Flashback: Year 2 of Interviews!

It’s time for a flashback into 2015. Once again I’ve been lucky enough to Interview some incredible individuals. A big “THANK YOU” to my interviewees and readers. These interviews gave me a kaleidoscope of perspectives and practical advice on life & work…among other things! Check out 2014’s Flashback.

Below are some memorable quotes. The links will take you to the respective complete interview.


Scott Epsley:

I came across the concept of “Surpetition” by Edward De Bono.  The premise is that one doesn’t attempt to compete with others, but focuses on being better than oneself, while still being aware of what your competitors are doing.  This has since become not only my philosophy in business, but in life.

Mike Horsfield:

Failure needs to be embraced in an organization as a great learning opportunity.  Do something!  Act!  It is too easy to be paralyzed by analysis.  If something feels right and the potential downside is not fatal then go for it and learn from the experience.

Kendra Gagnon:

The rise of high-speed internet, mobile devices, and WiFi has brought the possibilities of “anytime, anywhere learning” to almost everyone and gives instructors the opportunity to use video to create and share more engaging learning materials and provide synchronous, real-time learning and interaction.

Dr. Justin Dunaway:

We know nothing… or at least very little. There are so many beliefs and concepts out there that people cling to so strongly. They dig their heels in, defending certain concepts as if they were solid ground. There are a multitude of different camps in our profession and so many explanations for the same occurrence or outcome that are so different. And when we dare to venture outside of our profession, we are challenged with entirely new sets of justifications and approaches to the same concept that are again so different.

Alyssa Tait:

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.

Dr. Stacie Fruth:

So many studies that do get published have such narrow inclusion criteria that it’s quite difficult to apply the results to any of my patients (my folks have lots of comorbidities and biopsychosoical issues). So, it can be incredibly frustrating to create a study that tries to capture typical clinical populations. I think this is why so many studies that were once considered gold standards now can’t be reproduced – that fascinating variable called “the human being” is awfully tough to control.

Dr. Karen Litzy:

Know what you are good at and what you are not good at.  If something is not in your wheelhouse and/or you do not enjoy some part of the your business then outsource it!  I did not do this enough in the beginning and I regret that.  Even if it means spending more money (which it most certainly will) it frees you up to concentrate on the things you are good at and this will only strengthen your business.

Chris Johnson:

Take money, sex, and power out of your decisions and you will never make a bad one.

Justin Moore:

Slow down to listen and learn. I was at times in a hurry when I was younger and didn’t take the time to observe, learn, and listen to some experienced leaders in the profession and public policy. Looking back the time spent talking with friends, listening to leaders, and learning by observing how one approached an issue, carried themselves and developed their thoughts was never wasted. Those opportunities always centered me and prepared me to be more aware, more knowledgeable and more engaged but I didn’t always seek them or appreciate them at the time.

Michael Mullin:

Take pride in the work you do and do not be swayed by what you believe others may think of you.  It is easy to get hung up with the societal pressures of acceptance, not wanting to stand out, or even compliance.  Life is too short to not take full advantage of everything it has to offer. Work hard and have fun….

Thanks for another memorable year!

Best Wishes.




Twitter Interview!

I decided to close out 2015 with an interview with questions from twitter.

Check it out!

@therapyinsiders: Which Bourne movie was your favorite and why?

This is a tough one. I really enjoyed all three – yes, I’m excluding the one with Jeremy Renner. I’ll choose my favorite Bourne flick based on 2 things: villains and motorcycle scenes. And the winner is… The Bourne Ultimatum! Desh was the perfect roleplaying villain. I loved his fight scenes which seemed like a mix of Wing Chun Kung Fu and Capoeira. The motorcycle scenes were incredible! Watching Bourne ride through Tangier at a fast clip while negotiating daunting street obstacles in narrow alleys was thing of beauty.

@MattBobman: Biggest professional regret and/or failure?

I should’ve casted a wider net in my first few years as a PT. While I was lucky enough to have a role and gain experience on both sides of the business, I could have developed a wider view and started developing a Framework of thinking and action much earlier than I did. Here’s what I would recommend:

Experiment enthusiastically with different approaches of treatments.

Connect with a wide variety of professionals within driving distance and through social media.

Take more risks in terms of: creating new products, developing new platforms, re-inventing yourself.

Read a kaleidoscopic selection of books and authors. And, follow Jeff Bezos’ “Regret Minimization Framework.”

This is a great question! Jeff Goldblum – not because I look like him, but because he plays some interesting roles and for some reason his personality resonates with me. Anyway, check out his Top 10 Moments:

Anonymous: When are you going to Haiti with STANDHaiti?

Hopefully some time in 2016. In the meantime, check out STAND’s 2015 Re-cap and this inspiring story.

Doesn’t matter. Just get moving in anyway that you enjoy – play sports, lift heavy things, dance, run, yoga, climb things, conquer things… If I were forced to pick team or exercise, then I’d say go with whichever fits your personality the best.

@DrBenFung: If you could change one thing about the person that annoys you the most, what would it be?

This is a tricky one, and here’s why. If you find someone that annoying, then odds are this person means something important to you. Maybe s/he is someone you want to hold onto and have agree with you. Maybe s/he is someone you want to impress. Maybe you believe changing him/her will make your professional or personal life complete. Here’s what I think: maybe you should work on yourself & your environment before you think about think about changing someone. Changing someone is often a futile effort. Changing yourself is a much more powerful endeavor with compounding returns over time. Book Recommendation: The Education of a Value Investor by Guy Spier.

@Eric_in_AmERICa: If you could put a billboard anywhere in the world where would it be and what would it say?


@rupalPT: what is your pride and joy?

Spending time with my family & friends and providing as much value to the world as I can are my prides & joys.


Careful whom you marry.

Explore wider and faster. Do not ignore your instincts. Learn widely from outside the field of Physical Therapy. You need a framework – work hard at developing a foundational framework on which you can build further. And, don’t fear failure. Just make sure you learn from it. You might get more out of my interview with Dalin.

Hello. My name is Indigo Montoya…

Thank you everyone! And, best wishes for a fantastic 2016!

Connect with me @Cinema_Air

Interview with Michael Mullin, ATC, PTA, PRC

This interview is a first: my first interview with a Physical Therapy Assistant. Michael Mullin is one of my favorite follows on twitter because he makes me view the human movement system through a variety of lenses.  We dive into his unique and varied perspectives in this interview.

While concepts from a PT Continuing Education called PRI are mentioned, I want it to be clear that this interview is not meant to promote nor support PRI.

One last thing:  Check out Michael’s blog for larger conversations on topics touched on in the interview.


Let’s start at the beginning…the beginning of your day. Do you have a morning routine? What do you usually have for breakfast?

I am an early-riser as I find myself to be very productive early in the day–like, really early.  I typically get up, have some coffee (coffee is always, not typically) and check messages from various sources (i.e. e-mails, Facebook, Twitter).  I look forward to when my wife gets up, I like to make breakfast for my daughter and often send a text to my son at college.  Breakfast?  Usually eggs with some quinoa, potato or rice, maybe some leftover roasted vegetables as I’m a bit of a veggie-holic, followed with some oatmeal with nuts and seeds.  I have a lot of food allergies (celiac disease and therefore very strict gluten-free for 15 years, no dairy, very low sugar/yeast/additives, etc.) so I actually eat quite healthy.  With all my dietary considerations, it certainly helps that my wife is a dietitian.

You’ve come across a variety of concepts to assist in understanding and applying various approaches & treatments in the clinic. What are some of your favorite?

First and foremost, understanding the role that the respiratory system has on our body.  Having the ability to take the involuntary act of respiration (gas exchange) and be able to voluntarily modify it through ventilation training (air exchange) is one of the more powerful tools we have in the management of our organism.  I have been amazed at how establishing volitional control of this can positively–and significantly–affect performance, recovery, muscle tone, joint position, resting heart and respiratory rate, physical and psychological stress, as well as many of our other internal systems.  It is our environment which is often the big driver of the amount and degree with which we lose the ability to effectively manage this, so being able to take ownership of this mostly involuntary action is huge.

From an intervention perspective, without a doubt Postural Restoration® has changed the way that I look at human structure and function.  It is the lens I look through when working with patients and clients.  It is the direction I go to when providing activities, exercises, cueing, as well as providing other avenues of our system to tap into to aid in progress.  That does not necessarily mean that it is the only “treatment approach” or training I do, but I bias my intervention strategies around this methodology.  I feel strongly that our inherent asymmetrical structure and function, the inherent polyarticular chains that the Institute describes, their work and educational programs on how the different systems are integrated and how this influences the way that we move and position ourselves during the day, provides an invaluable roadmap for people to work with.  It is a complicated science, but by the same token, the body is quite complicated as well.

I incorporate the work of other great approaches as well, such as “corrective exercise” interventions (Gray Cook and Lee Burton’s Functional Movement System activities and FMS/SFMA principles), some the principles and reflex mapping of Janda, Lewit and Kolar from Prague School of Rehabilitation and Dynamic Neuromuscular Stabilization (DNS), and definitely good ‘ole fashion strength training!  I feel that a large portion of our population, including our young athletes, are generally weak and as such, have a difficult time negotiating gravity and its affects on our system.  Our society has changed dramatically over the past few decades and we have not developed well along with it.

I am also a big advocate of manual interventions and use a lot of hands-on work with patients and clients as well.  It could be called the Hruska (PRI)-Jones (strain-counterstrain)-Roth (Positional Release Therapy)-Mulligan (MWM’s, NAG’s, SNAG’s)-Johnson (IPA)-Myers (Anatomy Trains)-Weiselfish/Gimmatteo (IMT)-Rolf (Structural Integration)-Chaitow-Trager-Feldenkrais-Leahy (ART) approach.  I use components of manual interventions to supplement a treatment session for most conditions with varying degrees and amounts.  It is also very helpful in being able to quickly mobilize an area if a client is having difficulty feeling something or they are having an issue getting into a position during a training session.  I find it most effective after I have been able to achieve a zone of apposition of the diaphragm, as achieving this ZOA alone cleans up all sorts of tone and positional faults of joints and tissue.

I’ve been blessed with what I feel is an innate sense of touch with the body, (certainly the same can’t be said for my luck with machines), for as long as I can remember.  I am one of six children and growing up we all had to take turns giving my mother a back rub each night.  To this day she mentions how I always seemed to know where to work and how much better she would feel afterwards–and who can argue with the word of your mother :).  While I fully recognize that manual interventions are neither truly reproducible or measurable, I also feel that when I read articles or opinions debating the effects of the application of some of these methods, I have a hard time holding merit in their conclusions with something that helps almost every person I use some of these techniques on.  While I am not suggesting any type of “guru” component, the careful application of hands-on interventions provides–and human touch also helps with–creating a sense of connection, involvement, empathy and other very powerful responses with my patients and clients.

This is one of my favorite posts on your blog. What are filters do you use when reading research with the intent of clinical application.

I am cautious with direct application of studies that are performed on cadavers that provide information related to movement, as things change once it is applied to an organism that is trying to manage gravity, gas and pressure.   It is good information to understand the arthro- and osteokinematics of how things move, in a vacuum, but once the chaos of our environment is added, things change.  

Conclusions that try to create prescriptive (versus diagnostic or prognostic) clinical prediction rules as the way to do something I have some difficulty with, as there are too many variables that cannot possibly be accounted for in a living, breathing system.  It can’t possibly allow for behavioral influences, nutritional components, patterned bias’ and the like.  I mean, maybe they were hung over or had a fight with their spouse, either prior to their involvement in the study or as a patient sitting in front of you on the treatment table.  If a classification-based system were to become the standard, then we will have created practitioners who will not be able to use their ability to modify, adjust or adapt well to changes in a person’s presentation.  Clinical thinking is much different than critical judgement.

Thinking from my Postural Restoration®-based brain, I have some difficulty looking at articles that don’t specify right and left arm or leg, and I am not referring to “dominant” arm or leg.  I firmly believe and have found that our underlying polyarticular chained patterns have a tendency to make us use the two sides of our body differently, so I read critically things which do not glean this information out.  I read them, apply as I feel indicated, but with a discerning eye.

I do believe very strongly in the model that evidence-based practice and practice-based evidence share a place with each in their applications to the clinical world.  As soon as evidence is doing more than just guiding treatment, but is what is necessary in order to be able to render care, that is when I feel we are going to get into trouble.  It is unfortunate that there are those of the mindset that unless it can be validated through research it should not be employed–and I am speaking of health professionals as well as those who dictate payment.  As long as intervention strategies have the least possibility of producing some kind of iatrogenic response, on that particular person at that particular time, then no one should be able to tell a professional they are not allowed to employ that strategy.

You work with a variety of interesting populations including dancers and skiers. Let’s say I’m interesting in working with these populations. How do I make it happen? How did you end up working with them?

First would be to educate yourself on some of the things that are essential to know about that activity.  When I went to work at The Stone Clinic in San Francisco in the mid- to late nineties, the surgeon I worked for was a physician for the U.S. Ski Team as well as a number of dance companies, including San Francisco Ballet.  I had zero experience with dancers and didn’t learn to ski until college, so essentially, through baptism by fire, I had to do a lot of self-education on activities I was not as familiar with–in particular what it took to work with athletes at that level.  I spent time going to dance classes to observe, read trade journals and had discussions with teachers/instructors/coaches, spent more time at the ski mountains observing as well as spending time with experts who were willing to allow me to tag along.  I was responsible for coordinating dry land training camps for the U.S. Ski Team and World Pro Ski Tour so I had to figure out training protocols.  I was responsible for doing pointe screens for Marin Ballet so had to understand what it took to be able to do that.  I feel very fortunate to have been able to have had these opportunities and have been doing similar programs since coming to Maine as well.  

Second would be, as I alluded to above, it is pretty much volunteer work on your own time.  You have to be willing to put yourself out there and put in the time to become an expert at it.  Programs have less and less money for ancillary services so many dance schools or companies would love to have someone willing to help them out or organizations who might be willing to have someone come in to do an inservice or training program.  There can also be a tremendous amount of carry-over as well to other things which have similar movements or mechanics (i.e. ice skating with dancing).

I am able to apply a significant amount of the work I do to most populations and specialties if I understand the essential tenets of those activities and am confident in my understanding of the biomechanics and integration of multiple systems.  For example, if I am working with a ballet dancer who is in for “X” injury, and I watch them at barre or doing some of their movements, they likely have some underlying micro-pathology.  “Micro-patho” is the phrase I use to describe things which have happened to the body over time, or from an event, which creates a laxity, or imbalance, or response, that would not necessarily require surgical or extreme intervention, but does need to be managed.  I then apply activities and cues to address these in their particular situation.  Having the PRI roadmap, for example, to recognize their likely bias’ helps as well.  For example, most dancers like to turn clockwise onto their left leg so it would be easy to think that it is because it is their “dominant” leg, but it is actually due to their ability to use their dominant right leg while it is in close to their body to manipulate and balance them out, create more stability when turning, and also because of their turning bias to the right.  With skiers, patterns dictate–and research has shown–that right footed turns (turns to the left while skiing) produce more force, have easier time to transition into and are smoother, even at the highest levels.  Again, pattern driven.  Being able to use interventions which help to correct this on the base level and then apply it at the activity level is tremendously empowering for these athletes.

Another key aspect is that when you can “talk the talk”, or speak on aspects of their activity in their language, then that is also a huge buy-in for them.  When I speak about inclination and angulation and edging principles with skiers or 1st-5th positions in dance or ask them to do something like releve into passe or a rond de jombe, they realize that you “get it”.  From there, you can even then ask them things about positions, movements or even what a coach or instructor is doing so you can get a better understanding of the activity, as they will be more than willing to provide that info at that stage.  Everybody benefits.

We are biomechanics experts and with that we are able to impart a significant amount of change in how people are performing their activity or art.  I am not going to necessarily coach someone on their sport, but the things I can teach them about how to apply what I feel is best for their bodies from a biomechanical perspective, this will have a significant positive impact on their performance as well.

Favorite PT and non-PT books?

PT books:  Historically, I like, in no particular order:

  • Assessment and Treatment of Muscle Imbalance:  The Janda Approach (Page, Frank, Lardner)
    • Great book looking at the impact muscle imbalance has on on structure, function and movement
  • Positional Release Therapy:  Assessment & Treatment of Musculoskeletal Dysfunction (D’Ambrogio, Roth)
    • As far as I am concerned, the resource to have under your treatment table as after the manual techniques I use based on Postural Restoration®, this is one of the basis’ of my manual techniques.
  • Movement: Functional Movement Systems: Screening, Assessment, Corrective Strategies (Cook)
    • What Gray Cook has done and his views of movement and function are tremendous.  He is also one of the better orators there is out there.
  • Frankly, I spend a lot of time currently reading through my Postural Restoration course manuals.  These are, in my opinion, one of the most comprehensive course manuals out there in describing anatomy, physiology, assessment and intervention techniques, etc.
  • Anatomy Trains (Myers)
    • Thomas Myers has done an incredible job of mapping out and identifying various fascial lines and the influences these have on us.  I also believe that they are also influenced by other factors, but his descriptions and strategies for managing are quite good,
  • Functional Training for Sports (Boyle)
    • Mike Boyle has done groundbreaking work in the field of performance coaching and does an amazing job in this book on providing his methodology to the public.  I am fortunate to call him a friend and have learned a great deal from his work.   
  • I also like PT-ish books which discuss the influences other things have on us such as:


Non-PT books I like a lot are:  

I like books that follow a storyline, but also educate the reader on aspects of the topic they are discussing.  In the books listed, one learns about the space race and the Apollo spaceflight project; scuba and deep sea wreck diving and finding a U-boat within a few miles from our eastern shore; piracy within the fishing industry and the longest nautical chase in history; natural running and influences of a culture on how we function; and meteorology, storms and the influences on our environment.

Given that you’ve been in the field for 25yrs or better, what fads and themes have you observed over the years? Any favorites? Any keepers?

It has been very interesting being part of what I feel is the time where there has been the most significant amount of change and growth in our various industries–from a rehabilitation perspective, medicine, as well as strength & conditioning.  I think back on seeing my first ACL reconstruction patient in 1990 and how that person was one of the first the surgeon did where he did not cast them afterwards, this patient’s slow return back to activity, learning the more accelerated rehab methods and how the insurance paid for months and months of rehab, 2-3 times per week, for about 9 months if I remember correctly.  Certainly things have changed since then on many levels

For me, one of the biggest has been position training and education.  From the upright, stiff posture I learned in school and my early years, to knee position when bending under load and not allowing “knees to go past toes”, to what would be considered a “neutral” spine, there has been a lot of misinformation with the best of intentions.  We are a living, breathing organism that is designed for movement which has had to conform to societal influences that is, frankly, breaking us down.  We should not have to work as hard as we do trying to achieve some good postural position to sit, stand and walk–there just shouldn’t be the amount of muscle activity involved as many of us try to aspire to.  Knees have to be able to go past the toes when loading to some degree, as long as the body is able to decelerate it from going more forward than the pelvis and ankles can support (I tell people that with feet flat on the ground, drive weight through your heels and push your knees forward and that is where they should be).   And being “neutral” is not a single-plane strategy–it is positional and respiratory balance and a nonspecific area for the systems to reciprocally circulate around and alternate through in an attempt to negotiate gravity, pressure and movement.

“Good ergonomics” is another thing that has changed and is repeatedly being discussed and evaluated.  Many times it is in an attempt to get people to be able to sit for longer periods of time, which is incredibly ironic, and frankly many times not done correctly, in my opinion.  Vertical positioning with joints locked into a position which decreases the ability of our bodies to be able to move or breath merely feeds into our stressed out systems.  I wrote this article for Eric Cressey last year (http://www.ericcressey.com/tag/michael-mullin) which describes the affects long term sitting, inactivity, stress and a sedentary life can have on you and some strategies which can be employed to better manage it.

The use of modalities has changed dramatically as well and interesting in how my schooling spent an entire semester on their use and applications and how I use few to none of them anymore.  I haven’t used ultrasound in I don’t even know how long, e-stim on a rare occasion for pain as I think interferential/TENS can be beneficial for some at times, iontophoresis if indicated can be helpful in focal, more superficial inflammatory cases, but again far less than in the past.  Even cryotherapy I use and recommend considerably less than in the past.  Moist heat I think can be beneficial in the right situations, but that’s about it.  I don’t use IASTM or creams for manual rx, not because they are wrong, but I just haven’t found them beneficial for me personally.  I know some very good IASTM practitioners, I’m just not skilled with it.

Static stretching, as I learned it in school and early in my career, and even PNF stretching, has taken a big backseat in my treatments and training.  I will have people “stretch” some areas at times, but I feel it is just as much as for an inhibitory effect as it is muscle lengthening.  When I do stretch most anything, I have them hold the stretch for 3-4 full breaths vs. a set time.  More common areas would be:  calf musculature, hip flexors, posterior hip capsules (usually left), posterior mediastinums, pecs, and maybe hip external rotators (usually right and inferior focus).  I do, however, do a lot of mobility work which is markedly different.

What was it like to work with the Miami Dolphins? How did you get that gig?

It was and is an incredible experience.  Dave Puloka, who is the Assistant Strength & Conditioning coach for the team reached out to me, as he had received my contact info from Mike Boyle.  Dave wanted me to go to lecture the S&C and medical staff on Postural Restoration® and applications to that population.  (I think it’s important at this stage to clarify that I am not on faculty for the Postural Restoration Institute and as such do not teach their specific courses.  I do, however, lecture regularly on their principles, teachings and applications to rehab and training and am in regular contact with the Institute on the programs I offer.)  I have been down a couple of times and have also done some consulting on some of their players, both while I was done there as well as FaceTiming and working with the staff and players in that capacity.  That is a great staff and seeing the inner workings of an organization like that has been incredibly rewarding.

You’ve taken a ton of Continuing Education courses. I’m sure you’ve found some better than others. What makes for a good Con-Ed course?

Early in my career, anything I took was worthwhile and filled with information I didn’t really learn in school.  I learned a significant amount and have been able to apply some really excellent things from various programs over the years.  A good continuing education program, to me, is one where there is lecture and lab, as so much of what we do is activity based.  Practitioners have to be able to feel things on their own in order to be able to effectively apply them to their patients from a manual perspective or effectively cue them from an activity standpoint.

Certainly programs which include some of the most up-to-date research and evidence is important in terms of being able to understand and apply what has been found to be most effective (and for me, staying within the parameters that I listed above with respect to reading research). 

I also feel it is important that a quality course manual is provided.  I like to go back and read through material as I can’t take in nearly as much as I would like during a one-day or weekend program.  Having great references and resources to refer back to is also important to me.

Staying in the world of Physical Therapy, what important truth do very few people agree with you on?

Well that is an interesting question, CinemaAir, and I hope that there is nothing that very few agree with me on 🙂  I do think that the influence respiratory imbalance has on our system–both the system itself as well as our other systems–is the most under-appreciated thing in the medical and rehabilitation fields.  It is my observation that the strength, conditioning and performance world has been much more open to start doing respiratory training as part of their programming strategies which only makes sense, but I do find it incredibly unfortunate that more rehab practitioners have not studied, tried to implement components of it–let alone embrace it as the incredibly powerful tool that it is.

Taking that one step further, the respiratory imbalance piece I would further specify is the ability to achieve a Zone of Apposition, on both sides of the thorax, probably is the number one thing I have found which helps my patients the most, regardless of their condition.  Now unless someone has taken Postural Restoration® coursework, knowing what this is can’t be summed up just in an explanation or definition, and therefore whether others “agree” with me, I almost find irrelevant.  It is something that has be felt and seen in order for it to be appreciated.  But as a rehab practitioner, if I am doing most any activity, or if I have a patient who is getting stuck, once I achieve–or re-achieve, as some lose their understanding of its importance–a ZOA, then things just keep progressing.

Taking that one step further, I am amazed and confused by the sometimes almost visceral response some practitioners have towards Postural Restoration®.  Research and a basic understanding of anatomy and physiology clearly demonstrates the asymmetrical structure we have and the influence it can have on function, and yet to not at least recognize that this might play a role in even some of our patient’s symptoms and problems I find unfortunate.

Time for my time-travel question: You’ve just traveled back in time and are sitting face-to-face with your 30 year old self. What advice would you give yourself?

Take pride in the work you do and do not be swayed by what you believe others may think of you.  It is easy to get hung up with the societal pressures of acceptance, not wanting to stand out, or even compliance.  Life is too short to not take full advantage of everything it has to offer.  Work hard and have fun….

I work with a brilliant PTA. I’ve learned valuable lessons from her. As an ATC and PTA, what is that you would want any/all Physical Therapists to know or recognize?

First, I commend you on respecting and recognizing your co-worker’s skills and knowledge base.  I think that one of the biggest things for me that I feel very strongly about is that it really isn’t about what your credentials are.  The rehabilitation environment should be a supportive and interactive one where everyone learns from each other.  Humility is one of the more challenging emotions we all struggle with and being able to take a step back and ask questions without an ego getting in the way is huge.  There is no way we can all know everything so work alongside with who is in your clinic versus individually.

I also would want them to recognize that there are many bright minds out there that do some incredible work with none of the more recognized post-nominal lettering that some practitioners seem to think matters a lot.  I have seen some amazing things and some really smart people who are performance coaches or massage therapists, for example, that I would send people to before some of the allied health professionals that I have seen over the years.  It is about what is best for that particular person at that particular time in what they have going on that matters the most.  If you are good at what you do, then you should never have to worry about what others are doing.

Thanks so much Cinema Air for the opportunity to do this interview with you.  I learned a lot about myself and hope that some of the information will help others as well.  Cheers….

Michael, thank you for this incredibly in-depth interview!

Connect with Michael Mullin via twitter: @mjmatc

And find me: @Cinema_Air

Interview with Justin Moore, PT, DPT

Many of you (my readers) have requested that I interview Justin Moore, PT, DPT, (@policy4pt) the ATPA’s lead lobbyist on Capital Hill. And, it finally happened!

We touched on a variety of topics in addition to focusing on the APTA’s engagements in the political & advocacy fronts. For more info on things related to the APTA and Political Action check out this page.

Without further delay, here’s the interview. Enjoy!

You’ve got a unique professional story! You went from graduating College with a degree in Dietetics to Executive Vice President of Public Affairs for the APTA. Tell us your story. How did you get to where you are today?

I hope the story is still evolving. The chapters to date have been shaped by merging personal interests with the required education to practice physical therapy and be part of a profession. I came to physical therapy through an exposure and interest in serving individuals with disabilities. Dietetics was an early chapter by introducing me to the role of public policy and its impact on the health of communities.  Once in physical therapy, I found an environment that encouraged me to combine my interest in politics and public policy with my passion for my profession to begin to build a career. This was encouraged by Jayne Snyder early in my career which lead me to volunteer at the chapter level. These volunteer experiences led me to APTA’s federal and state forums. I joked to the Director of Government Affairs at the time, Nancy Garland, that she needed a PT on her staff. About a year later, she called to see if I was interested in joining staff. Being young and cheap, I was able to take this chance and begin to learn public policy, advocacy and government affairs from a great group of professionals at APTA. I hope this experiment APTA took on me 15 years ago has also opened doors for other PTs to seek non traditional career paths. The chance the organization took on me has been extremely rewarding and never short of challenge on a personal and professional level.

Let’s say someone at a non-PT event asks you “What is Physical Therapy?” How would you respond?

Physical therapy is about helping people get back what they have lost in their physical function and health.  Physical therapists are the bridge from what you currently cannot do physically to what you want to do.  Restoring movement to enable individuals to participate in their home, their work, their sport, their pursuits, and their communications is our core mission and purpose.

Since you have such a strong background in the public policy facet of Physical Therapy, what should every current and future PT know about how to push their profession forward?

To push the profession forward, you need a firm footing in the current public policies that define the profession and determine how, where and with whom we can practice. Understanding and appreciating the state practice act that defines physical therapy scope of practice is both the foundation and the opportunity. This policy provides the platform for recognition by payers and public programs, but also set up our potential to continue to advance our profession. To realize the opportunities ahead we need physical therapists to participate in public policy process from advocating on PT issues to community involvement to show our impact on society.

What is the biggest hurdle to complete Direct Access across the nation? What is the APTA doing toward this effort? And, what can PTs do to further fuel this effort?

Direct access is quickly becoming a reality. All 50 states have some form of direct access and we are seeing more rapid recognition by payers and the public at large. Direct access will only be a part of the equation as we will need to use this authority in different and new ways. Direct access has been incorrectly seen as our desire to seek independent practices and not as a mechanism to build collaborations with other healthcare professionals. These collaborations and partnership will be the next phase of demonstrating the importance of direct access to our practice and our impact on health care. APTA is seeking efforts to continue to expand commercial payer recognition, building the data case on direct access to show its use and value and efforts to educate the public on physical therapy and when to seek the care and services of a physical therapist. PTs should engage in their clinical environment, with their patients, and with payers to ensure that direct access is utilized and leveraged to improve our health care delivery system.

Pick one of the following you want as a Mentor? And why did you choose him/her?

  • Clark Kent (Superman)
  • Wonder Woman
  • Bruce Wayne (Batman)
  • Tony Stark (Ironman)
  • ______________ (your choice)

My knowledge of superheros is sparse, but I’m going to go with Bruce Wayne. I appreciate that he has become a superhero without a significant superpower. His message of leveraging your strengths, being resourceful, and building wisdom through experience and study have made Batman unique in the superhero space and I would love to have that mentorship.

What’s standing in the way of Dry Needling falling under the scope of all Physical Therapists across the US? How can PT’s help?

Physical therapists have been performing this intervention for years and clinician use is increasing. This intervention has also recently been subjected to the classic turf war of one profession seeking to have exclusive rights to this interventions. APTA is seeking legislative, regulatory and legal avenues to allow physical therapists to continue to use this intervention consistent with their education and training. PTs can help but understanding this public policy issue, educating their elected officials, and support efforts in states that are currently defending PTs ability to perform this intervention as part of their practice.

If you could speak to every PT in the US, then what would you tell him/her?

Remember why you choose the profession and keep that front and center every day. It is easy to get discouraged by the changing healthcare environment, the increasing demands, and all the distractions that pull physical therapists away from their purpose of service.

I would also tell every PT to never forgot that your license is yours. You’ve invested the time, energy, and intellect to have the privilege of a license, don’t underestimate it’s value, its potential, or ever compromise it.

Your calling to the profession and protecting your ability to practice by your license will serve you well and allow you to be a part of this great community of caregivers and clinicians.

Favorite books and/or authors? Any recommendations?

I’m not a voracious reader but have attempted to spend more time in books when on the road traveling and in the evening as my children read.   My favorite book is To Kill a Mockingbird (H. Lee). I’m currently reading Go Set a Watchman (H. Lee) and am disappointed in the start and struggling to stick with it.   

I would recommend Boys in the Boat (D. Brown) and Rome 1960 (D. Maraniss), both great story about young men and women coming of age in a changing world. They both have an Olympic thread as well which is an interest of mine as I love the Olympic movement, its history and the drama of each edition of the games. Lastly, I would recommend The Road to Character (D. Brooks). I bought this book for a friend that had just given an eulogy and was captivated by her remarks and the concept of eulogy virtues and how society is moving way from these virtues.   The book has one of my favorite lines and life themes about the importance and value of long obedience in the same direction.

Tell us about the Physical Therapy Outcomes Registry. How has it been going so far?

The registry is the project and initiative that I have been most excited about for some time. It’s potential is profession-changing but not without its significant challenges. The excitement and potential of the registry must be tempered by making it meaningful and easy to participate in at the clinic level. We need to systematically build the registry over the next several years and try to learn from each step and improve its utility and its value to clinicians and the profession at large.

The major hurdle for the registry and public launch of this platform for widespread participation is integration with electronic health records through an established sets of standards. Progress is being made but not at the pace we would like to see.

Do you have any passions or hobbies unrelated to PT?

My emerging and growing passion is about the importance of service and how we can participate in our communities to improve their lives and health. My particular interest is sports, recreation and physical activity for individuals with disabilities or significant impairments. I have two colleagues, one that volunteers with a little league baseball team for children with disabilities and one with a ski program. They both have my admiration and have sparked a desire to spend more time in service. My wife and family also have a passion to address hunger issues locally (comes from both my wife and I’s background in dietetics and nutrition). The number of children coming to school hungry in our neighborhood and community is unacceptable and if we can help one kid start their day a little better off than the day before, we want to help achieve that.

Since we’re coming up on an election year, is there anything we should consider in terms of Impact on Physical Therapists across the US?

The biggest impact physical therapists can have in elections is by actively participating. Educating candidates on the importance of health care and physical therapy to our communities and economy is essential. Our role and potential is still not widely understood, appreciated or leveraged. With the power of our collective profession participating in the electoral process, we can take great strides in realizing our role in improving the health of our patients and our communities. We also need more PTs to run for office. We have 11 in state legislatures but we need support and encourage more PTs to seek public service at all levels.

You’ve just traveled back in time and are sitting face-to-face with your 30 year old self. What advice would you give yourself?

Slow down to listen and learn. I was at times in a hurry when I was younger and didn’t take the time to observe, learn, and listen to some experienced leaders in the profession and public policy. Looking back the time spent talking with friends, listening to leaders, and learning by observing how one approached an issue, carried themselves and developed their thoughts was never wasted. Those opportunities always centered me and prepared me to be more aware, more knowledgeable and more engaged but I didn’t always seek them or appreciate them at the time.

Why doesn’t the PT profession have a super-PAC where anyone can donate money for the cause of strengthening ourselves on the political stage?

The physical therapy profession has an established and well regarded political action committee, PT-PAC. PT-PAC is the political action committee of the American Physical Therapy Association and a connected PAC. This means the PAC is limited to soliciting funds from a restricted class (APTA members) and distributing those funds in a transparent and regulated process to directly support candidates that are friends of the physical therapy profession. PT-PAC currently is a top 10 health care provide PAC with about 10,000 donors annually.   Our position on the political stage would be enhance by a greater market share of licensed PTs being members of APTA and a great percentage of these members contributing to to PT-PAC over the creation of a Super PAC in my estimation.

Super PACs are independent expenditure committees that do not make contribution directly to candidates but engage in unlimited political spending independently of the campaigns. These PAC are not subject to donor limitations as well and do more broad base issue advocacy. Due to limited resources and the cost of operating a Super PAC, APTA has focused its efforts to build the strongest, most effective connected PAC (PT-PAC). I also believe for a professional society that a connected PAC is most consistent with the role and purpose that these societies have in advocacy and public policy. Nothing restricts a SuperPAC from being established with its focus to advance physical therapy but I am also unaware of any significant or serious developments to form a Super PAC in PT and would encourage more widespread participation in PT-PAC over creating a Super PAC.

Share something about the APTA that most Physical Therapists across the country would/wouldn’t think of.

I think most physical therapists think of APTA as theirs and that is essential. APTA is and has always been the organization that physical therapists can call their own. APTA  is a collection of PTs that are set on protecting and advancing the profession. It will not solve the problems of PTs today or achieve the profession’s priorities without participation. Over our history many PTs as part of APTA have build a great foundation that all of us benefit from today. It’s our responsibility to participate, shape and add to the story of our profession for the next generation and continue to make APTA all of ours.

You’re a busy guy! Do you have any daily routines that keep you on task?

My daily routine is always better when I get a run in. I run for both mental and physical health and need that time on the trail or treadmill to think, plan and dream. I notice when I miss more than a day or two of running, I begin to slide in productivity and time management. I also like to run for solitude, no running partner, no iPod. My wife is the perfect running partner as we have trained for a marathon together and I bet we run for hours without saying a word, just both thinking and enjoying the steady pace. Another daily routine I’m working on is becoming a morning person. I have always worked late and been more of a night owl, but I am beginning enjoy starting the day earlier, doing some daily reading and getting my kids on the bus. My 9 year old son likes to play catch (baseball and football) as we wait for the bus and nothing starts the day better than tossing the ball around before meetings, emails, and time at a desk.

Justin, thank you for taking the time to share your thoughts & experiences! It was very informative and spotlighted the importance of a united effort on the political front.

Connect with Justin Moore via twitter: @policy4pt

And, find me @Cinema_Air

Interview with Chris Johnson, PT – Part 2

This is Part 2 of my interview with Chris Johnson – @ChrisJohnsonPT. Read Part 1 here. If you haven’t already, then head to his extensive library of Youtube videos that are well worth your time if you’re interested in specific exercise drills for rehabbing a variety of running injuries and more.

You can find Chris in person at Zeren PT in Seattle, WA.

There’s quite a bit of practical and pragmatic advice in here. Enjoy Part 2!

There’s an interesting overlap between coaching & being a Physical Therapist. Tell us about it, and how you’ve blended the two together.

First off, I’m glad that you see and appreciate the overlap. Being a physical therapist as well as a certified performance coach puts me in an incredible position to help athletes of all ages and abilities.

Considering the fact that we are human, and most likely have some remarkable past medical history or happen to possess subclinical pathology or certain risk factors for injury, it’s critical to first identify and address those risk factors so they do not come back to haunt us down the road. The bottom line is that things exist on a spectrum. All too often, I have athletes who are looking for coaching that really are candidates for physical therapy. Being able to effectively triage an athlete is critical to foster outcomes and reaching performance objectives. As I always like to tell folks, “you rehab to train, you train to compete, and you compete to redefine your limits.” It’s also funny that I’ve somehow gotten pigeon holed into being known as a running injury expert.

Considering that triathlon is a head to toe sport in every facet of the phrase I must have a solid command of the lower extremity but also of the spine, shoulder girdle as well as various bodily systems and how they interact. While I feel like I do a good job of staying current with the medical literature, I work tirelessly reading the performance literature to put myself in the ultimate position to ensure my athletes are ready come race day, or as I like to call it “harvest day.” In addition to being in a good position to help those seeking my services, I have also greatly benefitted from being a PT and coach when it comes to my own training and racing. When people ask me why I race, I often respond, “To find out how good my understanding and application of the medical and performance literature truly is.”

What are some of the most prevalent myths surrounding Performance Training?

In terms of triathlon, the greatest myth is that athletes are at a lower risk of injury considering the multi-disciplinary nature of the sport. The unfortunate reality, however, is that triathlon is a “triple threat” for injury, as Bruce Wilk likes to say. Triathlon involves three separate disciplines each with unique performance demands and risk factors for injury. Throw them all in the same pot and you invariably get a lot of over-trained, injured athletes who fall into the deep, dark abyss of a medical system that lacks the understanding to properly helm them. The other common myth as it relates to multisport endurance athletes is that weight training will only bulk one up and impair performance. The research shows that nothing could be further from the truth. Strength training has been shown to almost halve overuse injuries while improving economy of motion and rate of force development. Needless to say, if there is one thing that an athlete should do beyond their usual training for their discipline(s), it’s strength train. People would be surprised if they spent a week with me to learn how much I lift and perform drills. The irony of the situation is that most of the athletes that I work with always think I have a contrarian view until they realize that most everything I apply to their programming is based on the available body of medical and performance literature. The last myth, which continues to amaze me, is how much water endurance athletes think that they need to consume. I always laugh when people ask me how much water I drink when I compete in Ironman races. The answer is always zero, aside from occasional rinsing to clear any residual sugar from the gels and sports drink. Water does nothing beyond slosh around in your stomach while racing. It particularly leads to problems on the run secondary to all the jostling. Lastly, one of the myths among endurance athletes is that one can maintain race ready fitness year round. One of my greatest pieces of advice is to briefly lose fitness for a month. Once people get on the wheel, however, they can’t bring themselves to step off. As I always remind folks, if you don’t take planned time off and rest days, you will end up taking forced time off and rest.

This might be my favorite of your blog posts! Let’s dive into a parallel story: your knee that beat conventional thinking & carried you through the Ironman. Tell me about the journey you took to overcome your knee issues. What have you learned? How have these lessons affected you as a clinician and as a competitor?

This response could easily turn into a novel so I’ll spare you and give you the condensed version. At the age of 16, I remember the first time that I sought orthopedic consultation for a knee injury, which was aggravated by stair descent as well as when I was lining up to hit a backhand while playing tennis.

Naturally, my mother dragged me to local orthopedist for further examination. The physician’s office was a cold, sterile, and unwelcoming environment. After waiting for what seemed like an eternity, I finally was called back to see him. After talking to me for no more than a minute, and taking my knee through an orthopedic examination, he sent me for xrays down the hall. Once they were ready, he placed them on the stereogram and proceeded to point out an osteochondral lesion involving the right femoral condyle. He then muttered that I would most likely have to give up tennis and would never be able to run the rest of my life, “unless a miracle had occurred.” I did not place much faith in his words as I thought to myself, this guy talked to me for what felt like a second and failed to offer any meaningful solution to my problem. Fortunately, I sought a second opinion from Dr. Freddie Fu, a world-renowned orthopedist at University of Pittsburgh. Upon walking into his office I knew I was at the right place as his waiting room was filled with autographed pictures of world-class athletes. When he came in to see me, he also exuded professionalism, which was not hurt by the fact that he had a team of literally 10 residents and fellows following him around. He ended up having me go non-weight bearing for eight weeks before scoping my knee. Following surgery, he prescribed PT and recommended that I connect with Steve Hoffman, a well respected PT in the greater Pittsburgh area, who helped me return to playing tennis at an even higher level than before. Fast forward to my senior year of college when I was playing tennis in Florida as part of a Spring break trip which our team took every year. I was in the middle of a tight match and running full speed when I abruptly stopped and felt a sharp sensation in the anterior aspect of my left knee this time. Although I somehow managed to finish the match, I went to step into the team van afterwards and felt a strong, stabbing sensation and saw stars.

After returning to campus after the trip, I sought orthopedic consultation by the top knee surgeon in Delaware, who initially injected my knee, and had me undergo a bone scan as well as an MRI. Upon reviewing the results, I was told that the bone scan “lit up like a Christmas tree” and that I “had the knees of an 80y/o.” He diagnosed as having an avulsion fracture of the inferior pole of my patella. I also managed to get a copy of the MRI to read, which stated that I had no medial meniscus, severe degeneration of the lateral meniscus, severe chondromalacia of the patella, and bone erosions. I can’t think of anything more threatening! Although it took nearly a year before I could finally ride a bike without pushback, I finally took up road cycling. I used to always mountain bike before that, but shifted when I stopped to consider the smooth cyclical nature of the activity and how it would engender a great environment to restore the health of my knee. After a few years and several thousand miles under my belt, my knee started to feel really good again. I was no longer having any issues with walking around the streets of NYC, where I was living at this point in time, and was also tolerant of climbing stairs. Naturally, this prompted me to make an attempt to return to running.

Over the next several years, I slowly build my capacity and tissue tolerance to the point where I was running consistently while developing even great confidence in my knee. It was in 2007 when I competed in my first triathlon. Since taking up the sport, I have been injury free while racing for the past eight years and have been to Kona twice without having any signs of slowing down. I always make it a point to share this story with my patients to remind them of a few key things: 1) the body has a remarkable affinity to rebound from injury, 2) be careful of getting too attached to diagnostics as anytime you go into a tube there is nothing good that you will find out and 3) always remain patient and pro-active while ensuring that you have an accurate understanding of your situation.   

Pick one of the following you’d want as a Mentor? And why did you choose him/her?

  1. Jason Bourne
  2. Wonder Woman
  3. James Bond
  4. Tony Stark
  5. ____________ (not listed)

Bourne was the ultimate combination of intelligence, strength, skill, and getting himself out of seemingly impossible situations.

You have an incredible collection of Youtube videos! How do you come up with so many clever drills??

I first got into video recording when I used to spend my days skateboarding, snowboarding, pitching, and playing tennis among several other activities. I was always blown away by how much information one could pick up from going back to watch the tape. It’s pretty funny that I’ve continued to capture video through my professional career. While still in NYC, I initially started recording video of exercises and drills that I routinely prescribed to patients to ensure that I was providing a solid model of performance. I would record an exercise then go back to the camera to watch and would always find some aspects that needed to be changed or refined. Not only did these vids improve my own movement skills but they also started to comprise a video library for patients that I was working with in the clinic as well as a resource for folks across the globe. While we are on this topic, I think that is one of the greatest opportunities for improvement among clinicians and graduate programs. Therapists, similar to kids, need playtime and exploration to really enhance their skills when it comes to exercise prescription and demonstration.

One of my rules of thumb is that if I can’t demonstrate an exercise that I’m prescribing, then I need to either find a video that highlights keys to success or refer that person out to someone who is in a better position to help them reach their goals.

Let’s stick with the videos for a bit. Tell me what I need to do so that I too can produce sharp videos like yours.

First off, no need to spend a lot of money on fancy gear. At this point in time, all you need is a smart phone to be honest. Otherwise, everything is pretty much free. I suggest creating a Youtube or Vimeo account, get acquainted with Imovie, and start setting aside one day a week to shoot a bunch of videos. Of greater importance is to keep the videos, short, sweet and relevant. Also try to minimize clutter in the background to avoid distracting the viewer. No need to make the videos flawless either. It also never hurts to give people context. A prime example of this is when the police sirens would start up in NYC around 4pm (most likely when happy hour at the bars got underway). I used to always try to reshoot the videos, but I started to just keep the siren background as it gave viewers context considering that NYC is known to be a noisy, chaotic city. Lastly, if you plan to put the videos online, make sure to stay consistent with posting content otherwise your viewership will fall off a cliff.  

Favorite books and/or authors? Any recommendations?

Shel Silverstein: Where the Sidewalk Ends.

Otherwise David Sedaris is perhaps my favorite author. I remember reading his books while traveling on the subways of NYC and cracking up. I also like Jon Krakauer’s books in addition to any of Mark Twain’s stories. These days, however, I find myself reading “What to Expect When You Are Expecting” considering that my wife and I are expecting a baby girl in Jan 2016.

[Congratulations on your upcoming baby! She’s a very lucky girl!]

You’ve just traveled back in time and are sitting face-to-face with your 25 year old self. What advice would you give yourself?

  1. Remember that health and friends are the ultimate currency.
  1. Take money, sex, and power out of your decisions and you will never make a bad one.
  1. Read one research article per week.
  1. Never start your day checking email or social media.
  1. Make sure to read something funny before you go to sleep every night.
  1. Have transparency with others even if it upsets them as it will ultimately foster trust.
  1. Never buy more than one car per household and avoid it at all costs if you can.
  1. Make sure to learn another language.
  1. Spend a lot of time around professionals in other disciplines as it will only give you more refined understanding of your own.
  1. When you sit down to eat, make sure to do nothing else.
  1. Cardiovascular exercise and strength training are very important and one should never be done entirely to the exclusion of the other.
  1. NOW HERE or nowhere. I recently learned this from a friend, who used it when he was the MC of a wedding. I can’t think of any greater piece of advice considering the distracting world we live in. When you spend time with friends, family, and colleagues, make sure that you are present with them. You never know what you might be missing.

Chris, thank you for taking the time to do this fun & detailed interview! I learned tons, and I’m sure my readers have gleaned some great info. Thanks again!

Connect with Chris on twitter: @ChrisJohnsonPT

Find Me: @Cinema_Air

Interview with Chris Johnson, PT – Part 1

If you haven’t heard of Chris Johnson (@ChrisJohnsonPT), then you’re missing out. First, check out Zeren PT, then head straight to his extensive library of Youtube videos. Chris was also interviewed by Karen Litzy on her Podcast on Working with Endurance Athletes.

The interview provides a glimpse into how Chris has accomplished what he has so far, and what we can glean from his experiences. It’s so jam-packed with practical info that I decided to break it into 2 Parts.

Here’s Part 1. Enjoy!

So, how do you start your day? (breakfast, routines, etc…)

In all honesty, it depends on how much I had to drink the night before. By no means am I a boozehound but I do like drinking beer and happen to be in one of the best places in the world for doing so. I’m definitely not a typical endurance athlete, who is a slave to their training schedule and wakes up at 5am to train. Rather, I prefer to have a cup of coffee and read some research or catch up on world events. I also find myself doing a significant portion of my writing in the morning. One of the biggest mistakes I used to make in the past was top check my email or get on social media first thing in the morning. This undoubtedly stifled my creativity, as I’m definitely more lucid during the morning hours and need to take full advantage of this time.

Tell us about your orthopedic/sports graduate fellowship. Why did you decide to do it? And, given the benefit of hindsight, how has it impacted who you are today?

I had the distinct privilege of working in Dr. Lynn Snyder-Mackler’s lab in the UD PT department as an undergraduate, which morphed into a sports/orthopedic graduate assistantship at First State Orthopedics under Dr. Michael J. Axe. All in all, I ended up spending two years completing a Peter White Fellowship under Lynn as an undergraduate, which allowed to be a co-author on a couple manuscripts while spending nearly three years with Dr. Axe. Dr. Axe had an incredible work ethic so I was able assist him in seeing patients. He really taught me everything about clinic care and daily operations of running an orthopedic practice from the bottom up. These two individuals undoubtedly shaped my work as a clinician and demanded me to stay on top of the literature. I became very well versed in clinical reasoning pertaining to lower extremity injuries, post-surgical care especially involving the shoulder and knee, and develop a refined understanding of exercise prescription and weight lifting modifications for the injured athlete.

You spent 8 years in NYC at the Nicholas Institute of Sports Medicine and Athletic Trauma as a PT and researcher. How did this shape you as a clinician? Also, how did those 8 years shape you as a future business owner?

Having the opportunity to work at NISMAT was incredible for a number of reasons. First off, NISMAT was the first hospital based sports medicine facility in the country so it has a rich history. I also had the privilege to spend time with Dr. Nicholas Sr. (“Big Nich” as we used to call him). He was considered to be one of the original founding fathers of sports medicine and was a wealth of information. He had such a presence. I vividly remember him storming around Lenox Hill Hospital sporting his ring from the time when the Jets won the Super Bowl in which Broadway Joe Namath guaranteed the victory. He used to always remind me that “the research did not start when I was born,” and “everything in medical research comes with a date.”

Additionally, I also had the chance to interact and shadow several world-class surgeons starting with his son Dr. Stephen Nicholas, who was a pioneer in shoulder arthroscopy. I also developed a close professional relationship with the other surgeons in his practice. One particular surgeon, who I learned a great deal from was his partner, Dr. David Matusz, who is an exceptional spinal surgeon. Spending time amongst such high caliber and brilliant docs, demanded nothing shy of excellence from a rehab and communication standpoint. I was essentially their eyes and ears and always maintained close communication with them regarding all of their patients. I used to always joke with them by saying, “My goal is to disrupt your operating schedule, and cost you money,” to which they replied, “Be my guest!”

One of the most unsung heroes of NISMAT, who I’d also like to highlight, is Dr. Malachy McHugh, who is the current Director of Research. Considering the relatively small number of clinicians and researchers, it’s quite remarkable how much research the Institute publishes. Mal McHugh is one of the primary reasons for the prolific nature of this group when it comes to pumping out research. If you search MP McHugh on Pubmed, Mal’s contribution to the medical profession will be obvious and jaw dropping. One of the therapists, who also shaped me, was Tim Tyler, who is the current President of the Sports Section of the APTA. Tim had a wealth of experience and was not afraid to challenge me on every possible front irrespective of whether or not he agreed with my statements. As much as Tim used to piss me off, I realize in hindsight that it was ultimately for my benefit.

Any group would benefit modeling their professional endeavors after NISMAT, especially with their core curriculum. The core curriculum took place every Tues over lunch and involved a presentation by one of the staff members followed by a journal club pertaining to the topic just discussed.  The usual cronies sitting around the table were Dr. McHugh, the attending physicians connected with NISMAT, Karl Orishimo (biomechanist), Ian Kremenic (electrical engineer), Beth Glace (nutritionist), Tim Tyler (PT), Michael Mullaney (PT), Carmen Cheng (Managing Therapist) as well as the Sports Fellows and residents. Needless to say, we got into some pretty amazing and sometimes heated discussions and were always at the forefront of the research.

My time at NISMAT also shaped me as a future business owner though not in the way that one might think. Considering the high profile nature of several of the patients seeking our services, it forced to me to become very clear and calculated in my communication while mastering the art of motivational interviewing to elicit behavior change. It also forced me to appreciate my self worth because many of these individuals would seek me out for their rehab, which was flattering. It was always amazing to get calls from people all over the world, who would always make it a point to connect with me in the event that they found themselves in NYC doing business. I see far too many physical therapists undervalue their professional services and nothing upsets me more with regards to our profession.

What were some of the biggest hurdles you had to overcome when you opened your clinic, Chris Johnson PT, in 2010? What did you do to overcome these hurdles?

There are always going to be hurdles anytime one decides to “take the plunge” and start a business. My biggest hurdle, aside from the expensive nature of NYC, was opting to go into a space that was a bit further removed from Lenox Hill Hospital as far as Manhattan goes. This proved to be a deterrent for some though the patients, who ultimately valued my care, always took the time to travel downtown and crosstown to see me. You have to understand that in NYC, if one has to travel outside of a five block radius then it’s out of the way (first world problems ). Although business was initially slower than I would’ve liked, I took this time to develop my online presence.

After reading Gary Vaynerchuk’s book (who is also a friend/acquaintance), Crush It, it became abundantly clear that if one does not have an online presence in this day in age, they are creating a strike against themselves. Additionally, having spent the last eight years at NISMAT, without having much on an online presence, I was finally in a position to start taking everything I learned (right or wrong) and put it out there for the online community when I started my initial website/blog on Tumblr. Initially this was essentially a professional diary for me, though it soon became readily apparent that it was an amazing marketing tool and resource for people as well. Once I started getting positive feedback, I became that much more motivated to constantly write and would sit on the trains of Manhattan cranking out post after post.

Over the course of 12-16 months, I was in a physical therapist’s dream situation. I was operating a cash-based facility without doing any formal marketing while relying on no referral sources outside of patients sharing their positive experiences about working with me. I also always made sure to set aside a three hour window in the middle of the day to either train, write or shoot videos, which was an amazing way to break up my day. The only problem that I encountered, however, was that it was tough to grow a practice of this nature since no one wanted to work with anyone outside of myself. It also did not help that I named the facility after myself. In light of this information, I would therefore discourage anyone who is looking to set up and grow their facility to name it after themselves.

Staying in the universe of Physical Therapy, what important truth do very few people agree with you on?

Hands down the slow motion marching drills and isometrics (particular the ones featured in the “isometric training essentials” vid). The bottom line is that most folks simply do not have the patience to perform these drills as they are challenging, expose weaknesses, and do not make you sweat. Of the athletes I work with and coach, however, the ones who take the time to master these drills under various conditions become incredibly strong, robust athletes while improving their economy of motion. The reason I put such a huge emphasis on the marching drills is that they demand tolerance to unilateral loading while ensuring the performer can also fully weight bear through the affected extremity while assuming a balanced, upright posture. They also rely on no equipment and therefore are very practical even when folks are traveling. By slowing them down, they also demand a certain level of control and invariably demand the performer to audit the movement.

I should mention, however that once an individual masters the slow motion marching that I will increase the load through either using a weighted vest or performing them to a metronome at faster beat frequencies. As far as the upper body holds/isometrics go, they are a great way to introduce load to people. I’ve been giving isometrics for the past decade and everyone used to tell me that they were not “functional.” However, they also have a pain amelioration effect and are particularly effective in addressing tendinopathies. Cook, Naugle, and several other authors have recently highlighted the importance of training in this manner.

How did you end up with a writing gig for Ironman?

The power of social media! I simply messaged someone on twitter, who was connected with Lava, informing him of my desire to write pieces for their online publication. Within a matter of days, I had my first writing gig. Lava and Ironman eventually became two separate online publications, so I ended up sticking with the woman I had initially established communication with when she headed to Ironman full time. Writing for Ironman was very helpful for gaining even more traction online, especially with the international community, and I’m very grateful for this opportunity. I have not been writing for Ironman much as of late because my pieces are a bit technical in nature and inconsistent with their needs. This may be a bit surprising considering how technically minded and data driven most triathletes are. At day’s end I’m very grateful for having the opportunity to write for Ironman as they have built an incredible brand and still put on the best races in terms of reliability while ensuring a painfully awesome experience.

Who are your heroes? And, what is it that you admire most in them?

One of my heroes who is no longer with us was Scott Mackler (Lynn’s husband), who passed after fighting ALS for several years. He was the epitome of grit and determination. Even when he had lost nearly all of his motor abilities, he still was running a research team at University of Pennsylvania while maintaining a sense of humor. Anytime I feel like life is difficult and things aren’t going my way, I think about the challenges and hardship that he endured and I am quickly brought back to reality.

Read Part 2!

Be sure to connect with Chris on twitter: @ChrisJohnsonPT

Find Me: @Cinema_Air

Interview with Dr. Karen Litzy, PT, DPT

Interested in Cash PT? Podcasts? Learning more about the evolving business of PT? Interviewing? Then today is your lucky day…and mine!

I had the incredible opportunity to interview Dr. Karen Litzy, PT, DPT. In the off-chance that you don’t know Karen, then…welcome to a new you. First, connect with her via twitter @KarenLitzyNYC, then head straight to her fantastic podcast series, “Health, Wealthy, & Smart”, and finally, check out Karen’s “Strictly Business Virtual Conference” – a TED-talk styled conference for PT. In case you find yourself in need of some quality PT in NYC, then get in touch with Karen via her cash practice website. Connect with Karen. It’ll be worth your while.

It’s a truly power-packed interview full of valuable insights & experiences. I’d re-reading this a few times to absorb & digest it all. Enjoy!

Let’s start at the beginning. Tell us your story about what led you into the wonderful world of Physical Therapy.

I have always been athletic..I played softball since I was 4 and was a gymnast for almost 9 years.  When I was in high school the local physical therapist (I grew up in a really small town in PA) wanted to do some strength and flexibility testing on me (given my gymnastics background).  I hung out at the office and really liked what they were doing.  That is the main reason I decided to go right into PT school after I graduated high school.  I also knew I wanted to work in the medical field but was not quite sure I wanted to be a doctor.  Physical therapy seemed to be a good fit for me at the time and if I wanted to go to medical school I could always make that decision later.  Needless to say I decided to stick with the PT thing as I really enjoyed spending quality time with the patients.

Also, my older sister is PT so I had some exposure to the education and profession through her.  And of course being the annoying little sister I had to do the same thing as her 🙂

You took your time developing your cash PT practice. Given the benefits of hindsight, how can I replicate what you have in less time?

I think if you have the guts you can jump right into a cash based practice.  The reason I didn’t is because I live in NYC and it is really expensive to live here.  I am talking really expensive…my rent alone is more than some PT clinics’ (also not in NYC) monthly costs.  So, I knew that I needed to have a consistent and high flow of income.  That is the main reason I took my time developing my business.  I needed to feel 100% comfortable that I could pay the bills I needed to pay as well as save a decent amount of money for retirement.  And I had to create my business all by myself…I didn’t have the luxury of a partner or a husband to help me out or to be a back up.

How can you replicate what I have in less time???  Know what kind of business you want:

  1. Know who your ideal clients are.  Create a very clear narrative around the clients you really love to treat and be around.  Then you can go out, seek those specific clients and spend your day surrounded by the kinds of clients you want to treat.  This will make your day something to look forward to!
  2. Know what you are good at and what you are not good at.  If something is not in your wheelhouse and/or you do not enjoy some part of the your business then outsource it!  I did not do this enough in the beginning and I regret that.  Even if it means spending more money (which it most certainly will) it frees you up to concentrate on the things you are good at and this will only strengthen your business.  
  3. In the beginning say yes to almost everything!  Put yourself out there as much as you can. This is where the hard work of being an entrepreneur comes in.  I can be a bit of an introvert sometimes and I didn’t say yes in the beginning to things as much as I could have and that may have hurt my business a bit.  That being said remember to not overcommit if you can’t follow through!
  4. I suffered (and to a certain extent still suffer) from imposter syndrome.  It is defined as: a term coined in the 1970’s by psychologists and researchers to informally describe people who are unable to internalize their accomplishments. (from Wikipedia)  After listening to hundreds of podcasts with celebrities and other accomplished folks I am realizing that so many people feel this way.  Now I use this feeling as a way to push myself forward, whereas in the past I think it absolutely held me back.  So if anyone is feeling this (which I think is pretty normal) use it as a means to push yourself forward and break through those uncomfortable times in your business…not hold you back out of fear!  Then when you do accomplish something in your business be sure to celebrate it…even if you are celebrating it by yourself!!

One thing I want to make very clear…owning your own business is hard work.  It is very time consuming, especially in the beginning. There is no “leaving your work at work” anymore….you are your work….you are your brand….and you should be thinking that all the time.  That would be my biggest piece of advice to any budding entrepreneur.  Be consistent and true to your vision and your brand no matter where you are and who you are with.  You never know where that next referral will come from and who needs that special thing that only you have.

Why did you start podcasting?

I kind of fell into podcasting.  It all started after I was asked to be a guest on my friend’s podcast.  He was running his podcast out of an online radio station.  After our interview the manager of the that station asked if I wanted my own show, and I said yes.  Back then I was doing each episode live..no editing!  I had no idea what I was doing and at the time there weren’t many PT related podcasts to look for for guidance.  So I had to figure it out on my own, and I am still trying to move the podcast forward.  But I do know that I am so thankful for the guests I have had on the podcast and I continue to learn something new each week.  If nothing else I am pretty sure I could get onto Jeopardy at this point (which is one of my life’s goals).   

How do you find your guests? How do you prep for them?

So many ways!  When I first started I interviewed friends and colleagues I already knew.  This was a great decision because it helped me to be more comfortable with the interview process, and like I said above, at the time it was live…so no edits.  Once I was a little more comfortable I reached out to people I admired and they said yes.  Now I find a lot of guests through social media, mainly Twitter.  I also have a lot of guests reach out to me to come on the podcast.  That makes me really happy..that people value the podcast enough to ask to come on as a guest.

When I first started I think I over prepared for each interview.  This made the interviews stiff and robotic.  Now, I do my research on each guest.  I read their books, listen to lectures, watch Ted Talks, read blogs, etc.  I make sure that I am as prepared as I can possibly be and when I start the interview I give up about 70% of the control of the interview over to the guest.  I will redirect and summarize when necessary but the guest has to feel like they can speak freely, otherwise the interview will not feel authentic or organic.

How have you changed your interviewing style over the years?

I like to think I have gotten a little bit better!  I started taking improv lessons with Harris Doran a great writer and actor in NYC.  This was one of the best decisions I have made in a while.  Through my improv lessons I learned how to actively listen and think on my feet.  This has helped my interviewing style and process beyond words.

When it comes to interviewing, are there people you model or admire? How have they influenced you?

Of course! Once I started the podcast I tried to watch and listen to so many interviews.  The interviewers I connected with are:

Oprah…how could I now include her on this list.  She is thoughtful, empathetic, and a great listener.  Oprah shows that it is ok to be vulnerable as the interviewer which is something I need to get better at.  She has also been doing it for decades!

Marc Maron the host of the WTF podcast.  There is such an ease and curiosity with his interviews that makes them so engaging.  He also has a knack for getting his guests to really open up, which is not an easy thing to do.  This is what I am hoping I can do because it means that my guests feel comfortable and safe.

Claudia Dreifus, writer for the New York Times.  She has been in the interview business for decades and she gave me a great piece of advice about interviewing: As the interviewer you have to do your research and be as prepared as you can possibly be (so the guest is less likely to get one past you).  Once the interview starts, you ask the first question and then give about 70% of the interview over to the guest.  This advice changed the way I interviewed.  I went from a bit of an uptight interviewer to more relaxed.

Meredith Vieira.  I love her because she is so natural and at ease with every guest.  She shows that you can be smart, funny and witty no matter who you are interviewing.  She comes across as a real person and that is what connects with a guest and an audience.  Plus I was in an elevator with her a few months ago and she really is nice!

David Letterman.  He is so quick and smart as a result of years in the business and his stand up/improv background.  I only wish I was that quick.  But watching him did inspire me to take improv classes and I think it is helping with interviews on the podcast and with clients!

I love the virtual conference you’ve started! (http://healthywealthysmart.com/) Tell us about the process of getting this idea off the ground.

First of all thank you!  It was a lot of hard work and time and I am really proud of it.  I think it is full of great info from some of the smartest people I know.  

It took me a while to figure out what topics I wanted to cover and how I wanted it to look. That part probably took about 2-3 months.  That included talking with a lot of my clients (who happen to be very successful people) and talking with other PTs and students trying to find out what aspects of the business side of PT they wanted to learn more about.  Once I hooked up with my project manager it took another 4-5 months to get it all together.  That included reaching out to the contributors to the conference.  I had written down an ideal list of speakers and I was able to get everyone!  So that was a big win and was very exciting.  I have to say I really didn’t have many surprises…the project manager takes care of all of the backend stuff so if there were surprises she was there to handle it.  Like I said above if it is not in your wheelhouse then outsource it!  

The marketing aspect was good…but it s could have been better.  It was a lesson learned for me and the next time I have a whole new marketing strategy in mind…can you say Leadpages!!!  I will also change my planning process by using a very comprehensive survey funnel.  Erica Meloe and I have something up our sleeves right now and will hopefully have something fun coming out in the next few months! I will use all that I have learned through running these programs to make this new project very fun and exciting!

How did you find the right people to hire for this project?

I had been watching several online business conferences through a women’s entrepreneurial group I am a part of and reached out to one of the women who hosted a conference.  She gave me the information of the project manager she used, I reached out to her and she took me on as a client.  From there the project manager helped to hire the rest of the team.  The team included a virtual assistant, web developer (who we found through Fiverr), and graphic designer.  I also had my lawyer help out with contracts and disclaimers and finally a sound engineer to tweak some of the interviews.

Favorite books and/or authors?


Explain Pain by Dr. Lorimer Moseley & Dr. David Butler.  

Aches and Pains by Louis Gifford.  

Therapeutic Neuroscience Education: Teaching Patients About Pain by Dr. Adriaan Louw & Dr. Louie Puentendura.

In my opinion all of these books should be standard in every PT program.  If they are not please seek them out and read them.  They will change the way you see and treat everyone who comes your way…patient or not.

Not PT-related:

Bossypants by Tina Fey.

Yes Please by Amy Poehler

Start With Why by Simon Sinek

The Power of Habit by Charles Duhigg

The Life Changing Magic of Tidying by Marie Kondo (it really is life changing!)

Dead Wake by Erik Larson (I love all of his books..the Devil in the White City is probably my fav book of all time).

The Girl on the Train by Paula Hawkins

Why Not Me? by Mindy Kaling

The next book on my list is The Brain: The Story of You by David Eagleman. I will let you know how it is!

(I listen to a lot of books on Audible when I am traveling around the city seeing patients).

If you could have dinner with any famous individual who is no longer with us, then whom would you choose? Why?

This was absolutely the hardest question of the bunch! I think the famous person I would want to sit down to a dinner with is the lovely and hilarious Joan Rivers!  If you have not yet seen the documentary about her, A Piece of Work, then stop reading this right now and watch it!  There are several reasons I would want to sit down with Joan:

  • She broke so many barriers not only for women in comedy but for women in general.  I would love to talk to her about this and if she had an idea of the icon she was becoming.  Was she aware that she was busting through barriers at the time? I suspect she did!
  • She had been knocked down so many times in her private life and in her career.  I would ask her where and how she found the strength and perseverance to not only keep going but to thrive and grow. This is such an admirable quality in a person.
  • She had an amazing work ethic and I would love to know how, even in her 80s, she kept that going.
  • How did she become a stand out performer in a traditionally male dominated occupation.  Not that PT is a traditionally male dominated occupation but being a private practice owner in PT seems to be.  I also find that truly being heard as a woman in PT is a challenge.  I think Dr. Sandy Hilton put it perfectly (I am going to paraphrase here) but she said something to the effect of “women in PT are taken less seriously about serious stuff”.  I think that is spot on…at least in my experience.  I am sure Joan experienced this most of her life……so how did she deal with it??
  • Of course I would love her advice for a fellow female entrepreneur.  Everything from goal setting, marketing, relationships, networking and of course her best fashion advice!
  • Finally, this is a sit down dinner so I would want to spend the majority of that dinner laughing.  And with Joan I don’t think that would be a problem!

Karen, this has been a phenomenally informative & entertaining interview! Thank you so much for your time & generosity!

Connect with Karen on twitter: @KarenLitzyNYC

Find me: @Cinema_Air

Interview with Dr. Stacie Fruth, PT, DHSc, OCS

I had the chance to interview Dr. Stacie Fruth, PT, DHSc, OCS recently. Stacie (2009’s Teacher of the Year at Univ of Indianapolis!) is currently the Director of the DPT Program at The University of Indianapolis. You can read more about her here.

The interview is informative & entertaining! We covered something I’ve been very curious about, and it is a special interest of Stacie’s: Physical Therapy in the Emergency Room.


You’re involved in a field that I think is incredibly interesting and we’ll dig into that later, but first tell us your story. How did you end up where you are today?

I’ll assume you prefer I skip the fun stories of my childhood… 🙂 The brief tale of the journey is that I attended the University of Michigan on a swimming scholarship. I started off pursuing a degree in engineering and two years in decided it wasn’t for me, so switched to Kinesiology. I was infinitely more happy in that program, but realized there’s not much that can be done with that degree. So, I headed to grad school at the University of Massachusetts where I earned a master’s in exercise science. I wasn’t jazzed about my career options with that degree either so started exploring, and stumbled across physical therapy. I landed at the University of Indianapolis because, of all the places I interviewed during the admissions process, I felt the most “at home” there, even though the school was dramatically smaller than Michigan or UMass (which I thought would be a negative – and it wasn’t). I fell in love with the profession and the UIndy program and upon graduating, I told the dean that I would be back and I would somehow find a way to teach in the program. I went out into the world and practiced PT (mainly ortho) – truly loving it – but nine years later headed back to UIndy to start my doctoral degree. Two years into that, a faculty position opened up, and I jumped at the opportunity. I’m now in my 11th year of teaching in the Krannert School of Physical Therapy, and recently assumed the positions of Chair of the School as well as Director of the DPT program.

Check out this Podcast interview on Stacie’s book “Fundamentals of the Physical Therapy Examination: Patient Interview and Tests & Measures“. How was the writing process? What were your biggest challenges in writing & publishing the book?

Ahhh…the Purple Book (as it’s affectionately known)! Labor of love? Arduous? Painstaking? I can’t deny that it was a huge undertaking, but I’m very happy with the outcome. I applied for and was granted a sabbatical from UIndy for a semester and that’s really what allowed me to make the most headway. I secluded myself in a cottage in Michigan in the middle of winter for a month and that really helped to get it off the ground. My publisher (Jones & Bartlett Learning) was wonderful from start to finish. They strongly supported this project and put a ton of resources into it. As an untested author, I was absolutely thrilled to get a full color textbook with professionally made videos (and LOTS of them). What helped immensely is that I had taught this foundational material for 6 or so years and had progressively created a prototype of the book along the way. I was actually shocked that there wasn’t a textbook out there that covered these fundamental but essential skills needed to conduct a solid initial patient exam. So eventually, I just decided to fill that gap myself.

I really wanted the book to be useful to both instructors and students, so the biggest challenge was trying to conform to all the different DPT curricular models out there. For some programs (those that teach the basics of the patient exam first, then branch off into more advanced musculo, neuro, etc.), this textbook fits beautifully. For those with different curricular models (e.g. those that teach methods of doing a musculo exam separate from how to conduct a neuro exam), this text isn’t an obvious fit. Regardless, it does cover all aspects of conducting the initial patient interview (and I don’t think that exists elsewhere) and includes nearly every basic test and measure. The more advanced stuff – such as special tests – is left out on purpose. Plenty of textbooks cover that material quite well…no need for me to repackage that information.

I’m currently in the early stages of revising the book for the next edition and would absolutely LOVE to get as much constructive feedback as possible. I’ve got some reviewer comments, and of course the feedback from my own students, but I welcome anyone’s suggestions as I dive into this in the next few months.

Tanzania! Tell us about one of your unique experiences in Tanzania.

What an amazing trip! It was such a privilege to lead that group of 10 DPT students half-way across the globe and observe so many transformational experiences while we were there. I think a personal experience that was very meaningful for me involves a young girl I worked with during my first trip to the same village (Pommern) 10 years prior. She was a very small 4 year old at the time who had CP. Mind you, I’m no peds therapist, but I worked with this girl for several weeks and she took her first steps while I was there. Beyond rewarding. However, knowing that individuals with disabilities often don’t fare well in remote African villages, I always wondered if she would live a meaningful life. When I went back with my DPT students 10 years later, I was able to find this young lady, who was then 15 years old. Her mother (whom I’d spent a lot of time with during my first trip) had died of malaria, so the girl was living with extended family. I was beyond thrilled to find out that she was (generally) ambulatory and had a job doing laundry for her neighbors to help support herself. I have no idea if my work with her made “the” difference, but I’m pretty sure it made some difference, and that’s all that matters. While this was a very meaningful personal experience, it was so cool to share it with the students who came with me when we finally found this girl – to show them that the work they were doing with some of their own “patients” in the village (almost all were very young children) might have a true lasting impact.

A big interest of yours is Physical Therapy in the Emergency Department. How did this start? And, how has it grown?

That’s a long story, but the compact version is that I was hit by a car in 1997 while riding my bike home from work. I landed in an emergency department where I was misdiagnosed (and I knew it, but wasn’t listened to) and handed a pair of crutches still in their plastic wrapping. I remember lying on the bed thinking, “why aren’t PTs here?” I kept asking that question until 2002 when I ran into Michael Brickens, PT who had just started working in the Methodist Hospital (a Level 1 trauma center in Indy). At the time I was nearing the end of my doctoral program and was searching for my final research project. Many years and 6-7 studies later, we’re still going strong. When I met Michael, he was the only PT working in that ED, and the only other ED PTs in the country were in Arizona. Now, the Methodist ED has 2 full-time PTs and 4 per diems (I’m one of them). Indy also has another Level 1 trauma center with 2 full-time PTs (one of whom is one of my UIndy grads), so Indy actually offers the most ED PT coverage hours in the country (pretty sure about that…). Thus, it’s an ED PT research mecca, considering there are only a handful of US-generated published studies out there. I just got one back from PT journal with provisional acceptance for publication so I’m working on that revision now. Stay tuned!

Why is it called PT in the “ED”? ED sounds like something you don’t want to talk about in public… ER sounds exciting. Why “ED” instead of “ER”?

Okay, funny story about that. I was in Starbucks trying to prep for the education session my colleagues and I did at CSM last year. I had a binder of articles and the front of the binder was labeled “ED research.” A guy walked up to me and asked if I could tell him if there were any new treatments out there because “that pill” just wasn’t cutting it for him any more. I kid you not. That was a short but interesting conversation, and I went home and changed the label on the binder! Actually, the answer to your question is simple – the emergency department is just that, a department of most hospitals (with its own specialization, culture, resources, staff, etc.) and much more than just a “room.” So, the terminology has shifted to “ED” in all formal writing/publications. That said, “ER” and “ED” seem to be interchangeable in conversations (even with EM docs).

Let’s say I wanted to work in the ED. How do I prepare for it?

You need broad knowledge in just about every aspect of of PT practice (acute and chronic ortho, neuro, cardiopulmonary, wounds, fracture splinting, multi-trauma, and medically complex/multi-comorbidity). You also need strong differential diagnosis skills. The ability to multitask like crazy comes in handy and you need to be highly independent (ED PTs tend to work completely solo). Something else that’s important is having a high level of confidence in your professional opinions/impressions about patient intervention plans in conversations with the MDs. That said, the collaboration with the ED docs is amazing, and they have come to highly respect PT knowledge and skills. My schedule only allows me to work in the ED about once a month (have done so for 7-8 years) but I’ve worked with patients ranging from 2 to 101 years old, and conditions have covered the spectrum. There is no lack of variety in this setting!

So, you’re headed to a conference in the UK next month (Look here & here for info). What are you going to talk to the Brits about?

PT in the ED, of course! I’ve got one platform (influence of PT intervention on falls and return visits to the ED) and one poster (comparison of number of evidence-based interventions provided by PTs versus MDs in the ED for select musculoskeletal conditions). This will be interesting stuff to present because the Brits are way ahead of us in terms of allowing PTs to function autonomously in the ED setting. PTs in the UK can see patients with MSK conditions in the emergency setting independently, including the ability to order diagnostic tests and prescribe simple analgesics. This is exactly where we want to go with ED PT in the US, but we’re not there yet….

How much fun was this??

That was definitely a fun study! My colleague, Anne Mejia-Downs, and I had been looking for ways to get the faculty/staff at UIndy to be more active (and have fun doing so) right about the time that Dance Dance Revolution was hot. So, we designed a study and pulled in 6 of our DPT students to coordinate it. We actually got a nice-sized group to participate and the feedback we got from our participants was great! I presented that study at a conference in South Africa in 2008 and also at CSM in 2009. We then did a follow-up study to this one, looking at changes in balance and mood states following 6 weeks of DDR and also got some nice results (presented at APTA Annual Conference in 2010).

Favorite books & authors?

My favorite “fun” books might be a little on the odd side. I have a strange fascination psychopathology and what influences individuals toward some pretty dark/disturbing behavior. I prefer non-fiction in that realm, but fiction based on real events will do the trick too. So recently, the Gillian Flynn books (Gone Girl, Dark Places, etc), but also stuff like the Hannibal series, Patricia Cornwell’s non-fiction books, Peter Vronsky, etc. On a much less gruesome note, I very much appreciate Clarissa Estes’ Women Who Run with the Wolves. And, although seemingly less intriguing, I really like quality leadership books (The Leadership Challenge, Start with Why, etc.) and find they apply to life both from the professional aspect as well as the personal. That’s the nerd/geek side of me coming out!

What are some of the most challenging aspects of conducting & publishing research?

There is not room on 20 pages to list them all! Research is time consuming beyond belief – simply getting through an IRB can take many months. And the last paper I submitted took 2 days just to get the info into the submission portal. Speaking about the research itself, it is so challenging to find the balance between “high quality” and “clinically meaningful” studies. The higher the quality, the more sterile it is (e.g. by the time you exclude all participants with potential confounding conditions, you’ve excluded the typical clinical patient population). So many studies that do get published have such narrow inclusion criteria that it’s quite difficult to apply the results to any of my patients (my folks have lots of comorbidities and biopsychosoical issues). So, it can be incredibly frustrating to create a study that tries to capture typical clinical populations. I think this is why so many studies that were once considered gold standards now can’t be reproduced – that fascinating variable called “the human being” is awfully tough to control.

What’s the best gift you’ve ever received?

I’ll go with the first answer that popped into my head when I read this question. A pony! That was a VERY long time ago – I was 10 at the time – but the absolute blessing that horses have brought to my life since then is indescribable and it all started with that stubborn little pony. The purpose of horses in my life has changed through the years, but what it centers on is the peace in my soul when I’m with them. My relentless focus on work goes out the window and I can simply “be.” A gift beyond words.

Stacie, thank you for this fantastic interview!

Follow Stacie on Twitter: @StacieFruth

Find me: @CinemaAir

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