisions but today has grown to include a large array of healthcare practitioners and scientists so our officers are assigned in hard to fill essential positions within the various government agencies so we have physical therapist assigned to the Department of Defense Federal Bureau prisons prisons the Indian Health Service the coastguard National Institutes of Health the Food and Drug Administration and the health resources and services administration and outside of our specific profession officers per within the Centers for Disease Control Agency of Healthcare Research and Quality Agency for toxic substances and disease registry the Centers for Medicare and Medicaid Services. US Immigration and Customs Enforcement Substance Abuse and Mental Health Services Administration Office of the Secretary for preparedness and Response Officer the System Secretary of Health Office of the Secretary and the office of the Surgeon General so the commission core is an essential component of the largest public health programme in the world. It's a team mm upheld care professionals in uniform as one of the seven uniformed services were small with approximately six thousand six hundred officers officers all serving within their respective locations but we stand ready to serve on deployment missions to render medical humanitarian aid the mission of the US public how service commission core is to protect promote and advance the health and safety of our nation so while we're each station endon served within our respective agencies were called upon to deploy and render medical support in areas where the medical infrastructure is affected for example recent missions include humanitarian aid missions currently going on on the US and ask comfort ship serving communities in Latin America medical triage Russian care for unaccompanied minors at the border we continue support after the earthquake in Puerto Rico and a recent deployment was a Bola response providing on on site medical care to healthcare personnel affected by a bowl on west Africa and these are simply to name a few recent deployments but do know that public health service officers respond to almost every major national disaster or a bent nationwide providing on site medical care and infrastructure support our deployments employments typically range from two weeks to three months in duration however the United States Public Health Service. We've been called upon during times of conflict as well providing healthcare so important important infrastructure guidance as an unarmed uniform service and we've served in every wartime conflict from World War One until today wow I mean my mind is blown just hearing all of the areas that you find yourselves as an officer within the US public health just being able to be integrated in in an provide healthcare services but wow that is just phenomenal so for those listeners who are looking to have a variety of different options of unique area has in areas to serve and really get a good experience of providing strong service to our country man. It seems like a great option for people to go into especially with some of the perks and benefits that you talked about earlier deaths. One of the things that stuck out to me was your mention of the word underserved so serving underserve that mean from your frame of Reference Yeah. That's a great question mark in my mind. This is what the Public Health Service Awesome bodies treating each individual no matter what their background with dignity and respect we serve in areas of need and significant African health disparity always striving to see the divers humanity and each individual and to provide progressive evidence informed efficacious and cost effective care essentially it's meeting the patients where they are forming a respectful rapport and walking figuratively alongside of them on a journey Ernie to optimize their overall function health and we do this on a national and international basis so I see it as we treat humans and and the very essence of humanity drives us yeah I mean there's no better way to put it. There and I think it's really interesting that you brought up the fact that not serving any person that you encounter and obviously healthcare providers you know we have that same beam of reference or should at least for everybody we see but I think your environment to me is very interesting because you serve within the Federal Bureau of Prisons so can you tell me more or about what it is like being a PT within the correctional setting and how PT's add value with a semi certainly so I've had the great great fortune to serve as the director of rehabilitation services one of our seven medical centers within the Federal Bureau prisons. Essentially we have a hundred in twenty two federal institutions and out of those one hundred twenty two federal institutions those inmates requiring medical care will be he transferred to one of the seven medical centers within the system so it's a unique environment it's challenging and a number of ways as we treat inmates inmates of all security levels and backgrounds and as a physical therapist within this intimidate incarcerate environment were uniquely challenge to maintain contain an uphold evidence informed practice while recognizing the very humanity of each patient in which we have the opportunity to interact so it's an environment an exceptionally crafted intersect the science and the art of physical therapy as PT's within the correctional setting we work across a wide braff after the physical therapist scope working with whoever comes in the door so to speak and is transferred Tar Institution so we have inmates with medical goal and mental health needs transferred our institutions every week. It's also unique environment in which we become comprehensive generalists needing to know indepth indepth each respective facet of physical therapy in order to provide appropriate treatment and care so all army. I prided myself on my orthopedic in Sports. Medicine skill sets and the bureau prisons has been professionally challenging yet an area main thing grow I soon found on that I needed to progressively learn and become proficient in the areas of neuro rehabilitation wheelchair seating wound care and chronic pain management but from a team cohesiveness standpoint. I can at least speak to where I matt. It's a great environment as the healthcare staff works as a collaborative team with great respect and autonomy between physicians mid level providers and therapist. I like to think of it and I hope I can say this as socialized medicine tonight. It's best because eat profession is collaborating to provide efficacious evaluation and treatment with the utmost respect for the talents of each profession so every healthcare setting has its own challenges and problems. I can speak to the support of leadership we have within our House Services Division. Asian the chief therapists and locally through our institutions administration and clinical director one thing that's nice within the bureau prisons is physical therapists have expanded practice privileges consummate with advanced training so therapists within the Federal Bureau prisons work within the entire. I your purview of their scope of practice. We are particularly expansive not only serving as musculoskeletal experts in evaluation diagnosis but also in a multitude of rehabilitate areas so practice within the setting it can include wound evaluation a management cardiac conditioning programs. It's noninvasive vascular assessment with associated conservative management wheelchair seating and prescription neuro rehabilitation fall prevention chronic pain management prescription or a construction were thought ix medical footwear casting the stimuli rehabilitation and we provide a a lot of preventative care in the areas of diabetic foot care and ulcer prevention so we're able to evaluate the patient's providing comprehensive prehensile physical therapy evaluations and through our expanded practice privileges we can request are on imaging studies perform. Electro Maya Graphic evaluations nations order topical medications for wound-care and labs as appropriate and at our respective silly. We operate a musculoskeletal sick call program. I'm seeing inmates I with musculoskeletal complaints or injuries. We operate a chronic pain rehabilitation program. I Diabetic Foot Care Ulcer preventative program. I'm in a wheelchair seating clinic so I get asked fairly often. Why do we have physical therapists imprisons. It seems counter intuitive would've and it's all kinds of people who simply do not realize what we do therapists within the bureau prisons work within entire purview of the scope of practice actes and I guess the easiest means. Ticks Flaine is truly an area cost savings by providing comprehensive physical therapy early early ineffectively we save taxpayers millions of dollars each year by preventing also rations amputations injuries related to falls unnecessary. Azeri surgeries and ensure appropriate musculoskeletal imaging for example at our institution between our wheelchair seating program and Diabetic Foot Care Program we prospectively save greater than three million dollars annually not to mention the valuation and treatment that we provide for management of Musculoskeletal Care Post Operation and mitigation of litigation risk by having excellent board specialized therapist on staff so if we can contribute to enhance function the quality of life with less pain we have a better chance of reintegrating someone back into society so we worked towards improving the overall health author inmates preparing them for reentry with the ability to function and hopefully we can reintegrate them into society as a contributing member. Wow I mean the amount of knowledge that you must have to recall in. A given day probably expands quite into great depth. I mean when you're talking about all those areas. I'm just thinking about basically the full curriculum from start to finish in a PT program so I can see where you know. You've seen a lot of growth over the years. Being in this kind of sometimes are so focused in one little niche area in for you could be seeing someone with low back pain in next. Did you have someone with diabetic. Parents related to diabetes or something along those lines where you know you're doing wound care or wheelchair seated assessments. It's just very awesome. I'm in probably keeps you on your toes quite a bit in something that stuck out to me obviously as I have a acute interest with persistent pain. I can imagine there are many inmates with it's like longstanding paint complaints with significant histories of self medicating or risky lifestyle behaviors potentially. Can you provide an idea of the magnitude of what you're seeing when it comes to chronic pain and within the setting and how you're treating it. Certainly I'd be happy to so when I first we started with the Federal Bureau prisons. I was asked to facilitate a chronic pain rehabilitation course this daunting first of all working not with individuals with longstanding pain is difficult challenging and oftentimes. I felt I was left with more questions and answers and now now I was to help inmates with chronic pain. The seemed like a monumental task as many inmates are affected by the socio environmental fire mental context of incarceration. They're separated from their family and peer support structure and Namie have prior history of self medicating medicating with prescription or illicit drugs and a high prevalence of adverse childhood events well. Luckily we already had a support port a multidisciplinary team who had performed a couple of renditions of this new chronic pain rehabilitation course so we began delving moving further into the research regarding chronic pain and we were assisted by some great mentors like Dr William Hoon who is a pain anesthesiologist at Mayo Jio Clinic and previously the director of Mayo Clinic's Pain Rehabilitation Center and Joan Cronan who is an advanced practice and addiction pain specialist listeners at Mayo Clinic and under their tutelage in my own translational research based on literature reviews we learned a lot about the various slayers of pain and how to gradually optimize function while stabilizing the cyclic nature of the pain experience so we brought to the table I I team to include Psychology Social Work Dietetic Pharmacy Nurses Physicians Therapists and recreation therapist to work together the other to create a comprehensive immersive program involving pain science education acceptance and commitment therapy which is a form up cognitive behavioral therapy especially useful on the pain realm. We provide didactic education regarding the various facets related to pain gene to include self management techniques we provide progressive meditation training and an individually tailored consistent exercise program three times a week we have had some successful outcomes in the vast majority of our patients demonstrating clinically meaningful improvements in physical Google function depression catastrophes ing and even pain so I think chronic pain is quite common within the correctional setting which likely isn't a surprise although data's lacking within the federal offender population it is estimated that up to forty three percent of our US population poppulation is affected by chronic pain and inmates that frequently had lasts an ideal healthcare access prior to incarceration they may demonstrate low health literacy and they may have had numerous risky health behaviors predisposing them to the likelihood of developing longstanding and complaints and epidemiologic illogic research within the state prison system supports presumption in fact there was one large retrospective study in the state of Texas assists was done in the Texas state prison system and they looked at over a hundred and seventy thousand inmates and they noted that sixty percent had at least one medical condition and fifteen percent were categorized as having diseases of the musculoskeletal system and connective tissue which is vague but which is generally indicative of pain and they found that lower back pain was the fourth leading health problems identified in this study something else that's interesting set research also demonstrates the leading cause of death following prison release is drug overdose frequently by prescription opioids and although Abo- The prevalence of opioid and non opioid analgesic medications for use within chronic pain in the US correctional system isn't known studies from Switzerland and Norway suggests that up to thirty seven percent of prison inmates use some form of analgesic medication and this is critically important because prescription opioids. Loyd's have been identified as a primary contributor to drug related deaths following prison release in the US in fact in a study that looked at over thirty thousand inmates gets released from the Washington State Department of Corrections from a short period nineteen ninety nine to two thousand three the relative risk of death from drug overdose within the first two weeks following prison release one hundred twenty nine times greater than the risk for other state residents an up these overdose deaths desk thirty percent were directly attributed to prescription opioids so based on this data and certainly anecdotally working with inmate patients. I know the correlation between chronic pain states and addiction or self medicating histories and treating chronic pain is a priority within the correctional system to reduce the risk of opioid misuse and abuse especially after release hand to work to provide efficacious treatments within this uniquely challenging aging environment and the Bureau of Prisons. They've taken a progressive role in two thousand eighteen. They published clinical guidance document on pain management for inmates. This document provides recommendations for the assessment management and treatment a pain four federal inmates and they originally organized a multidisciplinary team of experts to come together to orchestrate a comprehensive document that was years in the making and we're not there yet bureau wide the guidance supports and evidence and four model highlighting the multidimensional aspects of pain through the bio psychosocial approach so our hope is to modify the sole holy pharmacologically based management one a multi immortal treatment involving the multidisciplinary team and I'm a big fan of the approach. The bureau is taking as has healthcare leadership is assuming an active role in multi modal treatment. That's patient centered for inmates with longstanding pain. They're implementing lamenting a two-tier program involving a multidisciplinary team and specific triggers of went incorporate the team approach and the overall take home message pige from this guideline is that pain is real. Chronic pain is its own disease or entity and it allows for pain in Phoenix typing to optimally addressed contributing factors an harness appropriate treatments so it focuses on communication Gatien Strategies Hain related clinical reasoning and it provides clear advice regarding when an opioid should be considered and when it should not so so overall this'll take time and a cultural shift across the spectrum for both inmates and providers as we strive to provide progressive care collaboratively with all the changes that go hand in hand the chronic pain experience and I think in a totally no not in the majority certainly only the minority of individuals that there's an entrenched mindset where they might not be ready to change or they made doubt intentions of the provider within a correctional environment where the ability to trust can be challenging so conversations regarding pain management they have the potential shoulder cause conflict especially within the correctional setting so even more importantly developing that therapeutic alliance mutual goal setting transparent planning in realistic expectations are really useful tools in establishing cohesive treatment relationship with greater potential for success so so today. I use many of these guiding principles for holistic review. Someone's paying experience using the clinical reasoning skills developed over the past S. twelve plus years have been refined by my roles coordinator for chronic pain rehabilitation program through interactions with providers in the Mayoclinic uh-huh clinic healthcare system watching leaders in the field of pain science education such as Louis pointed era Adrian Low correy's Zimny as well as my recent participation in the Im fellowships course on pain science and psychosocial implications musculoskeletal care which was excellent. I've learned a ton and I've come a long ways from the time in which I would perform one del signs during an objective exam to if there are indications indications of non-organic presentation. I don't even use those anymore so I'm continually learning but now I feel I have the tools to. Maybe not help everyone. Everyone especially those are not ready to start on the journey but for the majority who request assistance I've gained greater insight through my work within the bureau of prisons and that translational research into the neuroscience and plasticity that occurs in the developmental lasting pain and how to better identify address and phenotype the various types of pain to develop a comprehensive and patient centered plan to embark on the journey together other to come to a point of enlightenment in which they feel better and can do more so it's been a fun and exciting journey thirteen years ago. I dreaded added seeing the patient with longstanding pain. Now I get excited to see how we can change or influence or presentation through a thorough evaluation and treatment the combining education active physical therapy. I think truly were a function of nervous systems and amazing neural plasticity interconnections. It's a masterpiece of science harnessing. The nervous system's ability to change itself. It's fascinating in clinical pain rehabilitation. I think a couple of facets of Pain Management Ring True William Osler stated listen to your patient as he is telling you the diagnosis basis and this is really true in the pain experience listening. The patient helps us put all the pieces together in addition empowering. The person listen creates change so looking at how do we create behavioral change especially in someone who's entrenched in different mindsets while it certainly not through telling an individual what to do. We know this doesn't change behavior however joining the patient on their journey meeting them where they are providing insight and information that's directly applicable to their life and they can Z. The meaning and the why in a particular treatment makes all the difference so the `nigma pain and all of its complexity in perplexity asks asks become a joy professionally challenge myself and the patient to grow and change so that was a long answer but that's a little bit of Information Information About Chronic correctional system. I appreciate your input in inside any. It's just fascinating to hear. You're you're experience with this in knowing that this population is complex not only just the setting itself but knowing that there's a lot of layers is to the onion if you will and it's not just kind of your run-of-the-mill straight easy ankle sprain we used to always joke in the clinic every time he saw you know on the schedule an ankle sprain an ankle sprain and I'm sure it's the same with every patient you see with that. I think we'll wrap up our show. I think you could have tied up all those ends any better to show the way you serve your patients and not only that but also serve our country so can't thank you enough for what you do day in and day out and takes shedding some insight and light on what you do within the US public health services specifically within the Federal Bureau of Prisons so thanks for joining us. Thanks mark. It's a pleasure I really appreciate it okay so my head is swimming with facts on the US public health service. Listen all that encompasses hope. You enjoyed getting a peek into the ways. PTA Correctional Setting perform their duties as always thanks for taking time to listening. If you're a consistent listener we thank you be sure to tell a friend or colleague about the show and as always I look forward to you joining us on the next clinical thanks for listening to the clinical podcast cast with Dr John Childs and Dr Mark Sheppard for more information on the podcast guests and the latest in physical therapy visit. WWW w. w. dot evidence in motion dot com slash blog you like this episode be sure to subscribe like rate and review on your favorite podcast directory.

US Public Health Service Federal Bureau of Prisons Federal Bureau United States Public Health Se chronic pain United States Mark Sheppard officer Dr John Childs PT diabetic foot Steve Spoon army commander jess Surgeon General United States Pain Rehabilitation Center Ballon College
"#Social Distancing"

The Tony Kornheiser Show

1:17:11 hr | 11 months ago

"#Social Distancing"

"Previously on the Tony Kornheiser show. I am so pleased. We've been able to grow and develop the American East conference into one of the great conferences in the country. It's not it's not that I'm also low level D one please to keep Binghamton out tournament year after yes. Give me a number for her. I have a general number and I have an email. I don't want an email gentlemen. Her number this is what happened with American Express. You can call anybody representing up to send an email. They won't take your call. The Tony Kornheiser show is on now. You like apples. I got her number. Did got her number task to call her today. I got her number and make very very happy. I'm GONNA call her. I'm GonNa say what are you doing? What exactly allow pay dues into the General Fund of the America East? I think we do. You got to have a play in game. We're not GONNA win anything but you gotTa have a play. CanNot discriminate against anybody this way and now up particularly us so I got that. That was Nigel's voice on the other end Gary. Braun is here as well jared free. Who's a professional comedian and work last night? In Washington D. C. And is a friend of the show. Jared has joined us today. Michael Kornheiser is here as well. Bill Isaacson is here We have in honor of I think International Day of the women. We have no women on the show. Jeannie is in California. Liz is in Mexico and God knows where toward Gulfport. I believe there you go. So that's it exactly. That's it Let us start. We're GONNA start ultimately with social distancing a term. I heard today for the first time by Dr Anthony. Fauci who I watched on the today programme. 'cause he led the show. And I imagine a term. You would like of relevance. Yeah so Elizabeth. Warren dropped out yesterday. I watched that. She came out with her husband and her dog daily. Really lovely if you believe. That's really her husband. If you believe. That's really our dog. That was not rented just the afternoon. And maybe that's true maybe that's true. She came out She says you know she's waiting to decide. She's not going to endorse anybody. Right now. She may actually be undecided. She may be working for a better deal. I mean if I'm her I'm listening. I am listening to offers. What can Bernie Sanders? Give me. This is the same guy. She accused of smearing her on television during a debate. And Joe Biden who she happily ran against and thought was inadequate for job and thought was not as embracing of her policies as he should have been so you know. She's out there handing her small meager delegates to somebody and let's understand something. She finished third in her own state. In presidential primary she got beat by Bernie. She got beat by Biden on so. So how great her Massa votes is is yet to be decided but she's a player in this and like everybody else. She has the right to leverage her own position and make the best deal she can't maybe it's a cabinet position low ceiling but look extraordinarily loyal base. Yeah y'all those people however many there are most of them many more than half of them will go where she asked them to come right. So so we'll see about that She now she's she's really good at policy and all of that other stuff anyway. The the larger issue here is she killed. Bloomberg's he did so the Nago she not she. She ran across the ring. Tyson right through one punch and then it'll fists against her then if they hadn't pushed her into neutral corner he'd kill the garden that was. That's not a dude who's used to being spoken to that. He was stepping her morning coffee. Selena engineers Mug fifteen centrally burned half a billion dollars in thirty second costs on fire. So where where? This leaves us now. Is it leaves us. We're not having a brokered convention. Is these two guys sees two guys? One Guy was vice. President of the United States for eight years was a long-term senator had been at the forefront of a number of very sort of galvanizing moments including the Clarence Thomas hearings and Watergate hearings. When he was a kid he was involved in the Watergate hearings. The Guy Communist. I know that's funny. I say to be funny and also I think true democratic socialist. There's a lot of the things that have happened in my lifetime. That I didn't think would happen. I wasn't sure that the United States of America would elect a black man. President wasn't sure that I certainly was in my sixties. When it happened it had no one had ever run whether they'd run in the primaries but nobody had ever gotten this close. I didn't think businessman could win a reality. Tv Show Guy. Played Golf Lynn and said afterwards attack possibly be president and he won. So I don't think a communist can win but I'm over to in the most recent presidential deal so I could be wrong. We're jared you must have a load of material I I like to tell you the truth. This is where I get my political news so I this is my head. Yeah I but I'm saying like I to me like you know the the Bernie. You know the Bernie. Buzzwords are our worst to me than the Biden buzzwords. Like the things that motivate voter like you know you have people looking for free college and they would say well. What do that's not what it is. I don't care I look at headlines. I look at twitter. So I'm not. GonNa you know that the person that I imagined to be a Bernie person is an unlikable person to me L. Fair is a fundamental Hammond Ryan. So I and then they'll come back with healthcare and tell me that I'm an evil person so like they live. I This I'm I'm a fan of the show. I want to say that because I I love the show so much and I think like a lot of the political leanings are because of kind of the conversation that's had in the show that land the gray it lands in the you know these things you know. Our politics are tough and all this stuff is really difficult. And the Bernie. People seem to live in the land of your either evil or you're good and that's not like I think that's how they see things in a very black and white term. I mean that puts me off at any one of these two guys is going to be the nominee and if that person wins they're going to be in their eighties in first term which means that the vice president joice would be seventy nine on election day so you know. That's his birthday. Oh No September but he's currently we do this. You know every once in a while. Is Tom Brady every once in a while? A guy into his forties still great. But it's not it's not frequent bind doesn't even know who his wife is actor right and he's holding up. The hand of the winner goes. Oh that's not my sister's anyway result. That was going to start with. I did start with all that but then I watched this morning the today show in Fort. What's matter nothing? What is smiling shanking? Say He's enjoying the show. He was at dinner last night he cooked in the last three days. When reminded me make sure we need come over? You bring the bag your bag. He brought the whole rat samples. Right right we just got the good balls to save him for your house which is fine but we have enough. Because we're we're all we're not gonNA make it through this anyway so then I watched the today show is in full panic this morning. Absolute full panic because hold is not there and savannahs Craig. Melvin IS WITH KRISTEN. Welker and they're not usually doing this show. And their first thing is corona virus and they label that boat the corona virus crews and. I think we'll see. Can I sign up for that? Sounds like fun because everybody's got the same disease and decided where that boat will be incinerated still up again if you hold protection there Micky Arison you own on the line and the Miami Heat. Nobody nobody's not in the near future. Nobody's going anyway So there they bring on Anthony Pfau chief who is a brilliant man who is the head of communicable diseases. Nih and is you know right out there in front after trump speaks after trump says. This is what we're going to do an after pants three days later. Says you can't really do it. We don't have it then they bring on FAO cheap because you you assume about thoug- he starts talking about. He says look. It's not it's not yet. Don't worry about it yet. I mean you can worry about it. It's but it we're not into. He didn't use this. We're not into the doomsday sequence yet or anything like that. But he talks about social. Distancing heat says that phrase three or four times as if we're supposed to know what that means. I don't know what that means social this. I I assume it mean. Get away from me. Yeah don't touch anyone. Because now everybody is using their elbows though elbow. Use the HASHTAG social distancing to get some free pure L. on twitter. That's what it feels like a marketing campaign. He's going to be making money for some social. So I I think. I think it's incumbent upon Craig Melvin to say hold on a second knock. Just give me four or five things that that mean. Did you see the woman that She was telling people. Don't touch your face. Don't touch your skin. Your target goes. Don't touch your own face. And then she licks her finger to then turn the page. It's like these. Are The people giving us direction going crazy? Nobody here we still hold our phones or phone knows what to do when the greater level of this show. Who's going to be surprised if even at the NCAA tournament they say you can play the games but nobody can come in. You're going to have to watch it on television. Large crowds gather. Everybody SORTA gets nervous if if I logically. I got a lawyer in the room of. Tell me if I'm wrong. Social distancing would seem to me to say shelter in place. Get stay where you are. Don't be out and about routes hunker down not in the hallway. Give away ice and for and for those not low. Move to listen to this show since we last met three confirmed cases Montgomery County. That abuts. Where why are we do this? I Live County where I live. In fact yes in Washington state. Having said that everyone stay. They've already gone out again. That's that's that's great if you work as a computer person and you can have about the guy building a house. How about the Guy? Fixing the road? Yeah and the police and firemen. How about them? What are they supposed to? This is why the stock market is going down Wilson. Points a day. Yeah I mean it's GonNa it's GonNa have an impact on the economy doesn't feel like they're they're avoiding saying. Hey if you're above this age stay in the house. Well I'm not a but this is really. The people are three people diagnosed in Montgomery County tour in their seventies. One is in his or her fifties her fifties. So yeah I mean this is one of the good ones if you're young because you get rid of us you get the inheritance. Traffic is easier sure. Everyone's using apple pay. All the sudden life is good. Yeah get rid of you. Yeah nobody's using cash. Tsa parise really moving. All my his campaign released this thing because that would help him tremendously. I mean I'm as I'm as lost as all of you. I bring it up because it's it's funny until we die but it's funny funny for Awhile Comedies. About till you die. Let's laugh so we'll take a break. Day will join us when we return. She's got a bunch of movies to talk about and she's she talked to. Mick Jagger at great length which is something. I would have always wanted to do so. We'll be back with an horn today. I'm Tony Kornheiser. This is the Tony Kornheiser show. This is the simply safe fair. If you think Corona viruses designed to make you simply safe is flying in there as you just get more and more nervous you say. 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Tops as long as Michael's there and there's absolutely no trade offs to your safety. You'll have an army of highly trained security experts ready to dispatch police to your home at a moment's notice. Twenty four seven. It's only fifty cents a day with no contracts and that is why the verge simplisafe quote the best home security system. Go To simplisafe and let me spell that for you as always do s. i. m. p. l. i. simplisafe dot com slash. Tony Today you'll get free shipping and a sixty day risk-free trial. Nothing lose their go. Now be sure you go to simplisafe dot com slash. Tony that is simplisafe. Dot Com slash. Tony you're listening to the Tony Kornheiser show. This is a song called far from here. It has sent to us by had. Paxton who writes? Please play a doctor to do. Ron Ron it's available at Pat Paxton Books Dot Com again of skull far from here speaking of books really relevant book out now John Adams Really. What are you writing a book like I'm watching? Msnbc values John Adams. Oh I think today is the anniversary of your Boston massacre on. That is SAM's brother. That's why he did the beer thing. He was smarter. Tobu's lovely Paxton very very lovely It plays in an Horner Day. We got a whole bunch of things to talk to with an Hornets including some movies. We haven't talked to an since the Oscars and I've always thought we're in March now. I always thought in that. This was the time of year where they dumped bad movies where they felt these movies. Aren't that great. Let's see if we can get some sort of roll out of them because there's no real good movies now. Let's see what we've got him? I wrong on that now. Oh unfortunately and I. It's something of a an obsession with me that we need to fix it. And I don't know you know Oscars has a lot to do with it. Which is that studios are now holding onto their best stuff so that it can compete with the in the Oscars and so then that means we're Releasing it in the fall and so tends to be a little bit of a desert. I mean there are some there have been some good movies like often with the season. We're going to see some of those foreign language films that competed in the Oscars You know so. It's not like there aren't any good movies out there. But it's definitely an and it's you're right. That is definitely the dump season for when they put out their lease the stuff. They have the least confidence every once in a while. You get something really good but they tend to be quiet movies. That's true quiet Jarrett. Can't wait to get into. This is taken season at the time of year. That taken comes out okay. Yeah Yeah you get to see. His Dog Kidnap Little Chamber piece about human emotion but also went to grade. It was like Liam Neeson's because I remember the Greg. You were a big fan of the gray. I remember why you're right. Once since cool scrape Walberg I saw has a movie out right now. That like mark over come it looks very Liam Niessen Ish. You know all right so anyway. Let's get to what we've got on the docket here and the first thing is once we were brothers. This movie about the band. Is this a documentary about the band? Yes a matter of fact you'll understand this when I tell you when I saw The no direction. Home that Scorsese Dylan documented. That it it bothered me. No end that when they were talking about the tour in England when he got called Judas and everything like that I guess it was sixty six sixty seven sixty six that they didn't interview Robbie Robertson on a talking head and I'm thinking like wait a minute. You know he was there. He's a huge close friend. Who says what goods like. That is so weird to me that they'd and so now I get my answer. Which is they? Were saving it for this one. So it's a scorsese documentary. Based on Robbie Robertson's memoir it's very much Robbie Robertson's version and the other surviving people in the band. Hate his guts. Well yeah guards and I think is the only surviving personnel. The others before they died hated his guts right and so it's very but but even with seeing it through that Lens I think it was. There's a lot to value in just for those you know. Just for the the memories of those early years of the and there's some really fun like Ronnie Hawkins is in it and I'd never really you know great. It's all good to hear from a Rottie so you know for for For Fans I think it you know it again is limited to his point of view but they're still value in his point of view and it's just revisiting those great songs. And just that that amazing convergence that just amazing alchemy of of those five guys and I. I have a real kind of sentimental I duNno. It really gets to me when people work that hard from that young and get that good. You know like they've been doing it since they were fifteen. And I don't know that just like sends a shiver up my spine. You Know Young Mike go to school with Robbie Robertson daughter. I don't think so. I thought I thought she went to Penn. When you went to Penn I read that somewhere. I thought that but I could be wrong. Terry Francona Son. Was there when you were there but I thought this leads me a totally astray I have. There are two a music stations that I look at on my car. And if they're playing something that I wanna hear I play it in. One is called the covers station and today driving in here the wallflowers who are fronted. By Jacob Dylan Did into the mystic. Which is my favorite favorite song now. It's not van Morrison but there are when when Jacob Dylan start singing the hyper the you know the tough notes and then comes lower out of the tough notes you sit there in the car and go my God. That's his father God. The intonation is exactly Bob Dylan's intonation. I stopped the car to hear all of it because I was so amazed the inheritance of of that voice. Anyway I move I move around hope. Gap is something that Nigel told me about and he wrote a Middle Ages divorce story and so I thought why didn't think they had divorced. In the Middle Ages I thought was a a period piece. I thought the way you got divorced in the Middle Ages was somebody got put in tower guilt. That was how it works. So so this is not Middle Ages Middle Age. That's probably a Typo from my tax. Yeah it's like You ever see marriage story type. Did I see marriage story? And no no because I don't want to be depressed for two and a half hours by no of them. Is it all like last chance? Harvey which was sidelined rby. Yeah that was a great movie. Like that Dustin Hoffman Emma Thompson Thompson was so how is hope gap? You know. It's funny you should mention Emma Thompson. 'cause I was thinking. Why didn't they get him at towns visit? I really I liked it. It's bill nighy. Yeah see the science guy no impact. That's just being funny. Great Thespian. Go Ahead Bill Nye the British guy. And here's the here's the left turn at banning. She's not middle aged. I'm sorry. She's not middle aged. She's she's my age isn't she? What you call you old susceptible to the corona virus. What do you mean what would I call me? Cindy Boren Sixty seven me Tony Corners of seventy one. The next as now sixty one okay. Middle Lakes I guess. The next segment isn't called middle aged guy. Radio play a British couple and so my question was why isn't it then? I mean she's doing her. She's British actress. She's a future in this business. She's a very actress. But even but it's still very distracting to to you. Know to see her working on this British accent. That's my only quibbles. But no it's just it's based if the guy it's Written and directed by William. Nicholson who wrote a lot of movies. He wrote like gladiator and other stuff but but he also wrote shadowlands. Remember that Great Film Anthony Hopkins. I'm on that it's a really beautiful little movie and this is in that mode and it's it's a memoir of his own parents break up at an advanced age. I mean I think he was in his twenties thirties when it happened. And so it's very. It's not depressing. It's just kind of about these people moving through a passage. It's painful but they get through it and he gets through it and it's kind of contemplative and reflective and okay not a lot happens not bad thought it was not bad I thought it was actually really compelling really genuinely moving. Okay Chance Harvey which is is not the same kind of movie. It's really good. It's really good and it took me. I'm embarrassed to admit I don't think I appreciated it. The first time I saw and I probably gave it a middling review and then I happened to catch it on a plane. You see something on a plane and you see it for what it really needs to be and I just thought Oh my God that movie it worked it worked and that speech at the wedding that he gives it just on does every time There's a movie I don't know anything about it. But Steve Coogan is in it and he often makes me laugh and it's called greed. Greed is by. Yeah greed is by Michael winterbottom. I don't know if you know that. And they know the name. I don't know the work. Yeah he's edgy. And He makes he makes calm. You know he's always in it. He always got his finger in the in the in the wind. And he's always trying stuff out. I I would think this is kind of A. I don't know I think maybe fifty nine sixty forty proposition don't it didn't work for me. Coogan is always great to watch. He plays a high flying. You know superwealthy Clothing retailer. Who's made a fortune on the backs of sweatshop Labor And he's celebrating his sixtieth birthday in Greece. Oh speaking of gladiator you know. In his themes gladiator. He wants to kind of reconstruct a coliseum with lines and everything is you wherever we found the taken. I think we've found I. I'm setting my calendar so anyway. Yes so it didn't. It's a cut. Yeah I unfortunately. I don't think it necessarily works. Although my favorite you know my favorite Brit Com is this little show called upstart crow about Shakespeare. Oh ever hilarious and the guy that plays Shakespeare David Mitchell. He's in it so anytime one of my Brits is in a movie I rejoice because this would have been a great opportunity simply right. Greed is good. Yeah beginning or end. So my favorite Steve Coogan thing of all time and I know people are GonNa think it's the trip. It is not no it's in. It's in the Ben Stiller the fabulous tropic on Tropic Thunder when his head blows up just so good and tasks. It's so good the first time I ever saw him. And I just said this guy's great head blows up to what tropic. Thunder is. Great for you can't you can't make it now. It's so it's such a great Hypol- so there's there's something also called the burnt orange heresy. Yeah and Mick Jagger's at so I'm I don't care about the movie as much as I care about this. That the new direction of an Hornets career. The an Hornets cottage industry the Hornets. Annuity seems to be the viewing rockstars about movies. This is there's books in this. There's money in this. I've told I've told people a great story from Monday night. Football where my driver? My bus driver Jeff. Leonardo was for many many years a rock and roll bus driver. And he had jagger on a tour once and the rolling stones each had his own bus but Mick Jagger because of the difference in Time Mick Jagger when he was done with his set and it was about three in the morning that's when he called his parents and he called his parents and when they got on the phone he said it's Michael and I love that story. I love that story and and and the people who are named Michael Philip in the world are very special to me. So what was it? What's he like what's he like? Oh well he's absolutely early terming and and he was he was he called. It was not a one on one interview. It was not an in person face to face interview But so yeah we told you he hasn't called me so it must be important Yeah I and he was turning and and he's very good in this movie. Which makes it fun. You know the the movie is a little thriller about the art world and he has. He is not a cameo about the art world. There's only one there's only one thriller with the art world it and it's been made twice now hasn't it? That's right. We see McLean was in Britain and it's so good. Good the movie this movie. Has You know you could quibble with it and And I would if I were reviewing it which I'm not but no I so far. Everyone is agreed that he's probably the best thing in it. Yeah he's really good he. He gives a really good very specific very fun performance. And it's interesting that you said that one of his kind of one of his narrative jobs in the film is to kind of get the get everything going and sort of Jack it up and you can and you can see him do that. It's like Oh you you know here we go. He's just brings a lot of energy and sly humor and all that but no he was He was very very He he talked I think if I was more twenty minutes so I think I think I kind of like you know when I interview people. I tend to just want to have a conversation. Like don't I don't pepper them with quite like I don't go down a list and say okay number one did it a and I feel that in this case I should have you know because I feel like I. We both went off on tangents that weren't particularly productive but it was just fun to talk to him. You know and I and I and I did have to stick to because we have so little time. I had to stick to the movie and I would've loved to have just really chopped it up. You know about other stuff. But I just didn't have the time and it would not have been cool. So you've talked to Jagger and you've talked to springsteen next Dylan's on my I think it has to be. Don't you think it should be? He's GonNa be tough to track down a Bob Dylan. Paul Simon's actually been in movies. Sure that's a good one and I think he's produced a couple of movies in cave. Nominations I'll take I'll take suggestion. Just take the biggest the biggest people and then you save all the work and then you're kingsman released a new book. Interestingly enough in that Robbie Robertson documentary even you know and he he certainly has a big movie career Robbie Robertson is fine to put in yes in a newly dead you know when they first started getting success. His first instinct was to go do movies. Like I wanNA work with Birdman. You know so. There's a definite kind of Simpatico there between the Rock World and movie wanted to go. You know like this. That's good thank you. And what can I just WanNa give a plug for? Excuse me a movie that Ann had plugged when it was coming out. And now it's making the rounds on cable. If you've not seen that you love it. It's called Juliet naked. No it's it's music and movie. I'll know who's WHO's a block in it. I Forget Ethan Hawke. Oh Yeah it's just an utterly charming movie. Yeah you will love it when you see it and it's making around cable right now for you for all of us. I don't have to read it. Good not into movies in by everybody in. Hornets boys and girls. We will take a break We'll have news when we return. I'm Tony Kornheiser. This is the Tony Kornheiser show. This is the policy genius sad if there's one thing humans aren't great at its predicting the future is let's just take a look around noman of crystal balls fortune. Cookies are t leaves could predict the world that we're living in right now but unpredictability is also what keeps life interesting. Well that's one spin on it. The trick is to enjoy the ride without worrying about. What's around the corner? I Dunno if you're on one of those ships now I don't know I don't know And one way to worry less is to protect the things. You've worked so hard for like your home. Which means you need home insurance and you do. Which means you try policy genius. I had to policy genius. Dot Com. Answer a few quick questions about yourself and your property or properties. If you've done well then policy genus will compare your policy against options from top insurers to make sure you are getting the ride home insurance coverage at the best possible price. They've saved their customers. An average of six hundred ninety dollars per year. Doing just that. That's substantial to me if policy genius finds you better rate than what you're currently paying. They will do all the work to get. You switched Yona cars well policy genus will compare your home and auto policies across different insurers and even mix and match to find you savings so if you haven't found a play by play breakdown of your future inside a crystal ball or cookie that's okay protect the things you've worked hard. Forget home insurance with policy genius in just a few minutes you can find your best price and apply policy genius dot com policy genius. We will always get the future wrong so we better get home insurance right. You're listening to the Tony Kornheiser show. This is nick. Bowen played much of his music for and he writes his one to send you a new single called a moment in time for my upcoming solo album at Saint Name. Thank you for your time. I hope you enjoy. We always enjoy we do. We are watching. I'm watching right. Now get to Michael in a second. There's one of the House doctors on NBC on the Today Show. Right doing fat or fiction. You factor myth. Don't go to restaurants scare and should I be Carson. Daley is holding up a sign. I mean you just go please. Let's not trivialize this. Let's actually try and give people a chance to understand? What's going on social distancing? Does you're out doing six feet. Anyway gives us more time to listen to nick. Bowen you can listen to all songs in their entirety at the end of this high-quality podcast showing the social distancing everyone looks at the bash. Brothers right you have to. You have to be about four or five feet away. Stop making out with strangers. Michael how do people send us to music? And this music by emailing it to Jingles at Tony Kornheiser show dot com. My only problem with this. Well I mean I shouldn't say my only problem but it's the trivialization of it. This your life is on the line and they are holding up signs and you know I'm just treat people seriously and listen to what they say. Anyway go ahead on that note Mr Tony. The CDC has issued a new statement. I believe regarding the corona virus. They've said if you CAN DODGE WRENCH. You dodgeball rip torn in his. Greatest role. Take worth Would you like to start off with college basketball match that you wanted to speak onto the San Diego State game so yesterday? So on the P. We'll bond is God knows where is in Chicago yesterday's in L. A. Today Wolf is going to bring back the corona virus at some point and in a in a in a neatly row box and just handed to everybody So we don't have a show. I mean we don't really have had anything great with rehashing the same old young time and time and time again which we've only done for nineteen years now that we have a sense that we could have a big story because San Diego State is down in the first round of their conference tournament by four at half and then it's eight early in the second half so Kelleher says you know. Watch watch this. Because IF THEY LOSE WE'RE GONNA lead with San Diego State. Losing course we are because it bumps out of a one and probably puts Dayton in as a one So I sit down to make room and and within five minutes Sandiego stadiums so so we have the same old bitch. Tom Brady. Yeah that was. That was the one that was the one moment that we had yesterday. And also of a local nature American University which was the two seed in their conference was ousted by Bucknell which was a seven and what the only thing that surprised me about that. Because I don't know anything about either team 'cause I mean Aldridge is in charge of American Bucknell is usually very good. Yeah I was surprised. They were seven bucks. Bucknell is a team that has I think one games in the NCAA tournament. So I was surprised at that to Professional Basketball Steph. Curry returned to the court time in four months. Now fifty eight games you Miss Christie. Twenty three point. Three seven seven yeah. He's seven minutes. He was only six of sixteen but he handled the ball pretty well. They looked like they had great energy when he played. I couldn't believe he came back. I would wait. Why not wait Th this year I think you just come back to get your legs onto you. I mean I don't think it's anything of importance. They're not gonNA make the playoffs. They're terrible team yet. You don't WANNA get too high up to see we're going to find you a new team. Frankly given their issues with TV and ratings that that is a nice service to the fan. Yes I mean absolutely must. Tv watching him go through the great to see. He's great to see those one other game and talk about the Clippers Taipan went to Houston and and they won easily And that was a message game. That was one of those rare message games where they said you're within a couple of games of US third place and we want you to understand that you guys are losers so we're going to beat your brains out and that's what happened. James Harden who gags in the playoffs in all the time James Harden in a big game was over eight from three. The rockets were seven for forty two from three. They can't win with that lineup. They have to make twenty. Three's they have to make twenty. They take fifty. They have to make twenty to twenty five. Seven forty to their team has become like religious talk. It's very polarizing to talk about it. There are a lot of people who just hated hated. Yeah they hate the fact that they got rid of all the basketball. They're offended. This is Daryl. Morey who is still under house arrest right. Yeah but he's allowed to use the phone so he's able to tell my dad. Tony how he wants the team constructed in what will probably be his last shot because the owner looked. Nba owners lost money because of the China thing. Now everybody's losing money because of a different thing in China but the NBA lost money. China got very angry when Daryl Morey said and what about human rights abuses like an quick yeah the NBA said. Oh we love China. Well what about human rights abuses? Come on now so anyway. Down Mauri has been I think unfairly targeted as the worst person on earth but when you take away money from owners and players and players you know. I don't know how long are more gets with that team speaking about money and players the CBI has been sent to the players By the NFL. So you said it takes about a week for them to vote on this. They're being given a week. It's GONNA take three weeks for them to read as it anticipates tied hundred fifty six pages. The table of contents walls bracket knowing the table of contents alone is fifteen pack. No one is going to read this thing. The owner's haven't read it. The players aren't GonNa read it. I wouldn't read it. You wouldn read. It is four hundred fifty two pages long if you had to do a book report on it to graduate from high school. Maybe read a hundred pages. I I can't get through a solicit tweet. I mean I get it. Yeah I'm not so it's not no. It's not know what you do. If you're a player as you do the following thing she go to you. Play a rep on the team and you say what do I do? Tell me tell me what this is about. Then you call your agent and you say tell me what I ought to do. The somebody in your agents firm not your agent. Somebody in your agents firm is going to read this yet. But you're not the answers money always right. You know it's all your questions is money and the agent. That's how they live through. You know the agents going to tell you what makes us more money and what makes us less money. That's that's what's going to happen. I don't know if it's going to pass but if it's going to be an honest vote from people who've read it. There's no votes because no one's going to read it. It's an interesting like twitter versus reality moment to for me like you know what you hear from the big players. I'll we'll never. We'll never have enough money. Yeah and but it was. No one's talk asking you know what the The Guardian. Thanks Steve Percent of the people. This is shocking if you know anything about NBA salaries sixty percent of the of the workforce in the NFL makes a million dollars or less guys on a bench in the NBA. Making twelve million dollars a year average length of Adra at length. When you to make your money money take the money and say Darren Rogers thanks. I'm going the other way and good luck with state farm. Yeah that's right. Some news coming out of Ashbourne Mr Tony couple things. First and most importantly the redskins announced the tickets are on sale. Now for harvest fest commit winning. Also they have given seven time pro left. Tackle Trent Williams permission to seek a trade so permission going to leave epsilon and the redskins play now now. Rivera tried to convince them to stay. I understand that he wants to leave. He has his reasons. He's still never make up the money that he lost nine. Although twelve million or something like that was more than and they will never read. The team will never make up the value that they law. He was do you. Negotiate negotiate a contract with another team. The redskins you're saying. Well let's we'll trade them so at least we'll get something for a rouse. They they lose him. Complete emanates should not be commended for coming coming to that realization a year later than they should have done. It lasts never going to play for them again. Well what they thought was with a new coach he could. I'm sweet. I'm just saying if you believe done. And there was a lot of talk of it on this show with Jason. My he was Jason. Had this right. Yeah field by five miles on this. I mean I listen to this show. I'm not even redskins anything I've never you know I'm from New England. I'm a Boston Patriots. Fan Whatever but it's so interesting to hear you guys. Just talk about the Redskins like I I. It sounds like a like a like a family member with like a drug they do. I don't know and I feel for everyone because I know I've friends from the area and there is a love for the you know the memories and all that stuff and it's like it's just interested as a patriots fan. Where like I feel like you know I feel bad I thank you I got you guys. Welcome to Gulf Mr Tony Bay Hill the Arnold Palmer Invitational Roy mcelroy At six-under just stroke off the lead. Yeah that's best ever opening round. He hasn't finished worse than t six there. This all starts with the par. Fives got off to bit of shaky. Start but quote for more if you can play the par fives while you can play the rest of the course pretty conservatively and pick your spots. He said pointing out that. That's what tiger wood tiger woods used in. All of his eight wins at bail. That strategy works. How about a two hundred sixty yard three iron from a fairway bunker that sets up eagle to sixty two sixty out of sand how to sand now the best part about early coverage for the for the spring season is that you get a lot of Sandy? Yeah those early round coverage any almost one full rack though. I think I don't know who he's talking to but he goes. Come on man what we go out of your bed talked to captain kept going. I think shoots even par and just wonder. Is there still a lingering issue with that? Surgery had in the offseason. What's happening is really only gonNA get juiced up for the majors. But it's it's the it's the return of the Premier Golf League stuff with Rory. Rory was very open about being against it and he keeps using the phrase independent contractor. I don't want someone syncing where and when to play. And he's doing this sort of in the booth or and I didn't see the full interview so forgive me if they did address this you see the NBC crawl NBC Golf Channel Crawl or bug on the bottom. He's partners with the golf channel. Nbc sports through his Golf Pass. Which gives you insight to the life story. Macaroni and that just seems disingenuous. Where as an independent contractor? No you actually have a contract with someone who could be in play and I think that should be at the front of that conversation. He doesn't say that no. I didn't watch all this but I don't think he's really addressed that yet and I miss a few months ago. You and I were discussing if there was a player. This season and the National Hockey League. Who's going to school five goals? You adamant it was going to be. Mika Zibanejad for the first time this morning on a highlight and low behold he scored five goals to match the New York Rangers record and including the overtime goals. So the only thing that I thought about when I heard about this was what goalie did he get the five goals off? Was it Hopi me and it turns out. It was Samson Sam so I just wondered about that. He pulled because the game was closed the whole way. Obviously but you know five goals a lot of time to worry. Yeah you think that the quest for lovie getting seven hundred did take toll on the team. I think they they might be giving the most goals in the NHL at their tied where they were playing badly before that. Though I mean they've been five hundred or worse for about half a season I hope your. I hope you're getting excited for penguins in the first round. Yeah is that what it's going to be? I don't know I mean is the penguins of the flyers that face in the first round well the flyers just tied them. Fires have one eight. Strikes aren't fire. They just gotta find their footing 'cause we we haven't waved the flag outside the restaurant anymore. Maybe we should. Maybe you need to do that again. Bringing hope stick stick protected Congratulations Garth Brooks wins. The GERSHWIN Prize. That lovely I I read the story today. I'm Paul Simon. Wanted the first time it was given out over ten years ago now and Stevie wonder as one it Carol King is wanted Billy Joel Willie Nelson. Paul McCartney has won it. I guess I I didn't think a Garth Brooks in quite the same way but I don't know much about Garth Brooks. I've seen him perform a few times on television. I've always liked him a metamitron always like he was a lovely champ. Yeah so I'm happy for recent comments about his engagement with his audiences at these. Contrary does the full three sixty rotating stage to make sure he can try and connect with every single pocket. It's really great to hear the Beatles in the he was a football player in college. Do I have this? That sounds vaguely familiar. Oh why do I think it was something like? Oh Yeah Actually College football which you don't you know you don't expect them. That's been a huge fan a hater but predisposed to like him for whatever I find him very pleasant. Karaoke song friends in low places. Yeah right song you know. Great drunk vary okay. Yeah that's just seems nice and I know you undertook. Cbs is going to be airing on the national women's soccer league. I in High School Malate football and baseball and ran track and field. He received a track scholarship to Oklahoma State University. Where he maybe? Pti watcher maybe who knows he's never sung about it. Yeah so the women's League's going to get a chance. I don't think that'll be on. Cbs Network probably on CBS sports. Cbs Sports yes. But they're GONNA get a chance won't be there won't be their last chance. It won't be because these things recycling everybody gets chances but it is a chance to see how many people want to watch actual women's soccer and not the World Cup soccer world cups an entirely different right circumstance. I mean there's an emotional response to the World Cup. That is not the slog of a weekly soccer leap but we wish them on you. Don't go to the bar for the game. No doubt no you dumbass. No Day drinking Tuesday good. Yeah I've got one final story from my home country. In England. A drunk university student was trying to get home from a night on the town. Mistype the address into his Yuba when he got into the Uber in New Belgium. Now I just typed in Norwich address which is two hundred and fifty miles away. Didn't he did into a wall? Could ask slocum. Couldn't get to ninety five. Couldn't find the Delaware Bridge Seventeen hundred dollar bill? He awoke to but the driver said Oh. This was a mistake. I'll take you back. Don't worry about it. I'm not going to charge you for it. So a five K. And that's what we do it in England. My that would raise some concerns about what that did to me then. I got what I wanted. Let's get out of here. Return and we will talk at length to jared. I'm Tony Kornheiser. You're listening to the Tony Kornheiser show Kornheiser so most famous baseline in all of music guy. Radio this is Michael. One of the highlights of the temptation show on Broadway when they sing. This is just really really good. We're playing it because it's great. But yes because it's brilliant in on this date in nineteen sixty five it hit number one of the first number one hit for the temptations written by two members of the miracles smokey Robinson Ronald White and smoky not round white comedian. Not Run right the Canadian no but I think really he was. He wanted the bulk of it. It was written as an inspiration to his wife but he didn't singer. Oh we didn't see it. Oh He's if you write this song and then you listen to this other group. You gotta think to yourself on that one. Should I mean? That's what a million hits. Paul Simon would say that about bridge over troubled water because he gave it to. You should sing this well being the wings being like you know what? Yeah but let should be singing but they were. They were making together. I mean smokey Robinson was in smokey Robinson and the miracles not the temptations. I wonder how much of that was. Just the inner workings of of motown where they said. Look we've gotta get a number one hit for these guys all right so It's just a great song. It's really jared. Freed is with us. I'd I'm unfamiliar with your work. That's okay but But you're a big fan. Huge Fan of the Bat. Isaacs sent me a link to all the publications. You work for none of which I've heard now none at all none at all. My resume doesn't look a lot like yours. Yeah so you know. Jared from nine hundred seventeen and parasite yeah. It's very big year for your second world. Where are you from from Boston from outside of Boston from a suburb outside of Boston? Need them next to marry Dunkin? Yeah Yeah Yeah and I live in New York City. I am comic and I I have to say like I'm such a fan of the show. I like nervous to be here more than I have. No like seeing Gary Michael Seeing Sneaky. Tall holy man. This is everyone's taller that I thought Gary like the voice coming out of your face. I didn't see a common like radio. It's beautiful beautiful man. Michael The you know. The dulcet tones. I and I started you know I. I went to Penn State. I was selling life insurance and I. The best part of my day was writing funny emails to friends and I was like I just love when someone on a group email would be like. That was so funny with like. Come off the email chain or text me. That was so hilarious and I was like okay. I have to inject this drug in my vein so I went and told my parents I was like I'm leaving. My you know financial job to be a comedian and how they reacted like Jewish Jewish parents do and there they were like. I came out of the closet. They're like how long have been found. And it was really that moment and I'll never forget the conversation like my dad was like. Oh you'll be one of the guys in the writer's room at thirty rock like on that because the show was big at the time and I was. Yeah I was GONNA go knock on the door and talk to Lauren. You know like that's how it's going to but my mom didn't get it. 'cause MOMS I think in general want to like say. Here's what my son is doing. Here's what my daughters doing and have an easy answer for their friends and community And My dad was like Oh you know you wanna be funny for money and that's kind of how I've always seen an. It's an open mics every night. And you know I treated. This is a business and I started podcast. Just like you know you're doing here and I it's It is and now I tore the country. Doing stand up and live podcast. So how did you get? How did you get the nerve guts to jump into the volcano? How did you do that it? It feels stupid now looking back at the time I was like I'll break this down. I'll do everything like I. Funny for money has always been my like. I just WanNa make a living doing this funny as a kid. This is the thing no one tells you to be a standup comedian. No because they feel responsible for it right now. All you told me to do this. My life's ruined best friend was garry SHANDLING THREATEN I. I mean legend. It's I will ask ours at some later. If you're all the pressures on now I feel more nervous. Nobody my friends and I my fraternity in college. We were just like we were doing bits before we were doing bits like I didn't. It didn't dawn on me and I started doing so. I really did everything I dove. I took I took You know sketch writing classes Improv class. I was like I'll do everything I'll treat this like Grad school right and I went to open mics every single day. Do Three night and a New York City. That's where you are. I'm in the perfect place for comedy. So when you do something like that obviously you get feedback from an audience. You know what works in one thousand workshop do you? Then do you then sort of put together thirty minutes? Well thirty good minutes or do you not do it that no because I'm starting from zero so I have zero good minutes I have. That's don did you decide. This is the better question I guess. Did you decide? This is the kind of comedian I'm going to be. I'm going to concentrate on these areas. I'm not necessarily going to do what happened. Two days. It takes a lot of time to figure it out as you have to go on stage. I think that's you see a lot of comedians in the news for making a joke. That doesn't work and it's like yeah you have to go through the process of. Here's the idea in my head. That sounds funny to. Oh this is what it sounds like the state of people you know and then. Oh that's reaction. I didn't think it would sound that way. I didn't think it would come back at me that way. And you're building that way like when I go to a set it's I start with one hundred percents I end with one hundred percents and I'm putting nineties through you know through Zeros in the middle so I can I can dig out of holes. Come BACK FROM IT. And it's a. It's a living breathing thing that takes a lot of time and effort. That's why you have people walking up phones that shows now because they're like let me steal your stuff that will you heal your stuff but also tape you and say look out of context. It's not nice I mean. Look at Corona virus. We talk about it and we make fun but we also know that you make fun of it because you know it's serious subjects and you know it's you know it's affecting real people so it's like maybe the joke made sense that I remember. I you know I coughed in my hand at a month ago I said Oh man. I'm sorry I I just did a tour of the Wuhan province and they will be like Whoa. I didn't know if it was a joke. Yeah or China so I but huge. It's like it's funny now but like you know I mean I'm saying it on tape now and I'm okay with that. I understand why I grew up in the social media world where I know but you might have casualty of everybody having access to everything all the totally and you have to learn how to like you know but you know you know with your show you guys get emails. I hear you talk about it. You have to know what's a good note in a bad note and unemotional note and so I I work through every night. It's every night I'm working on new things. I Stan Bill Burr. I once heard him say I've made it kind of a religion for me where it's like new minute. A week means new of means fifty two minutes a year. And then I've added onto that and half of it's good now. I got you know twenty minutes so I kind of at least yeah exactly so like now. I'm at least working on it and it is a nightly job and I you know I'm here now because I'm opening Michelle Wolf and the she's one of the best comics in the country. You know there's nobody that's more you that gives you know. She's a friend but also unbiased. But also I know for a fact. She's one of the best. Because there's no better at taking note note in the back like you said with. Why would you give away? I say to her. Hey I got an idea for this guy and it is my great pleasure to see at work with in her voice. Do you How quickly can you assess an audience? And do you ever ask the owner of a place. Who what kinds of people do we have tonight do. We have torn Boston's Johnson here. Well I can only be me and I only have one act right. I understand it when it's an older crowd. I have to say I HAVE TO ADMIT TO I. Am I think a lot of stand up to is knowing what you look like to the people in the room and I think that's more important than ever now like maybe someone that looked like me? Twenty years ago wouldn't have to talk about being a white dude on stage. You know that's changed. I have to address. You know that I'm another got white guy. That's screaming on stage but that's a rich vein to tap of course of course now you flip it. You're you're thinking like a comedian. That's exactly the thought bras. Where okay now I have this angle. You know it's an it's it's the first thing it seems to me. The first thing you have to do a comedian is able to make fun of yourself. Absolute get people to like. You WanNa be likable. You want to be you. Don't yell at them all no. I'm not Bernie. Sanders wouldn't make a good comedian. No he would turn off a lot of people I I mean but also Bernie's fun to make fun of for me you know. I'm not a political comedian. I talk about issues like like you know the the I just. I talk about personal stuff like you know. I love talking about weight stuff. I love talking about trying to be healthy. I love talking about like I like being physical on stage like I'm not. They're I'm there to have fun. I want the audience as much fun as I'm having there's different comics for everybody. There's some people that are like you know I'm GonNa do political humor my whole life. And they're they're smarter than some of the people in politics like they. Are you have to know your stuff? Yeah I don't I know farts on your car. That's my t shirt. I know farts Hashtag. I know but but the podcast game has really helped me out individually. Because I have a you know. I through your podcast. I started one like I started one seven eight years ago and people were like you're early. I might not be right. You know I feel late and I remember listening to your show. On two different str- it was two different segments. And I found you because I was like I love talk radio. I love talk. I love de I in Boston like I grew up on that so I was like. I thought I'd be pretty good at this and I started a podcast and it's called the J train pockets and I I through you because you take emails at the end. I'll say I'll take emails at the end and people started asking for advice and a lot of it was dating and relationship advice. So now I'm a Dude. A straight guy telling people how to date and it's like. I didn't really ask for that because now I didn't ask for these questions. And now they keep asking and now like the audiences mainly women so I have like a great. It's great and it's eighty six percent women come to the show much fun. They love. You know they love Adam. Corolla this is kind of a certain version of Adam Corolla But this female crowd. That's been amazing and fun and they come out to party and It's great for me. So have you noticed in the last month or so is there any worry about touring that people don't want to get involved in in crowds with others that they don't know late at night or whatever? I haven't heard that I understand. It's to to me. It's still kind of like you know you still are people not going to go out. You know you kind of have that moment but I hope that doesn't real shelter in place kind of scary and you know people are saying well. We take the subway. I saw quote. We take the subway. So we're immune now it's like okay so but I I know that's not I just don't I guess what I want to get to and and I will preface by saying that one of the funniest people ever is Bob Newhart and he was an accountant. And that's what. He did shadow in his thirties and then he just became this. He was always funny but he jumped. He jumped. I always say to people. Yeah I I'm funny for a sports writer but no a professional comedian is a different atom. I don't believe I I've just gone to a gym. You know like I think that's the only difference like I. I listen to you guys. Gary You You know everyone on the show is funny like yes. It's different and I found that out the hard way like I thought I when you say like what type of comedian did you WANNA be? I WANNA be as funny for people as I was for my friends so I went onstage. I was like Oh these people hate me right away. I was like oh I have to figure out how to make the my friends and it took a long time it takes. It's still taking time did you? Did you go to anyone in particular? Who is your Guru and say just helped me out with this problem? More information Friends Comic Fran. Yeah peers people that like you know. Michelle and I started at open mics together. Like Michelle's a huge star now in in so great but like we were you know so when I say something she'll go. I like that. I don't like that that's kind of the the you know. I think Jerry Seinfeld's quarters like all. Comedians have a notebook in the pocket. They've done well. They've bombed so you have that common right away so sure. I have that in common with any comic. I mean I have done shows in China I went to China and I did shows in Shanghai and like you meet comics there and you go. Hey How do you? How does the somebody you're fluent? I'm fluent armed so I I saw the show that book shows in China and he was like come on out and I went and they have an American stand up club in Shanghai and they'd for Ex pats and I was like what are you say. What do you don't say they're like just? Don't Make Fun of the Government Daryl more. Yeah Yeah Yeah I was like. Oh God yeah great see. You don't do that my own country so I was like I'm good to go and Yeah it's just it's so even China felt. It's there's a comforting feeling being around people who do standup especially stand up so it's Yeah but you you know. The best comics are good listeners. So you have to listen. You have to hear yourself bomb. You have to hear yourself do well like it at all is relative. You know there's is the the one thing I remember one of those Second City bits. I think it was Moran. Est went up there to audition and act and an Eugene Levy was the more season comedian and Morales. Went up to told deliberately. Bad jokes had a tape recorded with them. Just took the taping. Get outta here with this. I mean it was so fun to hear you talk to Adam for our because I've become friendly with him and it's It's funny 'cause he's even before my time like like him talking about like an Italian guy in the back of a restaurant but like get up back hit like that doesn't have a relation to me because I'm thinking of going on podcast and talking and Scarborough Toronto. There enough comedy clubs left because they're rating of comedy went down and now it feels like we're in some of somewhat of a boom. I mean New York the comedy cellar in New York. If anyone if go to a comedy show you go to the comedy cellar? That's like the Mecca. I worked there every night. I'm in the city. That's like a huge pleasure but You know all over the country. I was at the comedy store L. A. That's l a New York thing going on but these the DC Improv like that. That's right near where we that? That's a basement. But that's a comedians favor called like people love club comics especially they chapelle is like a huge like drops in there. You know and that only happens because comedians talking. It's like it's like golfing. You know the good courses you know like just like we know the good clubs. That's good thank you so much. Thank you for that. I I have to tell you how much of a Fan I'll never forget. Walking INTO OPEN MIC. And having you in my ear going if you want to be in the money business going the business. I'm going and I'm having a bombed and I'm like jared. This is what you want to be in the bunny business. You don't win the money in that so I have to say this is like a bucket. List item agree. I'm so excited to be my brother. I mean I talked to other I find littles in the comedy clubs or really. Seton Smith is known as a DC comic who was on the mullany. Show the short-lived mullany show. He's a huge fan. My Buddy I imagine my buddy James Matter. And he's a huge like freak out hearing their names. David Aldridge moment cheeser easy as as the guy who did the thing with trump and as as what was that funny bid the he was an animal. Like what did you expect to happen? Was that mullany. Yeah yeah that's really really. I have to play a bit Delta Airlines which you will absolutely love so all right so we'll take a break. Great thanks to jared for coming in thank you and we will have email and a jingle when we return and I think I'm still Tony Kornheiser. You're listening to the Tony Kornheiser show. I got a cab driving this Honda till my eyes are leaden side hustling managing to save the little bit of money. Only eat one meal. A day. Can't afford to get this cavity build. It does not myself with that bill. Food isn't too hard to Dead Sea. Bernie's God solution says that people should be able to exist. Even if they aren't rich Marie Antoinette. All of a twist except just a little bit less won't sell my kidney falsehood loan debts tied to the phone exhausted coming from a friend WHO PICK ME UP. Robert Burgis simply not getting into the car for heartbeats fast does he have a gun in like on this street corner any muggy for me to roll my window and I don't know what this fossil law call nine one one of his character do not necessarily reflect those of its author any other use of this non-person or her sounds descriptions or accounts of the accosting is prohibited on Robert and I approve this jingles. Brilliant Oh possibly shaming early and helps marry that man this guy then this tremendous Let me remind you before we get to the mail. Bag Don't wear sandals tried to avoid scandals don't WanNa be a bum. You Better Chew Gum. The pump don't work Savannah's handles that still. In of course let me also say thank you to Washington Post movie critic and Hornets for coming on. Congratulations that she spoke. With Mick Jagger and comedian. Jared free see him at the DC Improv through Sunday. That's this week through Sunday but will also be at. Dc Improv. June eleventh through fourteenth does will be my. I'll be headlining full show with everyone out. Well it's it's late at night. Early Youtube like a four. Pm Show. I'll come to your house simply safe from policy genius sponsored the show today and remember you can listen to us on apple podcast spotify. Google play radio DOT COM. If you get the show through I tunes please leave us. A review with regards to John Feinstein new book which I believe is called back. Roads to March here is a Haiku Review. I have not read it. But I heard it's great and could be about basketball From Daniel Walls now that Elizabeth Warren and Mike Bloomberg or on the buyout market. Is there any way the wizards who pick them up? It's actually funny Joey writes if Hoda had corona virus. Nbc would be streaming twenty four seven. It'll be a ratings bonanza. They would give her another channel and everyone would be lining up interview her. Nbc wouldn't be able to help themselves so she probably doesn't that's probably right less she's resisting cashing in you. Don't know Mike. Separate oshkosh Wisconsin Dear Dabo Ganger of Larry David. Are you telling me that? Hbo's Curb Your enthusiasm is not at least loosely based on your life. No it isn't. They'll tom assumed it was considered this evidence. During this season alone Larry has decided to open a coffee shop not to make money but out of spite expressed hard opinions about how toilets should be designed cross paths with an anti-semitic dog been suspicious. That favorite restaurant has a separate section for ugly customers the Ven Diagram of idiosyncrasy shared by Larry. Overlap in a very tight circle. I'm pretty certain that Mr David ceiling the details of your life and the stories. You tell tells them so that we cannot see the similarity my only question for him would be who is wilpon on the show. I'm pretty sure it's not Jeffrey. Leon it's probably Richard Lewis because he will have a desire to argue with you and Larry about anything and everything so if we see a Richard Lewis hates analytics episode of Curb. You should sue. Let me also point out. He had an episode recently. That I thought of you. Because they had a friend who committed suicide and they just played golf with them and Larry's like he shot like an eighty two right. Exactly this Larry. David went to sheep's Head Bay High School. He was best friends with J Bloomfield. Who was my dear friend at Harper College? Larry David went to Camp Toga. A- I went to camp tug and met my wife at Camp Toga. I have met him a number of times. He has no particular regard for me. He ran away. Yeah he ran away from a couple of times But I it's not that I don't think it's funny. It's that everything he does. Seems reasonable seems Honda Civic next season Saturday March shepherd. Dr Mark Sheppard. Who I know in Rockville? Someone who's driven to Atlantic City? Many times it is about the same time for little out of the way to go down to exit three on the Jersey Turnpike to the Atlantic City expressway. It avoids all the lights on route. Forty and go straight into town. There is however no reason to get to the Garden State Parkway and this adventure Kudos to wow was helpful employees. I'm not I'm going east. I'm going east of Atlantic City a little southeast of Atlantic City. I'm not going all the way to Atlantic City but thank you Abraham Karzai Karzai. Dear I don't think so dear Dr Tony. Born and raised in silver spring with aspirations in entering the world of sports media frequently. Listened to your show as well as what was tuning into. Pti your expertise on not just sports but the stories of your wacky adventures in this beautiful area. Call Home DMV. Provide me with great joy as I go through my days as a freshman majoring in media and Communication Studies. But your take on allowing Binghamton to play in the America East tournament due to the fact that it's comprised of teams from a conference of Nineteen as blasphemous. This is the American East boomer. We separate the men from the boys around here. Now go ran on issues. That are actually open to debate like whether or not it's okay to leave the doors open at the indoor pool. Keeping Awesome and go retrievers K. Coming in hot Jeff folks in San Jose California dear Dr Ron. It sounds like you want Bernie Sanders to be president of the America East conference and want him to reach into Stony Brook's back pocket for a win to put Binghamton in the tournament. Come on man you gotTa Conference. Did you get a conference? Bid What are we doing here? Also I'm doing research on a new car. Purchase neater input civic or Subaru Subaru. Al Up and listen. Yeah Damon in Ventura California. I'm at LAX WAITING BOARD FLIGHT TO SEATTLE FOR. A job interview. Much thanks for such an uplifting pod show about my potential next city. Please wish me luck on the into and the virus. Fye It's Eliza. And from Steve The sycophant. It's fun time in Paris and will soon be in the valley. Dr Ron is my darling. Wife and I arrived on Thursday. We'd schedule his trip. Several months back to celebrate her birthday and decided the risk of corona virus in the DC. Area is as great as over here. The only difference I noted from our last visit in two thousand seventeen was very few people at Dulles and Charles de Gaulle. Airport wearing masks. I will keep you informed as our adventures continue. I'll do my best to avoid illness if it happens. Hey maybe I can be quarantined and Sancho pay. That's very good. If you're out on your bike tight. Everyone's always do wear white. I Hate Pumpkins. Do Lasts around baby? Ask Don down the shots nine Snail ban you say on the track the journey Straw and this plaques that is out some.

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