5 Lessons Physical Therapists can Learn from Bruce Lee

I wrote a guest post for Strive Labs. Check it out:

“Bruce Lee is one of my personal heroes. While there are many reasons I admire him, I find his philosophical approach to everything the most salient and magnetic feature of admiration. We can learn numerous lessons from his life. Here are 5 lessons that apply to Physical Therapists as individuals, and Physical Therapy as a profession.”

Continue reading…


Track & Field

Finding out that your hard work didn’t pay off is a terrible feeling – especially if you’ve put in the time & effort to allow for success. I’ve hesitated publishing this post since last year, but this feels like the right time.

I failed a second semester course in grad school. Many hours were spent studying for this class because it was my hardest. I knew my test scores didn’t quite measure up – let alone reflect how much I actually learned. Finals were coming up, and like a predictable movie everything hinged on the final. I missed the score by 2 points.

What followed was a terrible experience. I had to drop back a semester just to re-take this class. This meant that I wouldn’t graduate with my incoming class. It also meant I wouldn’t take the same classes they would; which means our schedules would differ and it would be harder to enjoy off-time with them as well. The next semester was incredibly difficult on an academic and internal basis. The class wasn’t any easier the second time, but I managed to pass (by 2 extra-credit points). I hear the class has been re-formatted since I graduated.

Looking back on this with years of hindsight I’ve realized that it truly meant nothing to me. In fact, the materials I learned from that particular class have been generally discarded – except for the basic framework of conceptual application. Today, I literally use less than 10% of the contents of that class. So, why am I re-living it?

Because it reminds me that all of us have the capability of perceiving little failures as the Himalayas – making mountains out of mole-hills. The real questions I should have asked myself:

A. Why did this fail? Not “why did I fail?” If you put in the time and effort for this to succeed, then you’ve positioned yourself to learn a great deal from this experience. Take the time to reflect on why IT failed, and what you would do differently the next time. Separate yourself from the event and give yourself the advice you would offer others.

B. Will this keep me from my long term vision? Usually the answer is NO. It’s been almost a decade since I failed that class; and today I am a much better clinician than ever. In fact, when I took my Boards I passed on the first try – many students with much better grades didn’t make it. If you don’t have a long term vision, then ask yourself: “where do I want to see myself in 5 years?” You’ll quickly realize that there are many ways to get there.

C. How could the failure have SAVED me?? Who’s to say that things would be better off today if I hadn’t stumbled on this hurdle? I may have never found my current interests. Which means I would not be where I am today – in the company of some incredible clinicians and individuals. In fact, one core components of that class is my bread & butter in the clinic today. I will always have room for improvement, but it’s nice to recognize the distance I’ve covered so far.

D. Why did you even try in the first place? There’s more to this than a simple PASS/FAIL Your profession requires you to jump a few hurdles before you reach the starting line. That’s right. Once you’ve finished graduate school, you’re now positioned in the sprinter’s stance with your professional track(s) awaiting discovery. Make it to the Starting Line. And, as you’re crouched down waiting for the gun, remember why you chose this track.

DPT students across the country just took the National Board Exam for Physical Therapy. Some of you made it through on the first try. Congrats!

To everyone else: can’t wait for you to join me on the track.


What Would MacGyver Do?

I wrote a guest post for Strive Labs titled “What Would MacGyver Do?” about some lessons we can learn from this 1980’s icon.

 MacGyver has been an icon of resourcefulness ever since he first hit TV decades ago. While we may not be able to cobble together lifesaving devices using toothpicks and chewing gum, there are some worthwhile lessons to be learned from Angus (can you believe MacGyver’s first name is Angus?? Me neither…). Let’s look at 2 filters of MacGyver wisdom; the first one is from a company that makes soap: Method.

Method grew from “a very dirty San Francisco flat” into a very successful brand and company. Their mascot was, and still is, MacGyver. “What Would MacGyver Do?” is one of their core values. Here’s how they described it: [read more]…

Hindsight Wisdom! Special Post for #solvePT 02/24/15

Tonight’s #solvePT discussion revolved around the following question:

It just so happens that I’ve asked a similar question repeatedly over the last year in my interviews. I highly recommend that you check out the interviews. There are TONS of wisdom and lessons to learn from these shared stories and experiences. 

The question I asked was some variation of: “Imagine you’ve travelled back in time right after your graduation from PT school and are face-to-face with yourself. What advice would you give to your younger self?” I’ve listed the responses below.

Enjoy this special post for #solvePT!

Dr. Nick Nordvedt: LEARN and find a mentor. PT students and new grads that I meet are frequently surprised by the vast amount of knowledge still to learn after graduation. We graduate as generalists, but must find our practice niche after graduation. I think the best way to do this is through taking advantage of every learning opportunity available and find a great mentor that shares core practice values with you.

DR. MONIQUE CARUTH: LOL, shouting out loud to my young self…”You do not know it all!!!!”,  I would tell myself to welcome constructive criticism because those that offer it they see potential in you and care about you to take the time to invest in sharing ways and means for you to better achieve your goals. Those that don’t care won’t waste time even offering anything good or bad. Don’t beat yourself up about getting a B on an exam, no one cares what your grades are when you leave PT school as long as you pass your boards. Take a few business electives. Chat with managerial students. Meet and sustain relationships with great mentors. Engage in social media. Advocate more for our profession.

Dr. Ben Fung: Get involved in legislative issues – licensure defines practice patterns. PERIOD. If you want to truly be regarded as a primary care, provider of choice for neuromusculoskeletal impairments – one must be first licensed to do so to effectively penetrate the market.

DR. ERICA MELOE: That’s an interesting question because I gave up a financially rewarding career to go back to school. I would advise the student to pay attention to the trends in healthcare. When I graduated PT school, it was during a time when no one was hiring! The Balanced Budget Act was in full swing and the Medicare Cap was just instituted. There is no way as a PT Student you could have prepared yourself for that, realistically. I would also have advised myself to seek a mentor out, someone who was already established as a PT. Mentors are so important for both personal and professional development. And I think as a student in a field that was undergoing so much change, it would have been nice to see the field from a different perspective.

When I was at Stern in my last year of business school, NYU set up “informational Interviews” with alumni and they endeavored to match you both with regards to industry. These were very helpful in the sense that it opened my eyes to the opportunities in my field. When I was in PT school, I did not have that opportunity. I would urge students to request this if their programs were not offering it already.

DR. DAVID BROWDER:  Daniel Pink, in his book ‘Drive’ lists three things that drive intrinsic motivation.  1) Autonomy, 2) Mastery and 3) Purpose.  My advice is to seek opportunities to work in an organization where the purpose of physical therapy is embedded into the culture, and where they can gain mastery in the practice of physical therapy.  For those so inclined seek out mentors who can help develop management and leadership skills.  I believe that specialization is an excellent route to this.  Autonomy is more difficult and can definitely be found professionally, but for those that have the ambition and determination to build their own practice – I think there is no better place than private practice physical therapy to find the confluence of these three things.

Dr. Sandy Hilton: Be bold and take chances. You will need to be persistent to get what you want, do it with grace and kindness, but do it.

And publish your masters thesis, because you were right.

Dr. Erson Religioso III: Clinically: You don’t know it all, and for God’s sake, stop beating on people to make them move better!

Personally: Start working on your symmetry and stop with the huge pounding overstrides so you don’t have to quit running due to knee pain. Also, invest in something called google.

Jerry Durham:I would beat the following statements into my Younger head….

-Believe in yourself, your ideas and what you bring.

-Understand that YOU being YOU is the most Valuable thing you can do (Fuck others who say dont be YOU)


-Don’t be afraid NOT to be the smartest guy in the room…You can learn from Everybody

-Find a Business Mentor TODAY (this woulda helped on multiple fronts, not just starting my biz)

-Set up a financial plan and follow it..

-Your parents are right!!…(almost all of the time).

All of those played a huge role in my personal and professional development.  A couple of those came way later than others.  If those were beat into my head 20 years ago, my learning curve would have been far shorter!

(I would also mention to hold that Apple stock I bought at $14 a share…no joke.  But thats for another day)

TODD HARGROVE: Invest in Google and Amazon. Chicken wing consumption needs to come down.

I don’t regret going to law school at all, it was one of the best times of my life. But I do regret not getting started with my current career a little earlier. Is there a difference between these two things? It feels that way to me. If I had gotten started with this career earlier maybe I would have been more involved in strength and conditioning and sports performance.

BRUCE WILK: It was 1980 and it was my senior year of physical therapy school.  I was disappointed because I was hoping to learn about running injury management and how to keep people running healthy. It took years to reach that goal, but I finally made it.

My advice: Stay the course.

BRAD BEER: Great question. My advice would be two-fold:

1. To not ‘look side-ways’. Avoid the comparison game. The grass may appear to be greener but it rarely is!
2. Be patient. Success is developed through the navigation of an array of challenges and various learning opportunities that life both professionally and personally generates.The degree to which you succeed and progresswill be determined by the degree that you stop to evaluate your learnings and lessons.It has been said that experience is an OK teacher but evaluated experience is an even better teacher.

JESSICA MCKINNEY: Study, travel, and read more before you start your family and trust your gut in bridging pelvic health and your orthopedic manual therapy training. You’ll know enough to do it way earlier than you think.

DR. SETH OBERST: Having a reason for everything that we do as physios. Having a paradigm for progression/regression as well as using a test-retest model that exposes the client to the intervention based on your hypothesis and then gauges their response is crucial! It’s what separates the zeros from the heroes. The key is to recognize patterns and that means a lot of deliberate practice. Experience itself does not equate to expertise; deliberate, thoughtful experience while being driven by what we don’t know yields expertise.

Expose yourself to other ideas outside of physio. Yoga, massage therapy, kettlebells, Oly lifting, anything. We try to own these little silos of information without considering other, often very effective, schools of thought. Way too many PTs have no clue about training methods and movements which is rather ridiculous. If you yourself cannot pull, push, press, and squat how the hell can you expect to have face validity when calling yourself a sports physio or trying to coach a patient (and yes everyone should be able to perform those movements in some capacity). Because ultimately PTs are movement coaches so take pride in owning movement.

ANDY LODATO: This profession and your patients will humble you. They will humble you with their generosity, their complexity and their vulnerability. You won’t realize the power that you have to help someone just by listening and talking. The profession is a “Physical Therapist”, but all of those psychology classes you took in undergrad will be of great use to you. Also, remember to be have patience. Your career and development will take not happen overnight. All of the bumps in the road are part of the journey.

ANN WENDEL: I would tell myself that it’s all going to be ok. That no matter what happens, I can turn it around and make a really satisfying life for myself.

JULIE WEIBE: Change is an evolution, not a revolution. Be patient, and stand strong even when you are swimming against the tide.

Never stop learning.

Stop cursing like a sailor.

Stop dating that guy. Wait for the Canadian….(I would sort of trail that last one off into a whisper, then slink back into the shadows….)

Find me on Twitter: @Cinema_Air

Life’s Inevitables…

What are Life’s Inevitables? Other than death and taxes?

Maybe Love, Loss, Disappointment, etc? In other words: “Highs & Lows”. If you’re reading this, then odds are you have at least a vague, but (and?) visceral understanding or experience of these Highs & Lows. So, maybe the Inevitables could be Death, Taxes, and Highs & Lows.

When it comes to Death, this article on The Top Five Regrets of the Dying is a must read. It’s worth your 3-5min to read the entire article, but I’ll list them here:

1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.

2. I wish I hadn’t worked so hard.

3. I wish I’d had the courage to express my feelings.

4. I wish I had stayed in touch with my friends.

5. I wish that I had let myself be happier.

Thinking backwards from the ending makes me want to live life ending at the finish line without any regrets. Maybe this Top 5 provides a strong starting point. Simple, but not easy. Maybe John F Kennedy was onto something when he said,

We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard.

Is that how I should view this? A personal Moonshot mission? Maybe. Maybe, yes. Maybe the resistance – the not-easy part – guides a meaningful direction. All I know is I want to hit the finish-line regret-free.

Taxes are beyond my understanding and interest. So, let’s leave that alone.

The Highs & Lows. I think experiencing this is also inevitable. The Lows seem to leave a much stronger impression than the Highs. At least, that’s true for me. It also seems to be true for Andre Agassi:

I feel, in fact, as if I’ve been let in on a dirty little secret: winning changes nothing. Now that I’ve won a slam, I know something that very few people on earth are permitted to know. A win doesn’t feel as good as a loss feels bad, and the good feeling doesn’t last as long as the bad. Not even close.

Is it possible to have the Highs without the Lows? I don’t know. Maybe we need the Lows to appreciate the Highs. Brian, from the movie “Vanilla Sky“:

Just remember, the sweet is never as sweet without the sour, and I know the sour.

Could the Lows be more meaningful and impactful than the Highs? Maybe it’s our response to the Highs & Lows that matter most. Dr. Victor Frankl:

“Everything can be taken from man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstance, to choose one’s own way.”

I hope I respond to Life’s Inevitables with determination, applying lessons learned to make the most of our time, and breathe the breaths of a regret-free peace of mind. I hope to live a life true to myself, work to live – not live to work, not hold onto bitterness or resentment, keep my closest friends closer, and choose happiness over comfort.

Gerard Way:

One day your life will flash before your eyes. Make sure it’s worth watching.


Interview with Scott Epsley, PT, RMSK, SCS

Some of you may have heard of Scott Epsley, many of you haven’t – and I think you should! Scott is a Physical Therapist with experience in private practice, research, sports PT, as well as strong interests in the use of diagnostic ultrasound in PT, Dry Needling, and more. He currently works as the Physical Therapist for the Georgetown University Athletics Department. You can read a short bio here

The world of Physical Therapy is studded with remarkable individuals, and Scott is one of them. I learned a lot from this interview, and I believe you will as well. Enjoy!

Let’s start with your professional beginnings. What drew you into the wonderful world of Physical Therapy?

I think it’s fair to say that Physical Therapy found me.  I’ve always loved biology and the human body.  In Australia Medicine used to be a six year undergraduate degree.  I intended to do Medicine however the year that I graduated High School Australia switched to a US styled post-graduate Medical degree.  The truth is I didn’t put Physiotherapy on my University application.  At the time it was the most difficult degree to get into at the University of Queensland, my Alma Mata, and required the highest graduating score from High School.  When I achieved the entry criteria I called our Career Guidance Officer immediately and changed my application to put Physiotherapy number one.  I still intended to return to Medicine after practicing for a couple of years.  However I began working with professional and representative teams and had an aptitude and passion for it.  The rest is history as they say.  I still haven’t ruled out Medicine one day.  If ever I lose the passion and don’t feel sufficiently challenged it’s time to move on.  Needless to say I’m still finding plenty of both as a Physical Therapist!

You had your own physio practice in Australia for about 6 years. Given the benefit of hindsight, what were the biggest lessons you learned from those years in private practice?

 I read a lot of marketing books.  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.

I learned a lot about people and teamwork.  I discovered that if you find someone’s gift and give them responsibility they will usually surprise you with their capability.  This requires anyone in a leadership role to be very secure in themselves.  It is also important to support them if they make a valiant attempt and things don’t go quite as planned, because confidence is a great motivator of future efforts.

We never made any decisions purely to try to make money.  We made decisions that led to better patient care, improved customer service, and the highest level of practice possible.  Our mission statement was to give each and every person the same care afforded to the Olympians we treated.  As a result we averaged 25% growth per year and had a very profitable business.

William Osler said “The value of experience is not in seeing much, but in seeing wisely”.  I hired young therapists who were passionate and demonstrated sound critical thinking, and then trained them well.  I’m far less concerned with how many years someone has been practicing than how they think.  Young therapists are the future of our profession.

Finally, success in business isn’t in the deals or things you do, but in those that you don’t do (which is over 90% of things that come your way).  I felt so validated when I read that this was Steve Jobs’ philosophy!

You’re lucky enough to have worked in both Australia and the US! What are the biggest differences you’ve noticed? And, what can the American Physical Therapy Association learn from its Australian counterpart?

This question is perhaps a little unfair if considered in the context of a profession functioning in isolation of societal and political influences.  Many of the differences I believe are reflections of different public attitudes toward health care and the healthcare systems themselves.  Furthermore understanding that there are distinct sociologic differences between the two countries is key to understanding the professional differences.

Australia is a very egalitarian society where people in positions of authority such as politicians and doctors are not revered quite as they are in the USA.  It is also a society where invasive (eg. surgical) or pharmacologic intervention is generally less adhered to as the “gold standard”.  This has helped Physiotherapists become high profile providers of direct access medical care.  The USA has long been doctor-centric whereby allied health may be seen more as an alternative to medical or pharmacologic intervention rather than a primary intervention in and of itself.  This attitude is changing however.

In the context of universal healthcare in Australia it is important to know that except for a select few conditions (where a limited number of treatments are approved) Physiotherapy is not covered.  Patients with private health insurance are afforded some coverage as an amount of the total treatment cost, with the remainder being their responsibility.  The predominant provider of outpatient care is private practice, and a large percentage of that is direct access.  Public choice of a provider is therefore partly driven by the cost-benefit theory of economics.  Therapists need to offer a better service in order to win business, thus improving the standard of the profession as a whole by increasing intra-profession competition.

In the USA improving the status of Physical Therapists to a highly sought-after member of the medical fraternity with the reputation for being the premier musculoskeletal experts should, I believe, be our goal.  While I understand the move to a DPT from a political perspective, this is an extrinsic change.  True change has to occur within the profession, enacted by each and every one of us.  It means no longer seeing ourselves as subservient to referrals with incorrect diagnoses and requests for outdated interventions.  As in any relationship, we will be treated as we wish to be treated.  It means raising the bar for ourselves, and then proving we can live up to that standard.

In my experience across two continents the formula for achieving this is the same despite the different social and political environments.  Why?  Because people are essentially the same anywhere in the world.  We can all begin today by building better relationships with our medical colleagues and our patients.  It is up us to engender trust, and trust I believe will fan the fire of change.  Fire purges and allows for new growth.  Let’s be the spark in our own communities and before you know it we will have an irresistible inferno!

RMSK. What is it? And, why are you so passionate about it?

RMSK (Registered in Musculoskeletal Sonography) is the credential in diagnostic ultrasound earned by passing the certification examination through ARDMS (the American Registry for Diagnostic Medical Sonography).  To date this is a credential attained by only a handful of PT’s in the country of which I’m proud to be one.  It’s fair to say that I’m passionate about ultrasound as a tool for improving practice, and the RMSK is a vehicle enabling me to be credentialed in this area.  Therefore I will direct my answer more specifically toward the question “why am I so passionate about ultrasound?”.

Ultrasound is a non-invasive, low risk tool for imaging musculoskeletal tissue in real time in order to aid rehabilitation, provide for early appropriate referral, assist in clinical decision making, and improve the efficacy and safety of interventions such as dry needling.  It has the major advantage over all other imaging modalities of being capable of providing for dynamic assessment.  As experts in movement the ability to perform dynamic imaging fits perfectly well within our scope of practice.

As a direct access practitioner and one who works in an elite athletics setting the precision in practice provided for by the use of ultrasound as an adjunct to a thorough examination enables me to improve outcomes and better manage expectations.  By developing my skills with ultrasound guided needling I have been able to treat conditions and obtain outcomes previously unattainable.  Rehabilitative ultrasound has aided in identifying unique patterns of muscle dysfunction that one is otherwise unable to appreciate, and induce a positive change where other methods of exercise have failed.

In short, proficiency in this skill further supports and improves our position as musculoskeletal experts.  This is why I’m so passionate about it!

“Evidence-Based Practice” has been the physio mantra for the last few years – and rightly so! Given your experience in research, private practice, and working with very high-level athletes, what are the limits and short-falls of being 100% EBP? (Also, is it possible to be 100% EBP?)

If one wishes to be 100% EBP then stay home, grab a cup of coffee, and enjoy your Netflix subscription!  If you look at the Cochrane Collaboration little of what we do has much if any effect.  Systematic reviews and meta-analyses, although considered the highest level of evidence, can dilute the value of good individual RCT’s.  RCT’s unfortunately  negate the clinical decision making process used when determining an intervention by reducing conditions to a defined set of symptoms, and treating those identically.  And finally case series’, while a great way to present consistent clinical observations, are not scientific evidence of a true treatment response.  They do however help the clinic to drive research and as such are incredibly valuable.

When I’m considering my own treatments I look for them to fulfill two criteria: i) A valid physiological basis for how the intervention may work, and ii) uphold the existing evidence.  If there is evidence without a sound physiologic basis, or a sound physiologic explanation that contradicts all existing evidence, then I would question the validity of that treatment.  I don’t however believe that a treatment is invalid because there isn’t an RCT or systematic review supporting it.

One final note.  I firmly believe that there exists an intangible “energy” interaction during treatment.  It is for this reason that two clinicians can administer ostensibly identical interventions to the same patient and get two completely different responses.  While I am a seeker of evidence from the physical sciences to support my interventions, I cannot discount the metaphysical.  The best scientific explanation I can muster for this lies in quantum entanglement, but this is purely supposition.

“Are Biomechanics Obsolete?”

I love this question, thank you!  It has been said that “to someone with a hammer everything looks like a nail”.  That is how our profession has become.  We are very good at addressing biomechanical issues, therefore everything has been reduced to biomechanical causes.

For those who don’t know, my research has been into Medial Tibial Stress Syndrome (MTSS).  I have read hundreds of papers pertaining to this topic.  Contrary to colloquial wisdom there is very little evidence for any consistent biomechanical “cause” of MTSS.  If you have seen enough athletes, especially very good ones, you would have seen a huge variance in mechanics even at an elite level.  Mechanics themselves don’t cause injury (short of catastrophic tensile load to failure such as an ACL rupture).  The biochemical response to tissue load is the cause.  Understanding mechanotransduction (how cells regulate protein synthesis in direct response to tensile, compressive, or shear forces) and the chemical pathways that ensue is the only complete way to describe and consider injury.

This is why I have coined the phrase the “Biomechemical” approach to injury.  It is how the mechanics cause the upregulation or downregulation of proteins that is the ultimate determinant of injury.  If you do not exceed the body’s physiological ability to adapt, or happen to have the right physiology, you will not get injured.

Truly understanding injury means extending our paradigm far beyond biomechanics and returning to basic science.

Favorite books and/or authors?

My favorite book and author are in kind.  “The Alchemist” is my favorite book, by my favorite author Paulo Coelho.  It is the story of Santiago a shepherd boy who goes in search of his dream, facing many challenges and the temptation of an easier life but persisting in order to realize his “personal legend” or life’s purpose.  I feel a deep connection to the parallels drawn by this book to my life.  In his many works Coelho articulates almost cathartically the struggles of humankind across the ages, while placing meaningfulness to the pursuit of Love, self awareness, and providing for a spiritual context to life.

I’m also very interested in the reconciliation between science and spirituality.  This has lead me to explore quantum physics and Buddhism.  I’m currently reading “The Quantum and the Lotus” by Ricard and Thuan.  The gap between science and spirituality seems to me best explained by quantum theory, and while I no longer identify with organized religion, the tenets of Buddhism blend best with my scientific mind.   Other books that I have read in this vein include “The Universe in the Rearview Mirror” and Deepak Chopra’s recent release “The Future of God” in which Chopra proposes a new model for God that transcends religion.

High Intensity Interval Training, Crossfit, P90X, and other extreme exercise routines are are the rage these days. What are your thoughts on such aggressive training?

The businessman in me thinks there should be more of it!  It’s great for job security!  Seriously though, I really think the appropriateness is as much dependent on who attempts these programs as the regimen itself.  I firmly believe that not everyone is designed to run marathons, and not everyone should be snatching hundreds of pounds.  Exercise pursuits tend to self select individuals.  For example a person with hypermobile shoulders is likely to gravitate towards swimming and away from football (if for no other reason but that they keep dislocating their shoulders playing football!).

One of the key considerations missing in the decision to undertake such exercise is past training history, childhood activity levels, and “training age”.  Physiologic changes occur in the musculoskeletal system beginning in childhood that determine how we respond to exercise later in life, and many of these also pertain to future injury risk.  This ranges from bone density to the responsiveness of muscle to training, and the sensitivity of tendon to load.  Someone who has been inactive as a child or adult for an extended duration should be much more cautious about participating in aggressive training of any kind than someone with a lifelong history of relevant exercise.  By relevant I mean that the training history should be somewhat consistent with the type of exercise to be undertaken.  In this sense I don’t think that the exercises themselves are necessarily inherently bad for the right individual (if performed correctly of course).

Finally one needs to understand that not all exercise is necessarily “good for you” and there may be repercussions that persist years beyond cessation.  I think the obsession with these forms of exercise frequently has little to do with the physical and more to do with the psychological.  Excessive exercise is socially acceptable, alcoholism isn’t, and yet both can be abnormal coping strategies or manifestations of other organic disorders.  In these states one frequently is blinded to future consequences, and there is positive societal reinforcement for the behavior.

Speaking of exercises, how many exercises do you usually include in an HEP? Why?

Three, maybe four, tops.  I mean, if you have an ACL reconstruction you have to have the gamut.  But I’m against giving exercises for the sake of it.  I work with division one college athletes in a highly academic school.  They have class, lift, practice, games, treatment, homework, internships etc.  The last thing they need is to be overburdened with exercises.  However I extrapolate this philosophy to treating all of my patients.  Your exercises should be addressing neuromuscular control, strength, mobility, and pain.  Giving one exercise for each of these categories and then progressing them appropriately is far more effective than a generic program.  I see far too many patients with redundant exercises.  In contrast I am very specific and targeted.  Furthermore there is much written about compliance.  I believe this optimizes compliance.

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

This was perhaps the most difficult question to answer.  I tried polling my colleagues, but of course they weren’t game to tell me even if they did disagree!!

One of the paths our profession has chosen to take is that of “Clinical Prediction Rules” (CPR’s).  Perhaps this is one of the things I am most vehemently opposed to, and certainly an area I have had many disagreements with colleagues over.

Phil Plait is credited with the quote “Give a man a truth and he will think for a day, teach a man to reason and he will think for a lifetime”.  In this way teaching young therapists CPR’s stunts their clinical reasoning, perhaps irreparably.  It is not the rules themselves that are the problem, they can be a great informative guide for an experienced therapist.  It is how they are taught and implemented, and when.  Clinical reasoning is like a developmental stage.  If one does not learn it at the appropriate time I have observed that it is very difficult to teach later.  The appropriate time to foster this reasoning is in the education system.  By relying on CPR’s at this stage, one will have great difficulty moving beyond them.

Today there is much less value in teaching facts because information is so readily accessible.  The true value of education for the future will be in teaching people how to think.

You’ve just traveled back in time to when you were 20 years old, and are sitting face-to-face with yourself. What advice would you give yourself?

I doubt my 20 year old self would listen!

I think one of the most difficult things to come to terms with in Sports Medicine (and perhaps life) is that no matter how much you know, how hard you work, how technically sound you are, or widely read you are, not everyone is going to be happy with your advice.  There are many varied personalities, from coaches to trainers, athletes, parents, and other medical professionals.  It comes as no surprise that not everyone involved in athletics is always rational, and you can’t logically reason with irrational people.  Therein lies a common source of contention.

People generally behave irrationally in response to uncertainty.  Being  comfortable with uncertainty requires a strong sense of self, but does not insist that those we interact with have yet similarly evolved.  Our response to this is key in determining the outcome of such conflicts.  If one acts indignantly or feels insulted you are likely to lose traction with your argument.  Accepting that rejection of our advice or treatment plan is not a reflection of the advice itself, but of many other factors, is key to moving beyond such disagreements.

Not everyone we can help necessarily wants the type of help we desire to give.  If I’d learnt to accept this at a younger age I would have significantly diminished my sleep debt!!

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

My most memorable adventure was moving countries and re-establishing myself professionally on a different continent.  This is why I identify with the book “The Alchemist”.

Since my first trip to the USA playing basketball in 1995 I had a sense that I would someday return.  After being encouraged by a number of Australian professional athletes that resided here but would see me when in Australia for treatment, I decided that it was time for a new challenge.  I had conquered private practice, worked at a professional, national, and international level in sport, all by the time I was thirty years old.  I had no idea the trials that awaited, which is just as well, because if I had I probably wouldn’t have  embarked on the journey!  People see me treating professional athletes or lecturing around the world, but very few know what it took to make that dream a reality.

Firstly there was the loss of my identity as a Physiotherapist when I was unable to get my license to practice here initially.  I sat six CLEP exams, taught myself economics, and attended a night chemistry class while working by day, all in an attempt to fulfill the requirements.  Despite that I was again failed by the Foreign Credentialing Commission by 1/4 of a point.  An eleventh hour trip to the DC Board who subsequently gave me a license meant that I remained in the USA.

My first job here was not a good fit and after many months of distress, having lived in the USA for only one year, I made the decision to return to Australia.  I believed so firmly in my heart that I was meant to be here, but between the job and difficulties obtaining my license I was faced with the possibility that I had been wrong.  At the time I was volunteering in the athletics department at Georgetown.  Upon hearing of my imminent return to Australia they advised me that they were unable to hire me due to budgetary constraints.  Two weeks before I was due to leave, my belongings booked to be shipped to Australia, a moment occurred that changed my life forever.  An interaction with the head basketball coach, and his subsequent intervention, (perhaps buoyed by a recommendation from a former Secretary of State), saw them create a position for me.

After cancelling the shipping and placing my belongings in storage, I returned to Australia temporarily to obtain the appropriate visa.  When I next landed in Washington DC I had the strongest sense yet that this was home, at least for a while, and that my dreams could become a reality.

From this experience I learnt some of the most important lessons in life: 

  1.  If you have a dream, hold onto it, believe in it, and don’t let it go, even when everything before you seems contrary to your vision.  It only takes one little miracle and it can all change in a second.
  2.  Be willing to forgo who you think you are to be who you want to be.
  3.  Persist, and when you are done persisting, persist.  It is likely that this is when the breakthrough is nigh.
  4.  Making the right decision for you, even if it seems like a step backwards, is often the inertia that the universe requires to bring about the positive momentum to move forward.

I’ve still many dreams left to fulfill, but I’m living the life I imagined!

Scott, thank you for this fantastic interview! I appreciate all the knowledge and lessons you shared. Maybe I’ll see you in class sometime!

Follow Scott on twitter: @ScottEpsley

And, connect with me: @Cinema_Air

On Complaining, Pain, and What to NOT Focus On…

The following excerpt from The Tim Ferriss Show where Tim interviews Tracy DiNunzio is fantastic!

Tracy DiNunzio: Yeah, I tried like complaining and being bitter. It didn’t
work. It was just terrible and I was definitely bitter. I
definitely went through my ups and downs. Okay, so
Stephen Hawking actually has the best quote on this and
also the best like legitimate story of, you know, has the
right to complain probably more than anybody. He says
that when you complain nobody wants to help you and it’s
like the simplest thing and so plainly spoken. Only he
could really say that brutal honest truth, but it’s true, right?

If you spend your time focusing on the things that are
wrong and then that’s what you express and you
projection to people you know, you don’t become a
source of growth for people, you become a source of
destruction for people. That draws like more
destructiveness. I think that because that was how it felt
for me when I was thinking about how I was in pain and
talking about how I was in pain, it started a momentum
that went in a negative direction in my life. At one point, I
would say, I don’t know, probably in like 2006-2007, I just

decided to, it’s kind of like Tim Ferriss challenge, but I
didn’t know you then. But, I put myself on like almost a
complaining diet, where I said like, “Not only am I not
going to say anything negative about the situation I’m in,
but I’m not going to let myself think anything negative
about it.” This coincided with, I had lost feeling in my feet
because of the surgeries, so I don’t have any feeling in
my feet, so I have to keep my eyes open when I walk.

At the time, I was reading about how plastic the brain is
when it comes to filling in the gaps where you’re losing
information and starting to understand just scientifically
how plastic the brain is, I thought, “Well, I refuse to have
negative thought and I only let myself have a positive
thought, eventually that’s going to change my brain, I
don’t know how long it’s going to take thought.” It took a
long time and I wasn’t perfect at it, but I definitely feel like
… Not only did replacing those thoughts helped me start
moving my life in a better direction, where I wasn’t
obsessing about what was wrong and I was just thinking
about what was right, it also made me not feel physical
pain as much, which is very liberating and kind of
necessary if you want to do anything because if you’re in
pain, it’s really hard to do anything else but feel it.

You know probably more about this than I do the way that
the body processes pain and how pain is in a way just a
thought. Yeah, I did this experiment where I tried to
control my thoughts for some time. It just started things in
the right direction. It doesn’t mean that everything is
always good. I definitely have days where I am still like,
“This sucks, I wish I just had like normal feet and could
go, run around and not think about all the little things that

I have to think about.” But for the most part, I just don’t
think about it anymore.

Pair the Interview with this blog post by Tim: The 21-day No Complaint Experiment


Exclusive Interview w/ Ann Wendel, PT, ATC

Some things benefit from shocks; they thrive and grow when exposed to volatility, randomness, disorder, and stressors and love adventure, risk, and uncertainty. Yet, in spite of the ubiquity of the phenomenon, there is no word for the exact opposite of fragile. Let us call it antifragile. Antifragility is beyond resilience or robustness. The resilient resists shocks and stays the same; the antifragile gets better – N.N. Taleb

Ann Wendel, PT, ATC, CMTPT of Prana Physical Therapy and growing Twitter-fame is a real-life example of Antifragility. I admire her not simply because of the fact that she won the acclaimed #sexyPT Award in 2014, but also for her resilience and ability to adapt to life’s vicissitudes.

We had a chance to pull together an interview recently and I was shocked by what came out of it. You’ll learn quite a bit from the read, and yes, there’s also some Exclusive Breaking News regarding Prana Physical Therapy. Ann’s response to this latest challenge is pretty amazing. Enjoy!

First, what did you have for breakfast today?

I was rushing out the door this morning to catch a flight to Kansas City, so I had eggs and a banana with almond butter.

Hard-boiled eggs for breakfast can get a bit boring after a while. What do you do to keep breakfast from turning mundane & repetitive?

Most mornings I eat leftovers from dinner the night before (protein and veggies); but, now that my kids are teenagers, there aren’t many leftovers anymore! On weekends when I’m home I try to make something that will last most of the week like a quiche or casserole. I make myself eat something every morning, even when I’m not hungry, because once I get going with patients, I might not get a chance to eat for several hours. I always eat some sort of protein and try to eat a vegetable like butternut squash or something. Many people have trouble with the idea of eating vegetables for breakfast, but butternut squash or sweet potatoes are slightly sweet and taste like comfort food to me.

You finally became an APTA Member last year. You’ve had your reservations and have been very open about it. What catalyzed the change?

Jerry Durham and Matt De Bole. Seriously. We all met up in DC for dinner and not even halfway through dinner they called me out on not being a member. They told me I had no right to complain about anything if I wasn’t going to be part of the solution. And I thought about it, and realized they were right. Both Jerry and Matt are very active in the APTA and are passionate about advocacy. I decided that I would get involved and try to work toward change from the inside. Since then I have been active in APTA and in both PPS and SOWH.

You recently joined the Editorial Board of PPS Impact Magazine. Why did you join the board? And, what does your role entail?

As you know, I have a real passion for writing about issues that affect our profession. When I joined PPS there was an opportunity to volunteer for different positions within the section. A position had just opened up on the Impact Editorial Board, and I jumped at the chance to participate. I want to learn more about the entire process of writing, editing, and publishing a monthly magazine. As a board member, I am responsible for content at least twice a year. My first assignment is due in October. I am contributing two feature articles, a member spotlight, and a tech review. I wrote one of the feature articles, and I have another PPS member writing the other, on his area of expertise. I think they will come out in early 2015. We have a very dynamic group and I’m excited to attend my first board meeting at PPS in November.

You just returned from the WebPT Ascend Conference! How was it? Why is it an important conference? And what is one of your biggest take-aways from it?

The Ascend Conference was fantastic. It was a one day conference focused on the business of therapy. We had some really amazing speakers on topics ranging from starting your practice to developing a website to preparing your exit strategy to sell your practice. I was there to provide social media coverage for WebPT and I was fortunate enough to sit on the final panel with all of the presenters. It was an important conference because it filled in the gaps of what most physical therapists would admit are their weaknesses: branding, marketing, networking, and business skills. We come out of our PT programs well prepared for a career of working as a physical therapist; but, we are terribly underprepared to run a practice. We need conferences that focus on how to be an effective leader, and how to grow a private practice.

During the conference, the subject of chiropractors and their marketing techniques kept coming up. I Tweeted that, “Chiropractors are taught how to brand, market, and run a business from day one. Let’s teach #DPTStudent about #bizPT.” That tweet received so many retweets and favorites, and is still being shared a week later. My point was that instead of looking down our noses at other professions (who are thriving, by the way), perhaps we should learn from them. We don’t have to use fear tactics and soft science to lure people into physical therapy; but, we could learn a thing or two about how consumers think by studying how consumers respond to marketing messages from other fitness and healthcare professionals.

SPEAKING OF CHANGE, PRANA PHYSICAL THERAPY IS UNDERGOING A MAJOR TRANSFORMATION! Tell us about what we can look forward to from you in the near future.

Yes, your reaction when I shared the changes with you was priceless. You said that you had to re-read my email several times to make sure you were reading correctly. I have debated about how to share the news with everyone, so when you asked me to do an interview, I figured I would give you the exclusive scoop.

I had been thinking a great deal over the past 6 months about the direction I wanted to take my business. When I reopened the practice in 2011, I was focused on providing physical therapy services. I started writing and blogging out of my experiences with getting the practice off the ground, in a very different environment than I faced the first time around in 2003. I have always loved writing, but I never did it on a regular basis until I started my blog. As the months went on, I realized how passionate I was about writing and connecting with other therapists through social media. Out of that passion, a whole new branch of my business grew. I am so fortunate to have connected with companies like WebPT, BossFit Magazine, Girls Gone Strong, and MedBridge as an outlet for my writing and speaking.

After growing the writing side of my business fairly quickly, I struggled a great deal last year with trying to balance running the PT practice and growing the writing and speaking side of my business. I was undecided on what I wanted to do long term.

In late July I found out I would be losing my office space (I was subletting) with only 5 weeks notice. I was devastated at first, and tried to scramble to find new office space on such short notice. It was difficult, because it didn’t make sense to find a large office and sign a 5 year lease, as we want to move out of the DC area once my kids are in college 5 years from now. I also thought about the implications of hiring staff and growing the practice, only to want to close it or sell it in 5 years.

Once I calmed down a bit, I sat and really thought about what direction I wanted to go in for the next 10 years, and I realized that I couldn’t keep up the current pace. As much as I loved my clinical practice, I am currently more passionate about sharing what I know through my writing and speaking. I made the difficult decision to close the in-person, patient care side of my business, eliminating the need for office space. Once I did that, it opened up new possibilities.

I have cleared time and energy for multiple projects I am working on and have been able to say yes to more of the type of work I want to be doing. In addition to joining the Editorial Board of Impact magazine, I have recently joined the Advisory Board of Girls Gone Strong, an organization run by my friend, Molly Galbraith. GGS is dedicated to providing the most current information to women in the areas of fitness, health, and nutrition, and through GGS I have the opportunity to reach thousands of women with good information about injury risk reduction and treatment. I was also honored to recently be asked to join the Clinical Advisory Board of Perfect Fit Health, joining my friend, Chris Bise. Perfect Fit is going to be doing some amazing things and I’m so excited to be part of the company. Additionally, I am continuing to produce webinars and provide consulting services to individuals and practices looking to learn more about marketing directly to consumers.

In an effort to continue to learn about #bizPT from a slightly different angle (to add to the experience I have with running a cash based practice), I have taken a position as a Clinic Director. This will allow me to gain experience with Medicare documentation and billing, as well as the opportunity to mentor new therapists and take students through clinical affiliations. Taking a position as a Clinic Director allows me to stay up to date on current clinical practice without the 24/7 stress of running my own business right now. This will allow me to develop the writing/speaking/consulting side of my practice without financial strain.

You recently joined the Advisory Board of Girls Gone Strong. What drew you to GGS and how did this relationship begin?

I have been drawn to GGS from the beginning. When they first announced what they were doing, I told my husband, “I want to be a part of this!” I believe so strongly in their mission, and knew that I could contribute to the organization. I became friends with some of the “girls” over the past few years, and continued to support what they were doing. I had dinner with co-founder Molly Galbraith last spring, and she shared with me that they were undergoing some organizational changes, and that she was looking to put together an Advisory Board. When she asked me to be part of it, I had to force myself not to jump up in the air! I am so fortunate to contribute a monthly column to the blog called “Ask Ann” where I answer a reader question related to physical therapy. I was also asked to speak at The Women’s Fitness Summit in Kansas City this weekend, co-hosted by GGS. I’ll be speaking alongside some amazing women at a conference with all female presenters and only female attendees. I am so looking forward to empowering women to take care of themselves!

You write for a variety of media outlets – MedBridge, BossFit magazine, and WebPT. (I heartily recommend you to read her articles. They are fertile grounds for ideas and conceptual thinking in your practice, including your practice of healthy living.) How did you establish these relationships? How can I establish similar relationships?

It all started with WebPT. I use WebPT as my EMR for my practice, and they asked me to do a member spotlight piece in 2011. They interviewed me by phone for the article and I talked with them for a while after the interview was over, mentioning that I would love to write for their blog. We came up with a contract, and I have been providing an article every month since then. That relationship continued to grow over the years, as I really love the culture of WebPT and their commitment to our profession. I met co-owner Heidi Jannenga at PPS last year, and got to know her a bit. I was thrilled to be asked to participate in Rehab Nation, a think tank type meeting hosted by WebPT, and the Ascend conference this year.

My relationship with MedBridge began in a somewhat similar fashion. I followed them on Twitter, and enjoyed talking with them through social media. They reached out to me last year and asked if I would like to contribute an article. My first article was on the kettlebell swing, and I included a video. I met the whole MedBridge crew at CSM in Vegas, and talked with them about doing more work together. I am happy to support them because they provide high quality educational products. We have some really exciting projects in the works, but I can’t share about them yet!

My association with BossFit started with following Chris Brogan on Twitter. His writing and speaking really resonated with me, and I frequently shared his articles and commented on his blog. When he announced on Twitter last year that he and Jacq Carly were starting a sister magazine to Owner Magazine, called BossFit, I started paying attention, as BossFit is a magazine dedicated to the health of busy business owners. They tweeted that they were looking for writers to contribute, and I reached out to them and sent some samples of my writing. Fortunately, I was chosen to contribute, and have been writing for BossFit monthly since then. I had the pleasure of meeting Chris and Jacq in Boston, when they hosted an Owner/BossFit Live event last March. I was interviewed by Chris on the topic of physical therapy, and got to share with the audience a bit about what I do. Since then, both Chris and Jacq have become dear friends.

In all these instances (and every other writing opportunity I’ve had), the constant is that I pursued the opportunities. I never waited for someone to approach me or ask me if I wanted to contribute. I offered to contribute and provided samples of my work. In the writing world, this is called a query: you write to an editor or contact at a publication, and share your idea with them in a way that attracts their interest. I only reach out to companies that I resonate with – if I feel passionate about their mission and about the topics they cover, I pursue the relationship. For anyone who wants to get started writing, my best advice is start writing! Don’t wait to be asked, don’t wait to send it out until it’s good enough – just do it. Decide where you want to contribute and start building those relationships.

I really admire how you’ve leveraged the many changes you’ve experienced over the last 7+ years. What lasting truths have you distilled from these experiences?

Everything changes, and I’m strong enough to turn it around and make it work. I think that we run into trouble when we resist the natural changes that occur in life. In the natural world, everything has a season. Work, life, and relationships also have seasons; yet, we resist this truth and it leads to failure and unhappiness. If we can acknowledge that changes are natural and endings are normal, then we can recognize a necessary ending and make a decision in a timely manner, allowing us to pivot our business or life in a way that serves us best. When I lost my office space, I talked with my friend, Sandy Hilton, and she recommended the book Necessary Endings by Dr. Henry Cloud. It was such a helpful book, and I highly recommend it. It clarified things for me and made me realize that it was healthy to change the way I was running my business, and to view it as a normal evolution of my passion.

The big lessons I’ve learned are to welcome change and endings as a necessary part of life, and to be decisive and act, so that you can stay successful in both business and personal relationships.

Tell us about your biggest take-aways from the Ancestral Health Symposium that you attended a couple years ago.

Because of my diagnosis with Hashimoto’s Thyroiditis about 7 years ago, I developed a keen interest in reading research about the effects of nutrition and lifestyle on health. As I read, I was drawn to the Ancestral Health movement. The first AHS was held in 2011, and I wanted to be part of the experience the next year. I was thrilled to present a poster on the Effects of Ancestral Nutrition on Type 1 Diabetes, at Harvard in August  2012.

The biggest take aways for me (from the entire movement) are that we have to focus on health in a whole person/lifestyle manner in order for changes to be lasting and effective. We need to encourage our patients to eat whole, nutritious food, engage in healthy movement, sleep for 7-9 hours a night, minimize stress, and build a sense of purpose and community into their lives. We can’t just treat a shoulder or a knee. With Direct Access, we are often the first healthcare provider that a patient has seen in years. We need to ask questions about general health in our initial evaluation and then provide resources for patients to make lasting changes.

I know you love The Alchemist & A Wrinkle in Time. Any other favorite books? 

I’m a bit of a history nerd, so I loved Joel Achenbach’s book, The Grand Idea. The book detailed George Washington’s business and personal life  immediately after the War of Independence. It detailed his plan to transform the Potomac River into the nation’s premier commercial artery. Given that I live only about 4 miles from Mount Vernon, I was fascinated to read about the area surrounding my house, and how Washington developed all of his holdings in the area.

You’ve just traveled back in time to and are sitting face-to-face with your 20-something self. What advice would you give yourself?

I would tell myself that it’s all going to be ok. That no matter what happens, I can turn it around and make a really satisfying life for myself.

What top 3 things can everyone do to live a happy, healthy, and fulfilling life?

Sleep. Go to bed by 10pm and sleep in a cool, completely dark room for 7-9 hours.

Eat. Eat a whole, unprocessed food diet of protein, vegetables, and healthy fats. And eat three good sized meals a day. It helps to regulate your blood glucose, insulin response, and hormones.

Lift heavy weights. Start light, learn good movement patterns, then increase weights appropriately. We need to continue to lift heavy things as we age – skeletal muscle is protective and necessary as we age.

Ann, thank you very much for sharing your time & lessons in this interview! I wish you the best of luck in your latest adventure – I’m sure it’ll be a great one.

Follow Ann on Twitter @PranaPT

And find me @Cinema_Air

LeeAnne K-G: Top 5 Life lessons Learned So Far

I recently asked LeeAnne Ketchen-Gullett, ATC, MS about her “Top 5 Life Lessons So Far” and she was generous to respond with this fantastic guest blog. It is a worthwhile read that I will definitely re-visit periodically. In case you haven’t already met LeeAnne, you can find her on twitter @LKetchen14ATC (not only is she a Certified Athletic Trainer, but she’s also a Full-time Volunteer!). Enjoy the read and I hope you get as much out of it as I do.

There is Value to Each Individual You Meet

Meeting new people is one of my favorite things whether it is on a plane, conference, sports event,  work related or standing in a line. I take it as an opportunity to understand people and myself. I am not saying I “like” or have great experiences with every person I meet but I do take something away from each individual and interaction and carry it with me. During good or bad interaction I learn how to listen, engage in intellectual conversation, know when not to speak, and use of body language.  I’ll admit, often I have learned communicating the hard way but its valuable the next time a similar situation presents itself. I have met amazing people in unique circumstances and they have made an impact on me forever and may or may not even realize it. The world is big and full of incredible people. I would like to meet as many people as possible for the experience and to take a little bit of them with me. I find great importance to live in the moment and take the opportunity for person interaction because everyone has their own story and we can all learn from one another. That being said- even the smallest interactions can play a role, never underestimate the impact you can have on someone else’s life.

The world owes you nothing

Just because bad things happen doesn’t mean something good will happen to make up for it. Just because you work your tail off may not mean you get the job you want or put you necessarily where you want to be. I have learned to not “expect” much in return for what I do or accomplish. It is about changing your mindset and attitude. I work and am there for people because I love to do it and the reward is it makes me feel good. It is about being a good person and waking up with a positive attitude. I find that if I can do that then it will trump many things. It is important to focus on what we do have control over and the goals we set for our self. It is not okay to expect rewards for all things we do because we feel that we “deserve” it. It doesn’t always workout that way and we must carry on, work hard, and move forward. In life nothing is ever guaranteed, so everyday create your own luck and opportunity.

You cant wait for the perfect opportunity- Take a chance and step out of your comfort zone

Looking back I feel like I missed out on some opportunities because I was waiting for the perfect “moment” or “timing” where everything would fall together nicely and work out perfectly. What I’ve learned: rarely does this happen. I discovered that I wasn’t good at having a plan. I just ruined plans. However, I was better at planning and found it to be more efficient in accomplishments. If you take a chance and go with a positive attitude, it WILL work out and you will find success. I used to be scared that something bad would happen and it would mean a big set back in my life. I was wrong. It was in the moments where I didn’t have a plan, that potential opportunities opened up, when I dove in fully. I had no idea how things were going to turn out or where it was going to lead me, but it is in those moments I learned the most. Being in uncomfortable situations uncovered feelings I didn’t know I had and didn’t know I could handle. It’s about discovering parts of yourself you didn’t know existed and using them for future situations. This has happened to me on more than one occasion and I couldn’t be more grateful for chances that I have taken on a whim. It has lead me down a strong path of meeting amazing people and being put in tough situations that has built me as a person and professional.

Show that you care, be present

I believe that we are all connected somehow and this kind of goes hand in hand with my lesson number one.  I have found that building trust, being passionate, being considerate and caring can be the most rewarding thing one can do.  I didn’t understand this until I started getting e-mails and cards from people expressing gratitude about how important it was to them that I gave them time, listened to them, and show that I care. I truly value each person I work and interact with. It has to do with being a good person, doing the right thing, and being there for someone because you want to be genuine, to be their listening ear, and show concern. When I get feedback (cards and emails), I realize how much their feedback affects me, and I then understand the impact I may have on others. That is what feels amazing.  I think it is so important to not only show that your care, but when given the opportunity, let others know that you appreciate them. Even if it is as simple as a solid “thank you”, I know in my industry it can go a long way.

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” ― Maya Angelou

Intuition and instinct can go a long way.

I think it is important to be in tune with our instinctive nature and follow the path it leads us down. Intuition and instinct isn’t measurable, it’s a feeling and belief based around experiences and facts that have been in our life. These experiences turn into our ability to problem solve and respond to situations for success. I suppose I can take the top four life lessons already mentioned and say intuition and instinct play a huge role in all of them. I would like to think growing up I have had a solid foundation built around strong morals and beliefs. As I get older and go through new experiences and challenges, I find self-talk and reflection to be one of the most beneficial parts to my day. Trusting my intuitive nature and making quick decisions has led me down an amazing journey.

Accept no ones definition of yourself because no one knows you better than you do. Society, parents, teachers may have an image about how you need to be and how to live your life in order to be successful. Fact of the matter is that everyone reacts and responds to situations differently. Life is here for us to create and define our self as a person, how we want to be and what path we choose. It is important to spend life on your own terms and what you believe in.  This is created by the choices we make and not the choices people think we should make. Be you, listen to yourself, and create yourself based on your intuition and instinct. I look forward to each morning, excited to create new opportunity and another day to build a better version of myself.

Connect with LeeAnne Ketchen-Gullett, ATC, MS on Twitter.

And find me @Cinema_Air

On The Shortness of Life by Seneca

Time management is a continual process. I value time more than almost anything in life. Lucius Seneca’s essay “On The Shortness of Life” should be an annual read for everyone; he shares timeless practical advice to help you filter out wasted time and make the most of he time we have. Pick up the book from Amazon. You can also grab a PDF copy of the essay here. Reading this could be the best investment of your time right now. I’ve highlighted some of my favorite lines. Enjoy the essay. It’s a 5-7min read.

The majority of mortals, Paulinus, complain bitterly of the spitefulness of Nature, because we are born for a brief span of life, because even this space that has been granted to us rushes by so speedily and so swiftly that all save a very few find life at an end just when they are getting ready to live.

Nor is it merely the common herd and the unthinking crowd that bemoan what is, as men deem it, an universal ill; the same feeling has called forth complaint also from men who were famous…

It is not that we have a short space of time, but that we waste much of it. Life is long enough, and it has been given in sufficiently generous measure to allow the accomplishment of the very greatest things if the whole of it is well invested. But when it is squandered in luxury and carelessness, when it is devoted to no good end, forced at last by the ultimate necessity we perceive that it has passed away before we were aware that it was passing. So it is—the life we receive is not short, but we make it so, nor do we have any lack of it, but are wasteful of it. Just as great and princely wealth is scattered in a moment when it comes into the hands of a bad owner, while wealth however limited, if it is entrusted to a good guardian, increases by use, so our life is amply long for him who orders it properly.

Why do we complain of Nature? She has shown herself kindly; life, if you know how to use it, is long. But one man is possessed by greed that is insatiable, another by a toilsome devotion to tasks that are useless; one man is besotted with wine, another is paralyzed by sloth; one man is exhausted by an ambition that always hangs upon the decision of others, another, driven on by the greed of the trader, is led over all lands and all seas by the hope of gain; some are tormented by a passion for war and are always either bent upon inflicting danger upon others or concerned about their own; some there are who are worn out by voluntary servitude in a thankless attendance upon the great; many are kept busy either in the pursuit of other men’s fortune or in complaining of their own; many, following no fixed aim, shifting and inconstant and dissatisfied, are plunged by their fickleness into plans that are ever new; some have no fixed principle by which to direct their course, but Fate takes them unawares while they loll and yawn—so surely does it happen that I cannot doubt the truth of that utterance which the greatest of poets delivered with all the seeming of an oracle: “The part of life we really live is small.” For all the rest of existence is not life, but merely time.

Vices beset us and surround us on every side, and they do not permit us to rise anew and lift up our eyes for the discernment of truth, but they keep us down when once they have overwhelmed us and we are chained to lust. Their victims are never allowed to return to their true selves; if ever they chance to find some release, like the waters of the deep sea which continue to heave even after the storm is past, they are tossed about, and no rest from their lusts abides. Think you that I am speaking of the wretches whose evils are admitted? Look at those whose prosperity men flock to behold; they are smothered by their blessings. To how many are riches a burden! From how many do eloquence and the daily straining to display their powers draw forth blood! How many are pale from constant pleasures! To how many does the throng of clients that crowd about them leave no freedom! In short, run through the list of all these men from the lowest to the highest—this man desires an advocate, this one answers the call, that one is on trial, that one defends him, that one gives sentence; no one asserts his claim to himself, everyone is wasted for the sake of another. Ask about the men whose names are known by heart, and you will see that these are the marks that distinguish them: A cultivates B and B cultivates C; no one is his own master. And then certain men show the most senseless indignation—they complain of the insolence of their superiors, because they were too busy to see them when they wished an audience! But can anyone have the hardihood to complain of the pride of another when he himself has no time to attend to himself? After all, no matter who you are, the great man does sometimes look toward you even if his face is insolent, he does sometimes condescend to listen to your words, he permits you to appear at his side; but you never deign to look upon yourself, to give ear to yourself. There is no reason, therefore, to count anyone in debt for such services, seeing that, when you performed them, you had no wish for another’s company, but could not endure your own.

Though all the brilliant intellects of the ages were to concentrate upon this one theme, never could they adequately express their wonder at this dense darkness of the human mind. Men do not suffer anyone to seize their estates, and they rush to stones and arms if there is even the slightest dispute about the limit of their lands, yet they allow others to trespass upon their life—nay, they themselves even lead in those who will eventually possess it. No one is to be found who is willing to distribute his money, yet among how many does each one of us distribute his life! In guarding their fortune men are often closefisted, yet, when it comes to the matter of wasting time, in the case of the one thing in which it is right to be miserly, they show themselves most prodigal. And so I should like to lay hold upon someone from the company of older men and say: “I see that you have reached the farthest limit of human life, you are pressing hard upon your hundredth year, or are even beyond it; come now, recall your life and make a reckoning. Consider how much of your time was taken up with a moneylender, how much with a mistress, how much with a patron, how much with a client, how much in wrangling with your wife, how much in punishing your slaves, how much in rushing about the city on social duties. Add the diseases which we have caused by our own acts, add, too, the time that has lain idle and unused; you will see that you have fewer years to your credit than you count. Look back in memory and consider when you ever had a fixed plan, how few days have passed as you had intended, when you were ever at your own disposal, when your face ever wore its natural expression, when your mind was ever unperturbed, what work you have achieved in so long a life, how many have robbed you of life when you were not aware of what you were losing, how much was taken up in useless sorrow, in foolish joy, in greedy desire, in the allurements of society, how little of yourself was left to you; you will perceive that you are dying before your season!” What, then, is the reason of this? You live as if you were destined to live forever, no thought of your frailty ever enters your head, of how much time has already gone by you take no heed. You squander time as if you drew from a full and abundant supply, though all the while that day which you bestow on some person or thing is perhaps your last. You have all the fears of mortals and all the desires of immortals. You will hear many men saying: “After my fiftieth year I shall retire into leisure, my sixtieth year shall release me from public duties.” And what guarantee, pray, have you that your life will last longer? Who will suffer your course to be just as you plan it? Are you not ashamed to reserve for yourself only the remnant of life, and to set apart for wisdom only that time which cannot be devoted to any business? How late it is to begin to live just when we must cease to live! What foolish forgetfulness of mortality to postpone wholesome plans to the fiftieth and sixtieth year, and to intend to begin life at a point to which few have attained!

You will see that the most powerful and highly placed men let drop remarks in which they long for leisure, acclaim it, and prefer it to all their blessings. They desire at times, if it could be with safety, to descend from their high pinnacle; for, though nothing from without should assail or shatter, Fortune of its very self comes crashing down.

The deified Augustus, to whom the gods vouchsafed more than to any other man, did not cease to pray for rest and to seek release from public affairs; all his conversation ever reverted to this subject—his hope of leisure. This was the sweet, even if vain, consolation with which he would gladden his labours—that he would one day live for himself. In a letter addressed to the senate, in which he had promised that his rest would not be devoid of dignity nor inconsistent with his former glory, I find these words: “But these matters can be shown better by deeds than by promises. Nevertheless, since the joyful reality is still far distant, my desire for that time most earnestly prayed for has led me to forestall some of its delight by the pleasure of words.” So desirable a thing did leisure seem that he anticipated it in thought because he could not attain it in reality. He who saw everything depending upon himself alone, who determined the fortune of individuals and of nations, thought most happily of that future day on which he should lay aside his greatness. He had discovered how much sweat those blessings that shone throughout all lands drew forth, how many secret worries they concealed. Forced to pit arms first against his countrymen, then against his colleagues, and lastly against his relatives, he shed blood on land and sea.

Through Macedonia, Sicily, Egypt, Syria, and Asia, and almost all countries he followed the path of battle, and when his troops were weary of shedding Roman blood, he turned them to foreign wars. While he was pacifying the Alpine regions, and subduing the enemies planted in the midst of a peaceful empire, while he was extending its bounds even beyond the Rhine and the Euphrates and the Danube, in Rome itself the swords of Murena, Caepio, Lepidus, Egnatius, and others were being whetted to slay him. Not yet had he escaped their plots, when his daughter and all the noble youths who were bound to her by adultery as by a sacred oath, oft alarmed his failing years—and there was Paulus, and a second time the need to fear a woman in league with an Antony. When be had cut away these ulcers together with the limbs themselves, others would grow in their place; just as in a body that was overburdened with blood, there was always a rupture somewhere. And so he longed for leisure, in the hope and thought of which he found relief for his labours. This was the prayer of one who was able to answer the prayers of mankind.

Marcus Cicero, long flung among men like Catiline and Clodius and Pompey and Crassus, some open enemies, others doubtful friends, as he is tossed to and fro along with the state and seeks to keep it from destruction, to be at last swept away, unable as he was to be restful in prosperity or patient in adversity—how many times does he curse that very consulship of his, which he had lauded without end, though not without reason! How tearful the words he uses in a letter written to Atticus, when Pompey the elder had been conquered, and the son was still trying to restore his shattered arms in Spain! “Do you ask,” he said, “what I am doing here? I am lingering in my Tusculan villa half a prisoner.” He then proceeds to other statements, in which he bewails his former life and complains of the present and despairs of the future. Cicero said that he was “half a prisoner.” But, in very truth, never will the wise man resort to so lowly a term, never will he be half a prisoner—he who always possesses an undiminished and stable liberty, being free and his own master and towering over all others. For what can possibly be above him who is above Fortune?

When Livius Drusus, a bold and energetic man, had with the support of a huge crowd drawn from all Italy proposed new laws and the evil measures of the Gracchi, seeing no way out for his policy, which he could neither carry through nor abandon when once started on, he is said to have complained bitterly against the life of unrest he had had from the cradle, and to have exclaimed that he was the only person who had never had a holiday even as a boy. For, while he was still a ward and wearing the dress of a boy, he had had the courage to commend to the favour of a jury those who were accused, and to make his influence felt in the law-courts, so powerfully, indeed, that it is very well known that in certain trials he forced a favourable verdict. To what lengths was not such premature ambition destined to go? One might have known that such precocious hardihood would result in great personal and public misfortune. And so it was too late for him to complain that he had never had a holiday when from boyhood he had been a trouble-maker and a nuisance in the forum. It is a question whether he died by his own hand; for he fell from a sudden wound received in his groin, some doubting whether his death was voluntary, no one, whether it was timely.

It would be superfluous to mention more who, though others deemed them the happiest of men, have expressed their loathing for every act of their years, and with their own lips have given true testimony against themselves; but by these complaints they changed neither themselves nor others. For when they have vented their feelings in words, they fall back into their usual round. Heaven knows! such lives as yours, though they should pass the limit of a thousand years, will shrink into the merest span; your vices will swallow up any amount of time. The space you have, which reason can prolong, although it naturally hurries away, of necessity escapes from you quickly; for you do not seize it, you neither hold it back, nor impose delay upon the swiftest thing in the world, but you allow it to slip away as if it were something superfluous and that could be replaced.

But among the worst I count also those who have time for nothing but wine and lust; for none have more shameful engrossments. The others, even if they are possessed by the empty dream of glory, nevertheless go astray in a seemly manner; though you should cite to me the men who are avaricious, the men who are wrathful, whether busied with unjust hatreds or with unjust wars, these all sin in more manly fashion. But those who are plunged into the pleasures of the belly and into lust bear a stain that is dishonourable. Search into the hours of all these people, see how much time they give to accounts, how much to laying snares, how much to fearing them, how much to paying court, how much to being courted, how much is taken up in giving or receiving bail, how much by banquets—for even these have now become a matter of business—, and you will see how their interests, whether you call them evil or good, do not allow them time to breathe.

Finally, everybody agrees that no one pursuit can be successfully followed by a man who is preoccupied with many things—eloquence cannot, nor the liberal studies—since the mind, when distracted, takes in nothing very deeply, but rejects everything that is, as it were, crammed into it. There is nothing the busy man is less busied with than living: there is nothing that is harder to learn. Of the other arts there are many teachers everywhere; some of them we have seen that mere boys have mastered so thoroughly that they could even play the master. It takes the whole of life to learn how to live, and—what will perhaps make you wonder more—it takes the whole of life to learn how to die. Many very great men, having laid aside all their encumbrances, having renounced riches, business, and pleasures, have made it their one aim up to the very end of life to know how to live; yet the greater number of them have departed from life confessing that they did not yet know—still less do those others know. Believe me, it takes a great man and one who has risen far above human weaknesses not to allow any of his time to be filched from him, and it follows that the life of such a man is very long because he has devoted wholly to himself whatever time he has had. None of it lay neglected and idle; none of it was under the control of another, for, guarding it most grudgingly, he found nothing that was worthy to be taken in exchange for his time. And so that man had time enough, but those who have been robbed of much of their life by the public, have necessarily had too little of it.

And there is no reason for you to suppose that these people are not sometimes aware of their loss. Indeed, you will hear many of those who are burdened by great prosperity cry out at times in the midst of their throngs of clients, or their pleadings in court, or their other glorious miseries: “I have no chance to live.” Of course you have no chance! All those who summon you to themselves, turn you away from your own self. Of how many days has that defendant robbed you? Of how many that candidate? Of how many that old woman wearied with burying her heirs? Of how many that man who is shamming sickness for the purpose of exciting the greed of the legacy-hunters? Of how many that very powerful friend who has you and your like on the list, not of his friends, but of his retinue? Check off, I say, and review the days of your life; you will see that very few, and those the refuse. have been left for you. That man who had prayed for the fasces, when he attains them, desires to lay them aside and says over and over: “When will this year be over!” That man gives games, and, after setting great value on gaining the chance to give them, now says: “When shall I be rid of them?” That advocate is lionized throughout the whole forum, and fills all the place with a great crowd that stretches farther than he can be heard, yet he says: “When will vacation time come?” Everyone hurries his life on and suffers from a yearning for the future and a weariness of the present. But he who bestows all of his time on his own needs, who plans out every day as if it were his last, neither longs for nor fears the morrow. For what new pleasure is there that any hour can now bring? They are all known, all have been enjoyed to the full. Mistress Fortune may deal out the rest as she likes; his life has already found safety. Something may be added to it, but nothing taken from it, and he will take any addition as the man who is satisfied and filled takes the food which he does not desire and yet can hold. And so there is no reason for you to think that any man has lived long because he has grey hairs or wrinkles; he has not lived long—he has existed long. For what if you should think that that man had had a long voyage who had been caught by a fierce storm as soon as he left harbour, and, swept hither and thither by a succession of winds that raged from different quarters, had been driven in a circle around the same course? Not much voyaging did he have, but much tossing about.

I am often filled with wonder when I see some men demanding the time of others and those from whom they ask it most indulgent. Both of them fix their eyes on the object of the request for time, neither of them on the time itself; just as if what is asked were nothing, what is given, nothing. Men trifle with the most precious thing in the world; but they are blind to it because it is an incorporeal thing, because it does not come beneath the sight of the eyes, and for this reason it is counted a very cheap thing—nay, of almost no value at all. Men set very great store by pensions and doles, and for these they hire out their labour or service or effort. But no one sets a value on time; all use it lavishly as if it cost nothing. But see how these same people clasp the knees of physicians if they fall ill and the danger of death draws nearer, see how ready they are, if threatened with capital punishment, to spend all their possessions in order to live! So great is the inconsistency of their feelings. But if each one could have the number of his future years set before him as is possible in the case of the years that have passed, how alarmed those would be who saw only a few remaining, how sparing of them would they be! And yet it is easy to dispense an amount that is assured, no matter how small it may be; but that must be guarded more carefully which will fail you know not when.

Yet there is no reason for you to suppose that these people do not know how precious a thing time is; for to those whom they love most devotedly they have a habit of saying that they are ready to give them a part of their own years. And they do give it, without realizing it; but the result of their giving is that they themselves suffer loss without adding to the years of their dear ones. But the very thing they do not know is whether they are suffering loss; therefore, the removal of something that is lost without being noticed they find is bearable. Yet no one will bring back the years, no one will bestow you once more on yourself. Life will follow the path it started upon, and will neither reverse nor check its course; it will make no noise, it will not remind you of its swiftness. Silent it will glide on; it will not prolong itself at the command of a king, or at the applause of the populace. Just as it was started on its first day, so it will run; nowhere will it turn aside, nowhere will it delay. And what will be the result? You have been engrossed, life hastens by; meanwhile death will be at hand, for which, willy nilly, you must find leisure.

Can anything be sillier than the point of view of certain people—I mean those who boast of their foresight? They keep themselves very busily engaged in order that they may be able to live better; they spend life in making ready to live! They form their purposes with a view to the distant future; yet postponement is the greatest waste of life; it deprives them of each day as it comes, it snatches from them the present by promising something hereafter. The greatest hindrance to living is expectancy, which depends upon the morrow and wastes to-day. You dispose of that which lies in the hands of Fortune, you let go that which lies in your own. Whither do you look? At what goal do you aim? All things that are still to come lie in uncertainty; live straightway! See how the greatest of bards cries out, and, as if inspired with divine utterance, sings the saving strain:

The fairest day in hapless mortals’ life
Is ever first to flee.

“Why do you delay,” says he, “Why are you idle? Unless you seize the day, it flees.” Even though you seize it, it still will flee; therefore you must vie with time’s swiftness in the speed of using it, and, as from a torrent that rushes by and will not always flow, you must drink quickly. And, too, the utterance of the bard is most admirably worded to cast censure upon infinite delay, in that he says, not “the fairest age,” but “the fairest day.” Why, to whatever length your greed inclines, do you stretch before yourself months and years in long array, unconcerned and slow though time flies so fast? The poet speaks to you about the day, and about this very day that is flying. Is there, then, any doubt that for hapless mortals, that is, for men who are engrossed, the fairest day is ever the first to flee? Old age surprises them while their minds are still childish, and they come to it unprepared and unarmed, for they have made no provision for it; they have stumbled upon it suddenly and unexpectedly, they did not notice that it was drawing nearer day by day. Even as conversation or reading or deep meditation on some subject beguiles the traveller, and he finds that he has reached the end of his journey before he was aware that he was approaching it, just so with this unceasing and most swift journey of life, which we make at the same pace whether waking or sleeping; those who are engrossed become aware of it only at the end.

Should I choose to divide my subject into heads with their separate proofs, many arguments will occur to me by which I could prove that busy men find life very short. But Fabianus, who was none of your lecture-room philosophers of to-day, but one of the genuine and old-fashioned kind, used to say that we must fight against the passions with main force, not with artifice, and that the battle-line must be turned by a bold attack, not by inflicting pinpricks; that sophistry is not serviceable, for the passions must be, not nipped, but crushed. Yet, in order that the victims of them nay be censured, each for his own particular fault, I say that they must be instructed, not merely wept over.

Life is divided into three periods—that which has been, that which is, that which will be. Of these the present time is short, the future is doubtful, the past is certain. For the last is the one over which Fortune has lost control, is the one which cannot be brought back under any man’s power. But men who are engrossed lose this; for they have no time to look back upon the past, and even if they should have, it is not pleasant to recall something they must view with regret. They are, therefore, unwilling to direct their thoughts backward to ill-spent hours, and those whose vices become obvious if they review the past, even the vices which were disguised under some allurement of momentary pleasure, do not have the courage to revert to those hours. No one willingly turns his thought back to the past, unless all his acts have been submitted to the censorship of his conscience, which is never deceived; he who has ambitiously coveted, proudly scorned, recklessly conquered, treacherously betrayed, greedily seized, or lavishly squandered, must needs fear his own memory. And yet this is the part of our time that is sacred and set apart, put beyond the reach of all human mishaps, and removed from the dominion of Fortune, the part which is disquieted by no want, by no fear, by no attacks of disease; this can neither be troubled nor be snatched away—it is an everlasting and unanxious possession. The present offers only one day at a time, and each by minutes; but all the days of past time will appear when you bid them, they will suffer you to behold them and keep them at your will—a thing which those who are engrossed have no time to do. The mind that is untroubled and tranquil has the power to roam into all the parts of its life; but the minds of the engrossed, just as if weighted by a yoke, cannot turn and look behind. And so their life vanishes into an abyss; and as it does no good, no matter how much water you pour into a vessel, if there is no bottom to receive and hold it, so with time—it makes no difference how much is given; if there is nothing for it to settle upon, it passes out through the chinks and holes of the mind. Present time is very brief, so brief, indeed, that to some there seems to be none; for it is always in motion, it ever flows and hurries on; it ceases to be before it has come, and can no more brook delay than the firmament or the stars, whose ever unresting movement never lets them abide in the same track. The engrossed, therefore, are concerned with present time alone, and it is so brief that it cannot be grasped, and even this is filched away from them, distracted as they are among many things.

In a word, do you want to know how they do not “live long”? See how eager they are to live long! Decrepit old men beg in their prayers for the addition of a few more years; they pretend that they are younger than they are; they comfort themselves with a falsehood, and are as pleased to deceive themselves as if they deceived Fate at the same time. But when at last some infirmity has reminded them of their mortality, in what terror do they die, feeling that they are being dragged out of life, and not merely leaving it. They cry out that they have been fools, because they have not really lived, and that they will live henceforth in leisure if only they escape from this illness; then at last they reflect how uselessly they have striven for things which they did not enjoy, and how all their toil has gone for nothing. But for those whose life is passed remote from all business, why should it not be ample? None of it is assigned to another, none of it is scattered in this direction and that, none of it is committed to Fortune, none of it perishes from neglect, none is subtracted by wasteful giving, none of it is unused; the whole of it, so to speak, yields income. And so, however small the amount of it, it is abundantly sufficient, and therefore, whenever his last day shall come, the wise man will not hesitate to go to meet death with steady step.

Perhaps you ask whom I would call “the preoccupied”?
 There is no reason for you to suppose that I mean only those whom the dogs that have at length been let in drive out from the law-court, those whom you see either gloriously crushed in their own crowd of followers, or scornfully in someone else’s, those whom social duties call forth from their own homes to bump them against someone else’s doors, or whom the praetor’s hammer keeps busy in seeking gain that is disreputable and that will one day fester. Even the leisure of some men is engrossed; in their villa or on their couch, in the midst of solitude, although they have withdrawn from all others, they are themselves the source of their own worry; we should say that these are living, not in leisure, but in idle preoccupation. Would you say that that man is at leisure who arranges with finical care his Corinthian bronzes, that the mania of a few makes costly, and spends the greater part of each day upon rusty bits of copper? Who sits in a public wrestling-place (for, to our shame I we labour with vices that are not even Roman) watching the wrangling of lads? Who sorts out the herds of his pack-mules into pairs of the same age and colour? Who feeds all the newest athletes? Tell me, would you say that those men are at leisure who pass many hours at the barber’s while they are being stripped of whatever grew out the night before? while a solemn debate is held over each separate hair? while either disarranged locks are restored to their place or thinning ones drawn from this side and that toward the forehead? How angry they get if the barber has been a bit too careless, just as if he were shearing a real man! How they flare up if any of their mane is lopped off, if any of it lies out of order, if it does not all fall into its proper ringlets! Who of these would not rather have the state disordered than his hair? Who is not more concerned to have his head trim rather than safe? Who would not rather be well barbered than upright? Would you say that these are at leisure who are occupied with the comb and the mirror? And what of those who are engaged in composing, hearing, and learning songs, while they twist the voice, whose best and simplest movement Nature designed to be straightforward, into the meanderings of some indolent tune, who are always snapping their fingers as they beat time to some song they have in their head, who are overheard humming a tune when they have been summoned to serious, often even melancholy, matters? These have not leisure, but idle occupation. And their banquets, Heaven knows! I cannot reckon among their unoccupied hours, since I see how anxiously they set out their silver plate, how diligently they tie up the tunics of their pretty slave-boys, how breathlessly they watch to see in what style the wild boar issues from the hands of the cook, with what speed at a given signal smooth-faced boys hurry to perform their duties, with what skill the birds are carved into portions all according to rule, how carefully unhappy little lads wipe up the spittle of drunkards. By such means they seek the reputation for elegance and good taste, and to such an extent do their evils follow them into all the privacies of life that they can neither eat nor drink without ostentation.

And I would not count these among the leisured class either—the men who have themselves borne hither and thither in a sedan-chair and a litter, and are punctual at the hours for their rides as if it were unlawful to omit them, who are reminded by someone else when they must bathe, when they must swim, when they must dine; so enfeebled are they by the excessive lassitude of a pampered mind that they cannot find out by themselves whether they are hungry! I hear that one of these pampered people—provided that you can call it pampering to unlearn the habits of human life—when he had been lifted by hands from the bath and placed in his sedan-chair, said questioningly: “Am I now seated?” Do you think that this man, who does not know whether he is sitting, knows whether he is alive, whether he sees, whether he is at leisure? I find it hard to say whether I pity him more if he really did not know, or if he pretended not to know this. They really are subject to forgetfulness of many things, but they also pretend forgetfulness of many. Some vices delight them as being proofs of their prosperity; it seems the part of a man who is very lowly and despicable to know what he is doing. After this imagine that the mimes fabricate many things to make a mock of luxury! In very truth, they pass over more than they invent, and such a multitude of unbelievable vices has come forth in this age, so clever in this one direction, that by now we can charge the mimes with neglect. To think that there is anyone who is so lost in luxury that he takes another’s word as to whether he is sitting down! This man, then, is not at leisure, you must apply to him a different term—he is sick, nay, he is dead; that man is at leisure, who has also a perception of his leisure. But this other who is half alive, who, in order that he may know the postures of his own body, needs someone to tell him—how can he be the master of any of his time?

It would be tedious to mention all the different men who have spent the whole of their life over chess or ball or the practice of baking their bodies in the sun. They are not unoccupied whose pleasures are made a busy occupation. For instance, no one will have any doubt that those are laborious triflers who spend their time on useless literary problems, of whom even among the Romans there is now a great number. It was once a foible confined to the Greeks to inquire into what number of rowers Ulysses had, whether the Iliad or the Odyssey was written first, whether moreover they belong to the same author, and various other matters of this stamp, which, if you keep them to yourself, in no way pleasure your secret soul, and, if you publish them, make you seem more of a bore than a scholar. But now this vain passion for learning useless things has assailed the Romans also. In the last few days I heard someone telling who was the first Roman general to do this or that; Duilius was the first who won a naval battle, Curius Dentatus was the first who had elephants led in his triumph. Still, these matters, even if they add nothing to real glory, are nevertheless concerned with signal services to the state; there will be no profit in such knowledge, nevertheless it wins our attention by reason of the attractiveness of an empty subject. We may excuse also those who inquire into this—who first induced the Romans to go on board ship. It was Claudius, and this was the very reason he was surnamed Caudex, because among the ancients a structure formed by joining together several boards was called a caudex, whence also the Tables of the Law are called codices, and, in the ancient fashion, boats that carry provisions up the Tiber are even to-day called codicariae. Doubtless this too may have some point—the fact that Valerius Corvinus was the first to conquer Messana, and was the first of the family of the Valerii to bear the surname Messana because be had transferred the name of the conquered city to himself, and was later called Messala after the gradual corruption of the name in the popular speech. Perhaps you will permit someone to be interested also in this—the fact that Lucius Sulla was the first to exhibit loosed lions in the Circus, though at other times they were exhibited in chains, and that javelin-throwers were sent by King Bocchus to despatch them? And, doubtless, this too may find some excuse—but does it serve any useful purpose to know that Pompey was the first to exhibit the slaughter of eighteen elephants in the Circus, pitting criminals against them in a mimic battle? He, a leader of the state and one who, according to report, was conspicuous among the leaders of old for the kindness of his heart, thought it a notable kind of spectacle to kill human beings after a new fashion. Do they fight to the death? That is not enough! Are they torn to pieces? That is not enough! Let them be crushed by animals of monstrous bulk! Better would it be that these things pass into oblivion lest hereafter some all-powerful man should learn them and be jealous of an act that was nowise human. O, what blindness does great prosperity cast upon our minds! When he was casting so many troops of wretched human beings to wild beasts born under a different sky, when he was proclaiming war between creatures so ill matched, when he was shedding so much blood before the eyes of the Roman people, who itself was soon to be forced to shed more. he then believed that he was beyond the power of Nature. But later this same man, betrayed by Alexandrine treachery, offered himself to the dagger of the vilest slave, and then at last discovered what an empty boast his surname was.

But to return to the point from which I have digressed, and to show that some people bestow useless pains upon these same matters—the man I mentioned related that Metellus, when he triumphed after his victory over the Carthaginians in Sicily, was the only one of all the Romans who had caused a hundred and twenty captured elephants to be led before his car; that Sulla was the last of the Roman’s who extended the pomerium, which in old times it was customary to extend after the acquisition of Italian but never of provincial, territory. Is it more profitable to know this than that Mount Aventine, according to him, is outside the pomerium for one of two reasons, either because that was the place to which the plebeians had seceded, or because the birds had not been favourable when Remus took his auspices on that spot—and, in turn, countless other reports that are either crammed with falsehood or are of the same sort? For though you grant that they tell these things in good faith, though they pledge themselves for the truth of what they write, still whose mistakes will be made fewer by such stories? Whose passions will they restrain? Whom will they make more brave, whom more just, whom more noble-minded? My friend Fabianus used to say that at times he was doubtful whether it was not better not to apply oneself to any studies than to become entangled in these.

Of all men they alone are at leisure who take time for philosophy, they alone really live; for they are not content to be good guardians of their own lifetime only. They annex ever age to their own; all the years that have gone ore them are an addition to their store. Unless we are most ungrateful, all those men, glorious fashioners of holy thoughts, were born for us; for us they have prepared a way of life. By other men’s labours we are led to the sight of things most beautiful that have been wrested from darkness and brought into light; from no age are we shut out, we have access to all ages, and if it is our wish, by greatness of mind, to pass beyond the narrow limits of human weakness, there is a great stretch of time through which we may roam. We may argue with Socrates, we may doubt with Carneades, find peace with Epicurus, overcome human nature with the Stoics, exceed it with the Cynics. Since Nature allows us to enter into fellowship with every age, why should we not turn from this paltry and fleeting span of time and surrender ourselves with all our soul to the past, which is boundless, which is eternal, which we share with our betters?

Those who rush about in the performance of social duties, who give themselves and others no rest, when they have fully indulged their madness, when they have every day crossed everybody’s threshold, and have left no open door unvisited, when they have carried around their venal greeting to houses that are very far apart—out of a city so huge and torn by such varied desires, how few will they be able to see? How many will there be who either from sleep or self-indulgence or rudeness will keep them out! How many who, when they have tortured them with long waiting, will rush by, pretending to be in a hurry! How many will avoid passing out through a hall that is crowded with clients, and will make their escape through some concealed door as if it were not more discourteous to deceive than to exclude. How many, still half asleep and sluggish from last night’s debauch, scarcely lifting their lips in the midst of a most insolent yawn, manage to bestow on yonder poor wretches, who break their own slumber in order to wait on that of another, the right name only after it has been whispered to them a thousand times!

But we may fairly say that they alone are engaged in the true duties of life who shall wish to have Zeno, Pythagoras, Democritus, and all the other high priests of liberal studies, and Aristotle and Theophrastus, as their most intimate friends every day. No one of these will be “not at home,” no one of these will fail to have his visitor leave more happy and more devoted to himself than when he came, no one of these will allow anyone to leave him with empty hands; all mortals can meet with them by night or by day.

No one of these will force you to die, but all will teach you how to die; no one of these will wear out your years, but each will add his own years to yours; conversations with no one of these will bring you peril, the friendship of none will endanger your life, the courting of none will tax your purse. From them you will take whatever you wish; it will be no fault of theirs if you do not draw the utmost that you can desire. What happiness, what a fair old age awaits him who has offered himself as a client to these! He will have friends from whom he may seek counsel on matters great and small, whom he may consult every day about himself, from whom he may hear truth without insult, praise without flattery, and after whose likeness he may fashion himself.

We are wont to say that it was not in our power to choose the parents who fell to our lot, that they have been given to men by chance; yet we may be the sons of whomsoever we will. Households there are of noblest intellects; choose the one into which you wish to be adopted; you will inherit not merely their name, but even their property, which there will be no need to guard in a mean or niggardly spirit; the more persons you share it with, the greater it will become. These will open to you the path to immortality, and will raise you to a height from which no one is cast down. This is the only way of prolonging mortality—nay, of turning it into immortality. Honours, monuments, all that ambition has commanded by decrees or reared in works of stone, quickly sink to ruin; there is nothing that the lapse of time does not tear down and remove. But the works which philosophy has consecrated cannot be harmed; no age will destroy them, no age reduce them; the following and each succeeding age will but increase the reverence for them, since envy works upon what is close at hand, and things that are far off we are more free to admire. The life of the philosopher, therefore, has wide range, and he is not confined by the same bounds that shut others in. He alone is freed from the limitations of the human race; all ages serve him as if a god. Has some time passed by? This he embraces by recollection. Is time present? This he uses. Is it still to come? This he anticipates. He makes his life long by combining all times into one.

But those who forget the past, neglect the present, and fear for the future have a life that is very brief and troubled; when they have reached the end of it, the poor wretches perceive too late that for such a long while they have been busied in doing nothing. Nor because they sometimes invoke death, have you any reason to think it any proof that they find life long. In their folly they are harassed by shifting emotions which rush them into the very things they dread; they often pray for death because they fear it. And, too, you have no reason to think that this is any proof that they are living a long time—the fact that the day often seems to them long, the fact that they complain that the hours pass slowly until the time set for dinner arrives; for, whenever their distractions fail them, they are restless because they are left with nothing to do, and they do not know how to dispose of their leisure or to drag out the time. And so they strive for something else to occupy them, and all the intervening time is irksome; exactly as they do when a gladiatorial exhibition is been announced, or when they are waiting for the appointed time of some other show or amusement, they want to skip over the days that lie between. All postponement of something they hope for seems long to them. Yet the time which they enjoy is short and swift, and it is made much shorter by their own fault; for they flee from one pleasure to another and cannot remain fixed in one desire. Their days are not long to them, but hateful; yet, on the other hand, how scanty seem the nights which they spend in the arms of a harlot or in wine! It is this also that accounts for the madness of poets in fostering human frailties by the tales in which they represent that Jupiter under the enticement of the pleasures of a lover doubled the length of the night. For what is it but to inflame our vices to inscribe the name of the gods as their sponsors, and to present the excused indulgence of divinity as an example to our own weakness? Can the nights which they pay for so dearly fail to seem all too short to these men? They lose the day in expectation of the night, and the night in fear of the dawn.

The very pleasures of such men are uneasy and disquieted by alarms of various sorts, and at the very moment of rejoicing the anxious thought comes over them: “How long will these things last?” This feeling has led kings to weep over the power they possessed, and they have not so much delighted in the greatness of their fortune, as they have viewed with terror the end to which it must some time come. When the King of Persia, in all the insolence of his pride, spread his army over the vast plains and could not grasp its number but simply its measure, he shed copious tears because inside of a hundred years not a man of such a mighty army would be alive. But he who wept was to bring upon them their fate, was to give some to their doom on the sea, some on the land, some in battle, some in flight, and within a short time was to destroy all those for whose hundredth year he had such fear. And why is it that even their joys are uneasy from fear? Because they do not rest on stable causes, but are perturbed as groundlessly as they are born. But of what sort do you think those times are which even by their own confession are wretched, since even the joys by which they are exalted and lifted above mankind are by no means pure? All the greatest blessings are a source of anxiety, and at no time should fortune be less trusted than when it is best; to maintain prosperity there is need of other prosperity, and in behalf of the prayers that have turned out well we must make still other prayers. For everything that comes to us from chance is unstable, and the higher it rises, the more liable it is to fall. Moreover, what is doomed to perish brings pleasure to no one; very wretched, therefore, and not merely short, must the life of those be who work hard to gain what they must work harder to keep. By great toil they attain what they wish, and with anxiety hold what they have attained; meanwhile they take no account of time that will never more return. New distractions take the place of the old, hope leads to new hope, ambition to new ambition. They do not seek an end of their wretchedness, but change the cause. Have we been tormented by our own public honours? Those of others take more of our time. Have we ceased to labour as candidates? We begin to canvass for others. Have we got rid of the troubles of a prosecutor? We find those of a judge. Has a man ceased to be a judge? He becomes president of a court. Has he become infirm in managing the property of others at a salary? He is perplexed by caring for his own wealth. Have the barracks set Marius free? The consulship keeps him busy. Does Quintius hasten to get to the end of his dictatorship? He will be called back to it from the plough. Scipio will go against the Carthaginians before he is ripe for so great an undertaking; victorious over Hannibal, victorious over Antiochus, the glory of his own consulship, the surety for his brother’s, did he not stand in his own way, he would be set beside Jove; but the discord of civilians will vex their preserver, and, when as a young man he had scorned honours that rivalled those of the gods, at length, when he is old, his ambition will lake delight in stubborn exile. Reasons for anxiety will never be lacking, whether born of prosperity or of wretchedness; life pushes on in a succession of engrossments. We shall always pray for leisure, but never enjoy it.

And so, my dearest Paulinus, tear yourself away from the crowd, and, too much storm-tossed for the time you have lived, at length withdraw into a peaceful harbour. Think of how many waves you have encountered, how many storms, on the one hand, you have sustained in private life, how many, on the other, you have brought upon yourself in public life; long enough has your virtue been displayed in laborious and unceasing proofs—try how it will behave in leisure. The greater part of your life, certainly the better part of it, has been given to the state; take now some part of your time for yourself as well. And I do not summon you to slothful or idle inaction, or to drown all your native energy in slumbers and the pleasures that are dear to the crowd. That is not to rest; you will find far greater works than all those you have hitherto performed so energetically, to occupy you in the midst of your release and retirement. You, I know, manage the accounts of the whole world as honestly as you would a stranger’s, as carefully as you would your own, as conscientiously as you would the state’s. You win love in an office in which it is difficult to avoid hatred; but nevertheless believe me, it is better to have knowledge of the ledger of one’s own life than of the corn-market. Recall that keen mind of yours, which is most competent to cope with the greatest subjects, from a service that is indeed honourable but hardly adapted to the happy life, and reflect that in all your training in the liberal studies, extending from your earliest years, you were not aiming at this—that it might be safe to entrust many thousand pecks of corn to your charge; you gave hope of something greater and more lofty. There will be no lack of men of tested worth and painstaking industry. But plodding oxen are much more suited to carrying heavy loads than thoroughbred horses, and who ever hampers the fleetness of such high-born creatures with a heavy pack? Reflect, besides, how much worry you have in subjecting yourself to such a great burden; your dealings are with the belly of man. A hungry people neither listens to reason, nor is appeased by justice, nor is bent by any entreaty. Very recently within those few day’s after Gaius Caesar died—still grieving most deeply (if the dead have any feeling) because he knew that the Roman people were alive and had enough food left for at any rate seven or eight days while he was building his bridges of boats and playing with the resources of the empire, we were threatened with the worst evil that can befall men even during a siege—the lack of provisions; his imitation of a mad and foreign and misproud king was very nearly at the cost of the city’s destruction and famine and the general revolution that follows famine. What then must have been the feeling of those who had charge of the corn-market, and had to face stones, the sword, fire—and a Caligula? By the greatest subterfuge they concealed the great evil that lurked in the vitals of the state—with good reason, you may be sure. For certain maladies must be treated while the patient is kept in ignorance; knowledge of their disease has caused the death of many.

Do you retire to these quieter, safer, greater things! Think you that it is just the same whether you are concerned in having corn from oversea poured into the granaries, unhurt either by the dishonesty or the neglect of those who transport it, in seeing that it does not become heated and spoiled by collecting moisture and tallies in weight and measure, or whether you enter upon these sacred and lofty studies with the purpose of discovering what substance, what pleasure, what mode of life, what shape God has; what fate awaits your soul; where Nature lays us to rest when we are freed from the body; what the principle is that upholds all the heaviest matter in the centre of this world, suspends the light on high, carries fire to the topmost part, summons the stars to their proper changes—and ether matters, in turn, full of mighty wonders? You really must leave the ground and turn your mind’s eye upon these things! Now while the blood is hot, we must enter with brisk step upon the better course. In this kind of life there awaits much that is good to know—the love and practice of the virtues, forgetfulness of the passions, knowledge of living and dying, and a life of deep repose.

The condition of all who are preoccupied is wretched, but most wretched is the condition of those who labour at preoccupations that are not even their own, who regulate their sleep by that of another, their walk by the pace of another, who are under orders in case of the freest things in the world—loving and hating. If these wish to know how short their life is, let them reflect how small a part of it is their own.

And so when you see a man often wearing the robe of office, when you see one whose name is famous in the Forum, do not envy him; those things are bought at the price of life. They will waste all their years, in order that they may have one year reckoned by their name. Life has left some in the midst of their first struggles, before they could climb up to the height of their ambition; some, when they have crawled up through a thousand indignities to the crowning dignity, have been possessed by the unhappy thought that they have but toiled for an inscription on a tomb; some who have come to extreme old age, while they adjusted it to new hopes as if it were youth, have had it fail from sheer weakness in the midst of their great and shameless endeavours. Shameful is he whose breath leaves him in the midst of a trial when, advanced in years and still courting the applause of an ignorant circle, he is pleading for some litigant who is the veriest stranger; disgraceful is he who, exhausted more quickly by his mode of living than by his labour, collapses in the very midst of his duties; disgraceful is he who dies in the act of receiving payments on account, and draws a smile from his long delayed heir. I cannot pass over an instance which occurs to me. Sextus Turannius was an old man of long tested diligence, who, after his ninetieth year, having received release from the duties of his office by Gaius Caesar’s own act, ordered himself to be laid out on his bed and to be mourned by the assembled household as if he were dead. The whole house bemoaned the leisure of its old master, and did not end its sorrow until his accustomed work was restored to him. Is it really such pleasure for a man to die in harness? Yet very many have the same feeling; their desire for their labour lasts longer than their ability; they fight against the weakness of the body, they judge old age to be a hardship on no other score than because it puts them aside. The law does not draft a soldier after his fiftieth year, it does not call a senator after his sixtieth; it is more difficult for men to obtain leisure from themselves than from the law. Meantime, while they rob and are being robbed, while they break up each other’s repose, while they make each other wretched, their life is without profit, without pleasure, without any improvement of the mind. No one keeps death in view, no one refrains from far-reaching hopes; some men, indeed, even arrange for things that lie beyond life—huge masses of tombs and dedications of public works and gifts for their funeral-pyres and ostentatious funerals.

But, in very truth, the funerals of such men ought to be conducted by the light of torches and wax tapers, as though they had lived but the tiniest span.

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