Interview with Alyssa Tait, PT, Naturopath…

I had the opportunity to interview one of the more under-followed Physiotherapists on Twitter: Alyssa Tait. She is also a Clinical Nutritionist, Naturopath, and an Accredited Teacher of the Billings Ovulation Method. I highly recommend you give her a follow on Twitter for the vast amount of information she shares combining nutrition, women’s health, and chronic pain. You can find Alyssa in person in Brisbane, Australia at Equilibria Physiotherapy & Nutrition.

Enjoy the interview!


So, what did you have for breakfast today? And, do you have a morning routine?

Breakfast was my usual routine! Coconut cream, almond milk, pea protein smoothie with a banana and mixed organic berries. Lunch was more interesting-baked potato with grass-fed mince and zucchini, dill goat’s cheese and avocado, mixed greens and nasturtiums with macadamia oil. Yum!

My morning routine, before I do anything,  is mindful walking barefoot on the lawn…but it has just got too cold, so the shoes were on today!

What led you into the wonderful world of physiotherapy?

My obsession with the bladder, initially – I knew I was meant to be a pelvic floor physiotherapist when I sat enthralled through our one lecture with Ruth Sapsford, where my friends didn’t share my rapture. Recurrent UTIs and bedwetting as a child led me to develop and uncommon interest in this organ. But actually, I initially was going to be a speech pathologist as I am fascinated with language…my brother beat me to it, but I still ended up doing Linguistics at university.

All of us go through professional growth and evolution. Describe your progression through the years.

I continually make discoveries – new paradigms, new insights –  that I think are going to revolutionise my practice, and they do…but the longer that goes on the more in awe I am of some of the experts in these innovative fields, especially in functional medicine, and I choose to consolidate my role as more of an “integrator” of fields than a top expert in any of them – and I would see this as my particular strength. I have a rather broad set of skills in a fairly narrow field: urogenital, pelvic and gut health.

I achieved my goal of working in pelvic floor from my first year out; travelled to Norway to learn from Kari Bo; did a postgraduate qualification in the field in my fourth year out; started a nutrition medicine qualification the year after; got a certificate in teaching Evidence Based Practice and discovered a love of PubMed; moved into osteopathic manual therapy and subsequently visceral manipulation, which I travelled overseas for 18 months ago; changed my way of seeing chronic pain through study with the Neuro Orthopaedic Institute and adapted their insights to vulval pain from 2007; returned to naturopathic school to gain further qualifications in nutrition and Western Herbal Medicine; and delved deeper and deeper into the field of integrative nutrition, making connections between the chronic pain syndromes and functional gut disorders I was seeing and the underlying faulty mechanisms at play.

You’ve peaked my interest. Tell us a bit about the relationship between Chronic Pain and Nutrition. 

There are a number of mechanisms whereby nutritional factors affect chronic pain. I’ll just name two:

  1.       Inflammation. Where pain is related to inflammation, nutritional medicine really comes to the fore. Specific phytochemicals have documented anti-inflammatory activity, and in some cases clinical research (such as EPA from fish oil and curcumin, an extract of the spice turmeric). A more comprehensive nutritional medicine approach looks at the underlying causes and drivers of inflammation in the individual and addresses them. This could be anything from an underlying epigenetic compromise in certain detoxification pathways to insulin resistance to food sensitivities to gut microbial imbalance.
  2.       Secondly, in chronic pain in particular, anything that modifies production of neurotransmitters (such as serotonin) or cortisol will affect the functioning of the central nervous system and the hypothalamic-pituitary-adrenal axis, both of which strongly influence the pain experience. Nutrients are essential cofactors for the manufacture of these substances. Nutrients are essential to their transport and modification.

I share your interest in nutrition. What are some of the biggest nutritional revelations you’ve experienced or learned over the last few years?

I have personally experienced how intelligent, dedicated integrative nutrition based on understanding of biochemistry can transform health when orthodox medicine has long since run out of ideas. (Of course, it is possible to get the best of both worlds).

Clinically, the insight that the understanding of nutritional biochemistry may be the key to the mysteries of my personal interest areas of vulvodynia, irritable bowel syndrome and chronic pelvic pain.

Tell us about the beginnings of Equilibria. What sparked the idea? And, what challenges did you face?

I was working in a public hospital, and becoming specialised in women’s health physiotherapy. Unfortunately, I was developing interests that went beyond my role – in nutrition, in particular – and when I completed my first qualification in this field I was no longer satisfied limiting myself to physiotherapy. I have the utmost respect for the talent in our field of physiotherapy – both the brilliant clinicians and the researchers – but being an ultra-specialist has never held appeal for me. I am too interested in exploring new territories and making connections across different paradigms.

The main challenge has been that as far as I can see, no one is really doing what I am doing, so it is challenging to strike the right balance. While I have excellent mentors in my different fields, with respect to the challenges of shaping my practice, I have always been on my own! Integrative nutrition and physiotherapy are quite different fields. The ongoing challenge is helping people who are referred for one see how the other could be of benefit to them. My other major challenge has been in pacing myself – my thirst for knowledge needs tempering at times in order to continue to model to others the kind of balance I am espousing.

What are the biggest lessons you’ve learned since opening Equilibria?

Set and stick to boundaries.

Keep your vision in sight and trust your instincts.

Reflect continually on what you do, but don’t be too concerned about what others think.

Strive for mindfulness.

Favorite Books & Authors? (professional & personal)

I love Kazuo Ishiguro. The Remains of the Day was a masterpiece and The Unconsoled was utter brilliance. His compatriot Murakami wrote, in Japanese, one of the most gripping books I’ve read – 1Q84 – mind you, I read the translation, not the original!

I love Hugh MacKay for ethics and CS Lewis for things numinous.

I trawl PubMed for my professional reading, as well as relying on some of the leaders in my fields of interest to condense worlds of knowledge down into 15 hour webinar series!

Imagine if you could pick up the phone and call your younger self right after graduating physio school, then what advice would you give her?

Trust your instincts.

It’s ok to go hard because that’s how you will add value. But LEARN MINDFULNESS NOW.

Your Top 5 things-to-do/experience in Australia:

  1. Skate the inner city bikeways on one of our many glorious Brisbane days. (Had to have rollerblading at number one, and with all the great cities in Aus, I don’t think you can get past my home town.)
  1. Sing with – or at least attend to experience the joy of – the St Stephen’s Cathedral Choir at the annual Christmas Carols.
  1. Swim in the sea on New Year’s Day early morning on the Strand in North Queensland’s Townsville when everyone else is home in bed with sore heads.
  1. Stay at Nambucca Heads, a beautiful tiny coastal town where the mangroves and the river meets the sea and my dad works single-handedly to preserve the rainforest.
  1. Get some insight into our convict history at Port Arthur, a former penal colony on our island state off the south coast of the mainland, Tasmania. Read the Australian classic For the Term of His Natural Life beforehand, not after as I did.

Alyssa, thank you for sharing your story in this great interview! The nexus of nutrition & chronic pain/women’s health is an interesting place, and I’m looking forward to learning more about it.

Follow Alyssa on Twitter: @AlyssaTait1

And, connect with me: @Cinema_Air

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Turning Machiavellian

Outcomes… It’s what our patients want; it’s also what clinicians want. It isn’t unusual for a patient to say, “I don’t care what we do, I just don’t want this pain anymore.” In fact, it’s what drives clinicians to deliver better patient care – better outcomes more efficiently. Better patient outcomes & experiences creates a self-reinforcing virtuous cycle of greater efficiency and consistent outcomes. It is something worth leveraging.

As far as patients are concerned, many just want to feel better. To them, the end justifies the means. They want to get well & stay well. What about the clinicians? Does The End (outcome) Justify The Means (treatment/interaction)?

Being able to justify your treatments and interactions requires the ability (& willingness!) to determine the effectiveness of your plan of care. Consistent measurement of outcomes plays a significant role here. If you aren’t continually reassessing your outcomes – both positive & negative –  then you aren’t doing yourself or your patient much justice. Determining the efficiency & effectiveness of your service is an important component of the value proposition of every clinician. The question that comes to mind is, “Am I delivering the best value that I can?”

On what basis would you answer that question? By what your boss says? By what your colleagues say? By what your patient says? Or could it be based on contemporary (latest) themes of scientific understanding?

Let’s tackle that last one first. Science always changes. The tides of data, winds of politics, and the drive of capitalism continually shape and direct the future of science. And, let’s not forget inherent biases within Scientific Research itself that funnel & lead Scientific Conclusions that both the public & private sectors leverage for their own interests. Even if we ignore the financial levers in scientific research, it’s difficult to account for the personalities involved and contemporary zeitgeists. Here’s how Craig Venter puts it in his biography A Life Decoded:

Too many times I had seen science driven less by data and more by the force of a particular personality or the story on which a professor had built his career.

Could this rising tide of Data overwhelm our ability to Keep up with The Scientific Joneses? Maybe. Here’s a study that says that there are too many studies! While some clinicians may do their best to keep up with the latest literature, many clinicians rely on webinars, weekend courses, and other aggregators of latest research. Given this, all clinicians should be familiar with Academese (Academic lingo) to help them navigate the labyrinth of terms, interpretations, limitations, and applications of research papers. Most clinicians do not (and, maybe, can not) keep up with the growing avalanche of peer reviewed literature.

In many instances, what your boss or supervisor says is coloured with the tinge of achieving pre-set numeric hurdles that may or may not involve your progress as a clinician. To a certain degree a better clinician yields better outcomes on the bottom line as well, but that could depend on business models and practice settings. In essence, reaching a target Units Per Hour does not make you a better clinician. Neither does juggling 3-4 patients per hour make you a better clinician.

What about what your colleagues say? Maybe a majority is simply Noise, and some of the rest of Signal being unintentional more than intentional. How many of your colleagues have contributed to your improvement as a clinician? While many co-workers and colleagues come & go, there will be those few that are worth holding onto; continually renovate and fireproof these bridges. Coming back to the main issue, a majority of co-workers (a few exceptions excluded) don’t necessarily make you a better clinician. At best, what you are receiving is external locus of control (creating dependency) versus internal locus of control (fostering independence).

Given this never ending climate of continual change and murk, what can we (you & I as Clinicians attending to individuals with various physical dysfunctions) do to maintain a sense of direction? Maybe we could look for things that don’t change: Nobody wants to live in pain; Nobody wants painful movement; Nobody enjoys the inability to move or return to work due to painful experience with sitting, standing, etc. Nobody is pleased with his/her difficulty walking, lifting, having sex, pushing, pulling, carrying, holding their grandchild, etc. No athlete doesn’t want to return to their favorite sport. She values the End (a pain-free functional life) regardless of a complete understanding of the Means. Many Grandparents don’t even care about how you get them to lift, carry, and hold their Grandchild, as long as they can lift, carry, and hold their Grandchild! Their desired functional Outcome generates significant value to him/her.

My basis to answer the question “Am I delivering the best value that I can?” is this: It Depends on My Patients’ Outcomes. Outcomes includes more than reaching their individual goals in Physical Therapy, it also involves referring him/her to other clinicians who could assist in their progress or take over her case, if that’s what’s needed. What patients want is to return to a pain-free life that allows them to provide for & spend time with the ones they love, to be independent, to re-experience the joy of movement, to get back to the life they once had.

As a clinician, I want to leverage outcomes to demonstrate my value to more than just my employer(s) and the insurance companies (purse holders). I want to leverage these outcomes to demonstrate my value to current & potential future patients.

Consistent & Repeatable Patient Outcomes has become such a directional indicator for me that if someone were to call me Machiavellian in this respect, then I’d take it as a compliment.

Related: This podcast by Therapy Insiders with Jerry Durham is worth your time. The last 10min or so rhyme with the post you just read.

@Cinema_Air

Andre Agassi on his Back Pain

Tiger Woods’ remarks about his back pain spawned a rumble in the physio community. This piece by Peter O’Sullivan sums things up nicely. My favorite thing about Peter’s write-up is that it’s aimed at health care providers, not the athlete. Tiger’s latest injury involves his right wrist:

Keeping with the theme of athletes and their bodies, check out the following excerpts from Andre Agassi’s autobiography, Open, describing his experience with back pain. It’s a great first person’s view on the relationship between back pain and emotions.

Now rising from the center of the fatigue comes the first wave of pain. I grab my back. It grabs me. I feel as if someone snuck in during the night and attached one of those anti-theft steering wheel locks to my spine. How can I play the U.S. Open with the Club on my spine?

I was born with a spondylolisthesis, meaning a bottom vertebrae that parted from the other vertebrae, struck out on its own, rebelled. (It’s the main reason for my pigeon-toed walk.) With this one vertebra out of sync, there’s less room for the nerves inside the column of my spine, and with the slightest movement the nerves feel that much more crowded. Throw in two herniated discs and a bone that won’t stop growing in a futile effort to protect the damaged area, and those nerves start to feel downright catastrophic. When the nerves protest their cramped quarters, when they send out distress signals, a pain runs up and down my leg that makes me suck in my breath and speak in tongues. At such moments the only relief is to lie down and wait. Sometimes, however, the moment arrives in the middle of the match. Then the only remedy is to alter my game – swing differently, run differently, do everything differently. That’s when my muscles spasm. Everyone avoids change; muscles can’t abide it. Told to change, my muscles join the spinal rebellion, and soon my whole body is at war with itself.

The cortosine injection:

I stretched out on the table, face down, and the nurse yanked down my shorts. The doctor said he needed to get his seven-inch needle as close to the inflamed nerves as possible. But he couldn’t enter directly, because my herniated disc and bone spur were blocking the path. His attempts to circumvent them, to break the Club, sent me through the roof. First he inserted the needle. Then he positioned a big machine over my back to see how close the needle was to the nerves. He needed to get that needle almost flush against the nerves, he said, without actually touching. If it were to touch the nerves, even if it were to only nick the nerves, the pain would ruin me for the tournament. It could also be life-changing. In and out and around, he maneuvered the needle, until my eyes filled with water.

Finally he hit the spot. Bull’s-eye, he said.

In went the cortisone. The burning sensation made me bite my lip. Then came the pressure. I felt infused, embalmed. The tiny space in my spine where the nerves are housed began to feel vacuum packed. The pressure built until I thought my back would burst.

Pressure is how you know everything’s working, the doctor said.

Words to live by, Doc.

Soon the pain felt wonderful, almost sweet, because it was the kind that you can tell precedes relief. But maybe all pain is like that.

Perception of our bodies, pains, and injuries can have stunningly strong effects on our daily function.

Andre Agassi’s book is the first autobiography I’ve read cover to cover. And, it’s one I’ll be re-reading over & over. Pick it up here.

@Cinema_Air

Interview with Dr. Justin Dunaway, DPT… Part 2

Last week we learned the backstory of Dr. Justin Dunaway DPT, OCS, Cert. SMT, Cert. DN, as well as the importance of Physical Therapy advocacy and Professional humility. Now let’s do a deep-dive into his latest & greatest venture: STAND – The Haiti Project. I highly encourage you to learn more about & donate to STAND Haiti, click here for more info. When he’s not busy improving the lives of Haitians, he plays his role as a staff Physical Therapist at One Accord Physical Therapy, and an Executive Board Member of the Arizona Physical Therapy Association

Just like Part 1, this final part will make you want to bigger & better! Enjoy!


Given the choice of anyone in the world, whom would you want as a dinner guest?

For me, this question is easy. I’d love nothing more than to travel back in time to dine with Galen of Pargamon, one of our forefathers in medicine. I believe we have grown so far from the original roots of medicine and medical philosophy and I would like to converse with this genius one on one, over a nice plate of chicken parm.

In this day and age, I see gross medical mismanagement, unnecessary surgeries, over medication, and unnecessary labs and imaging. This country boasts the highest healthcare costs, the second highest rate of chronic pain, and the highest rate of depression in the world.

I often find myself conjuring a quote from Galen that I feel everyone in the profession should take the time to consider.

“ Disease is an unnatural state of the body which impairs functions. The nature does its best to restore unnatural states to their healthy condition. The function of the Physician is to cooperate with her. When a patient is suffering from a disease, nature is struggling to overcome the pathogenic agents and if she is plainly succeeding the Physician should do nothing. If however, she is getting the worst of the struggle, he must come to her aid by doing what she would do if she could. The Physician must preserve what is according to nature, eliminating what is not”

While much has changed in the last 1,850 years… there are definitely parts of that quote and his philosophy that remain true, parts that we have forgotten or turned our backs on.

Love it! Now, tell us about Phoenix Rising For Haiti, as well as your role with this organization.

Once I finished PT school and had received my first real paycheck, I began looking for ways to give back. My circumstances have always been lucky and felt it was my turn to return the world its favor. However, as a new grad, no volunteer organization would take me: not enough experience, too little time, etc. But lady luck was apparently looking over my shoulder and swung me into an impromptu group of seven preparing to travel to Haiti to build prosthetics.

I had never worked with an amputee in my life. I had never been anywhere but Ohio and Arizona and I had no details on the trip… but I was in!

The original team entailed seven strangers, from varying professions and skill sets. Our original mission was to build legs for amputees and teach them to walk, but at the end of three treatment days, we had treated 60+ orthopedic injuries and built legs for 14 amputees (all of which walked without assistive devices by the end of the trip).

In those three days, I learned that with a completely different population, just about every rule about PT I  had learned was completely different. What is needed is the ability to think outside of the box, let go of the dogma instilled in you, and give the patient in front of you what THEY need, not what WE BELIEVE they need. I also learned that I’ve never loved anything that I have ever been involved with, the way I loved this work in Haiti.

After the first trip, we realized that there was a huge need and we could do so much more. Phoenix Rising for Haiti was formed. Over the next five years we went from trips that entailed three days, seven volunteers, and sixty patients to forteen days, teams of 15-20 volunteers, and 1000+ patients treated. I functioned as vice president, recruiter, and clinical director for the organization over my five years with PRH and resigned from this organization at the end of 2014 after my 10th trip.

There’s a new project you’re involved with: STAND – The Haiti Project. What is it about? And, how can Physical Therapists participate?

Sustainable Therapy And New Development was founded at the end of 2014 after my resignation from PRH. While PRH has done, and will continue to do amazing work, I really saw a need to move in a different direction. My dream has always been to create an education system in Haiti, train Haitians to be independent orthopedic clinicians, and hire them to staff clinics that we create locally.

With this in mind, STAND was formed by myself, Dr. Morgan Denny DPT, Luke Slipski MPH, and Janet Lamoree PTA. This new team brings in a variety of experiences and talents that will benefit the building and implementation of STAND on many fronts. This dream team can tout experience in building non-profit organizations, sustainable living education throughout the US, and public health projects in India. Additionally, our board holds extensive experience in amputee rehabilitation, experience in lecturing and course development, and knowledge of the previous successes and pitfalls from five years of work in Haiti.

STAND’s mission is to establish permanent access to orthopedic rehabilitative services in the country of Haiti through direct patient care and clinical training of its citizens.

We are incredibly excited about this new project and the new board is working diligently on fund-raising, “friend-raising”, organizational development, educational development, and solidifying our amazing network of volunteers in Haiti and internationally. We have partnered with with several small PT clinics and are working with the Physical Therapy Department at Youngstown State University to build a new curriculum specific to and appropriate for Haiti. We are firing on all fronts and plan to have STAND’s first volunteer treatment trip to Haiti in the fall of 2015.

At this phase of the game, people (not only PTs) can help in many ways. We will be looking to build a team of medical professionals from multiple backgrounds; PTs, prosthetists, orthotists, nurses, ATCs, LAcs, and non medical staff will all be considered for volunteers on our trips to Haiti. If you have the ability to evaluate and treat an orthopedic patient with little to no equipment, we want you! We treat general ortho, neuro, pediatrics, woundcare, fracture, first aid, and many other things you have never seen, and will never see again in your career.

We also need financial supporters. STAND currently needs donations in order to lease our new clinical/educational space, build the equipment needed in the clinic, and to create and outfit our new prosthetics lab. Much of this equipment (tables, tools, generators) can be found, purchased, and built in Haiti, allowing donations to feed directly back into the Haitian economy and its skilled workers. Donations of any size can be made on our website (STANDHaitiProject.org), with the option for a one time donation or reccuring monthly donation. If your business or the company you work for is interested in supporting STAND, we offer multiple packages and donation levels that can benefit both STAND and your business’ marketing goals!

To volunteer for future trips, recieve our newsletter, find out more about the organization, or to donate your much needed financial support, please check out our new website www.StandHaitiProject.org or email me at JDunaway@stand4haiti.org.

Life is an adventure. Tell us about one of your most memorable adventures.

Aside from Haiti, my life hasn’t been very adventurous. But work and travel in through any developing country, such as Haiti, will yield many an interesting story. So I will tell you about one of my most memorable experiences in Haiti. The things that happen in this country…

I was on a two week trip to Haiti with PRH. Typically, we had teams that would come in for one week and cycle out as the second came in, with a handful of volunteers that would stay for the entire two weeks. On the transition Saturday, one of our directors took the two week volunteers to the beach to decompress and see some of the beauty that is Haiti. The second week volunteers hadn’t arrived yet. A few of us, including our amazing Aussie prosthetist, Monique, stayed back to work on fabricating legs for the next week and greet the new team.

The new volunteers showed up as expected, two PTs, a nurse, and a PT tech. We gave them the tour and had them unpack and settle in. Monique and I were working in the prosthetics lab when we heard a very loud crashing sound. We looked at each other, brushed it off, and went back to work (many many loud sounds erupt from the busy market road of Port-de-Paix). Just as we had mentally moved on, another one of PRH’s directors (Billy) ran into the lab frantic, saying there had just been an accident in front of the clinic.

At this point in time, our translators had gone home for the weekend and half of the team was off at the beach. Billy and I both had previous EMS experience, but knew very little Creole. We grabbed a box of gloves, a few plastic bags, and ran out into the now very loud, crowded, and chaotic street. People were yelling, screaming, and crying; we were quickly able to recognize three specific and separate masses of people. As we approached the first, we found two gentlemen with minor scrapes and bruises. Using our limited communication skills, we instructed them to head to the clinic where the volunteers cleaned and dressed their wounds.

As we worked our way through the second crowd, we found a woman in shock, lying in the ditch with a complete amputation of her left ankle. I grabbed the amputated foot and Billy and I carried the woman back to the clinic where I used a strip torn off a bed sheet to create a tourniquet while the nurse dressed the residual limb. We headed back out into the street a third time where we discovered a woman who had been completely run over by the runaway vehicle and was wedged underneath the vehicle. We sent someone back to the clinic for a mattress and bed sheet, rolled the truck off the woman, and proceeded to log roll her, place her on the mattress, and tie her down with strips from the sheet. We then loaded her into the back of a truck with Billy stabilizing her C-spine. The truck drove to a hospital across town, along completely unmaintained or paved roads while Billy stabilized her head. At this point in time, there were several hundred people in the street, yelling and screaming, crying, and the crowd was growing in front of the clinic gates.

I headed back to the clinic, desperately trying to find some form of transportation to get the newly amputated woman to the hospital. After what seemed likes hours, we were finally able to locate a truck and communicate enough to get a ride to the hospital. Monique, the patient, and I drove in the back of a van, stabilizing and elevating her leg. As we arrived at the hospital, we realized it was highly understaffed and again we didn’t speak the language. Eventually, we were able to get the patient admitted and into surgery. The next day, we visited the patient and she had received a transtibial amputation; the surgery had gone very well. We met her family and promised them a new leg.

Six months later we returned to Haiti for our next trip and the woman showed up to the clinic, healthy and excited for her new limb. Unfortunately, despite our best efforts, we had been unable to recruit a prosthetist for that trip. We had to tell her that she would not be getting a leg this week, but hoped that she would return again for our next trip, at which time we would be able to build her a prosthetic. The patient returned during our next trip and our prosthetist was able to construct her a new leg. We built her a new limb, trained her, and she left our clinic… happy, healthy, and walking without an assistive device on her new limb.

This is one of my favorite memories from Haiti because this patient needed every skill set we had to offer. If the accident had happened five days earlier, five days later, or half a mile further down the road in either direction, this woman’s life would probably have ended. Instead she lived, had a complete recovery, and a new lease on life. This case is a constant reminder to me of the need in Haiti; and of the huge impact a few volunteers with the right skill set, in the right place, at the right time, can have. Below is a picture outside our clinic with the woman from the story.

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Keep up with the latest STAND news via Twitter. And visit STAND website to donate to this fantastic cause and/or participate in a life-changing experience.

Connect with Dr. Justin Dunaway via Twitter: @DrDunawayDPT

And find me: @Cinema_Air