Podcasts about advanced concepts

This week planet Earth is seeing two re-entries of man-made objects: first the uncontrolled, possibly life-threatening, Soviet-era Kosmos 482; and second, the W-3 - an example of the very controlled, defense and in some cases possibly life-extending, business case that is Varda Space Industries. Laura Winter speaks with Delian Asparouhov, Varda Space Industries' co-Founder and President, and Partner at Peter Thiel's Founders Fund; and Muk Pandian, Varda's Director of Strategic Partnerships and Advanced Concepts.

Clement Bonnet discusses his novel approach to the ARC (Abstraction and Reasoning Corpus) challenge. Unlike approaches that rely on fine-tuning LLMs or generating samples at inference time, Clement's method encodes input-output pairs into a latent space, optimizes this representation with a search algorithm, and decodes outputs for new inputs. This end-to-end architecture uses a VAE loss, including reconstruction and prior losses. SPONSOR MESSAGES:***CentML offers competitive pricing for GenAI model deployment, with flexible options to suit a wide range of models, from small to large-scale deployments. Check out their super fast DeepSeek R1 hosting!https://centml.ai/pricing/Tufa AI Labs is a brand new research lab in Zurich started by Benjamin Crouzier focussed on o-series style reasoning and AGI. They are hiring a Chief Engineer and ML engineers. Events in Zurich. Goto https://tufalabs.ai/***TRANSCRIPT + RESEARCH OVERVIEW:https://www.dropbox.com/scl/fi/j7m0gaz1126y594gswtma/CLEMMLST.pdf?rlkey=y5qvwq2er5nchbcibm07rcfpq&dl=0Clem and Matthew-https://www.linkedin.com/in/clement-bonnet16/https://github.com/clement-bonnethttps://mvmacfarlane.github.io/TOC1. LPN Fundamentals [00:00:00] 1.1 Introduction to ARC Benchmark and LPN Overview [00:05:05] 1.2 Neural Networks' Challenges with ARC and Program Synthesis [00:06:55] 1.3 Induction vs Transduction in Machine Learning2. LPN Architecture and Latent Space [00:11:50] 2.1 LPN Architecture and Latent Space Implementation [00:16:25] 2.2 LPN Latent Space Encoding and VAE Architecture [00:20:25] 2.3 Gradient-Based Search Training Strategy [00:23:39] 2.4 LPN Model Architecture and Implementation Details3. Implementation and Scaling [00:27:34] 3.1 Training Data Generation and re-ARC Framework [00:31:28] 3.2 Limitations of Latent Space and Multi-Thread Search [00:34:43] 3.3 Program Composition and Computational Graph Architecture4. Advanced Concepts and Future Directions [00:45:09] 4.1 AI Creativity and Program Synthesis Approaches [00:49:47] 4.2 Scaling and Interpretability in Latent Space ModelsREFS[00:00:05] ARC benchmark, Chollethttps://arxiv.org/abs/2412.04604[00:02:10] Latent Program Spaces, Bonnet, Macfarlanehttps://arxiv.org/abs/2411.08706[00:07:45] Kevin Ellis work on program generationhttps://www.cs.cornell.edu/~ellisk/[00:08:45] Induction vs transduction in abstract reasoning, Li et al.https://arxiv.org/abs/2411.02272[00:17:40] VAEs, Kingma, Wellinghttps://arxiv.org/abs/1312.6114[00:27:50] re-ARC, Hodelhttps://github.com/michaelhodel/re-arc[00:29:40] Grid size in ARC tasks, Chollethttps://github.com/fchollet/ARC-AGI[00:33:00] Critique of deep learning, Marcushttps://arxiv.org/vc/arxiv/papers/2002/2002.06177v1.pdf

FLUTE would use the physics of fluids to create a large mirror more than four hundred times the size of the mirror in the Hubble Space Telescope.

A team of researchers are hoping fungi and asteroids will help solve future astronauts' agricultural dilemma.

In this conversation, Brendan Housler and Landry Bobo discuss the concepts of durability and torque training in cycling. They explore what durability means in the context of cycling performance, how to identify if it's a limiting factor for cyclists, and various strategies to improve it. The discussion also delves into torque training, its benefits, and how it can enhance a cyclist's ability to produce power effectively. The conversation emphasizes the importance of building a strong foundation through base fitness and strength training, as well as the mental aspects of training. Chapters: 00:00 Introduction to Torque Training 01:45 Benefits of Torque Training 04:45 Incorporating Torque Training into Your Routine 07:34 Who Should Try Torque Training? 09:59 Torque Training in the Real World 14:25 Torque Training and Efficiency 15:50 Advanced Concepts and Conclusion

Proudly sponsored by PyMC Labs, the Bayesian Consultancy. Book a call, or get in touch!My Intuitive Bayes Online Courses1:1 Mentorship with meOur theme music is « Good Bayesian », by Baba Brinkman (feat MC Lars and Mega Ran). Check out his awesome work!Visit our Patreon page to unlock exclusive Bayesian swag ;)Takeaways:Teaching Bayesian Concepts Using M&Ms: Tomi Capretto uses an engaging classroom exercise involving M&Ms to teach Bayesian statistics, making abstract concepts tangible and intuitive for students.Practical Applications of Bayesian Methods: Discussion on the real-world application of Bayesian methods in projects at PyMC Labs and in university settings, emphasizing the practical impact and accessibility of Bayesian statistics.Contributions to Open-Source Software: Tomi's involvement in developing Bambi and other open-source tools demonstrates the importance of community contributions to advancing statistical software.Challenges in Statistical Education: Tomi talks about the challenges and rewards of teaching complex statistical concepts to students who are accustomed to frequentist approaches, highlighting the shift to thinking probabilistically in Bayesian frameworks.Future of Bayesian Tools: The discussion also touches on the future enhancements for Bambi and PyMC, aiming to make these tools more robust and user-friendly for a wider audience, including those who are not professional statisticians. Chapters:05:36 Tomi's Work and Teaching10:28 Teaching Complex Statistical Concepts with Practical Exercises23:17 Making Bayesian Modeling Accessible in Python38:46 Advanced Regression with Bambi41:14 The Power of Linear Regression42:45 Exploring Advanced Regression Techniques44:11 Regression Models and Dot Products45:37 Advanced Concepts in Regression46:36 Diagnosing and Handling Overdispersion47:35 Parameter Identifiability and Overparameterization50:29 Visualizations and Course Highlights51:30 Exploring Niche and Advanced Concepts56:56 The Power of Zero-Sum Normal59:59 The Value of Exercises and Community01:01:56 Optimizing Computation with Sparse Matrices01:13:37 Avoiding MCMC and Exploring Alternatives01:18:27 Making Connections Between Different ModelsThank you to my Patrons for making this episode...

Soil made on asteroids could then be used to create agricultural areas on orbiting habitats, making space farming possible.

Grayson muses on concepts and techniques for pointing dog finished work. Listen closely for the sidebar on selection and the talent/temperament balance. Notes avaialable at: https://losthighwaykennels.com/   Visit my sponsor: https://www.uglydoghunting.com Learn more about your ad choices. Visit megaphone.fm/adchoices

After BDSM teacher Andy Buru came into The UNcivilized Nation and dropped this notion for all of us, I've been seeing how potent of an idea this is — balancing space holding and selfishness actually is. AND how confronting it is for so many people to lean into the one that's not their natural way. In this short solo episode I break down why being able to do both will change your sex life, your income, and your relationships at large. Enjoy. Please do share this with one person in your life, or twenty.  Cheers, Traver

Dr. Jeff Musgrave // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Jeff Musgrave discusses research supporting the effects of high-velocity resistance training on older adults, including benefits for bone mineral density, the effects of detraining, and different ways to implement power training with patients.  Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. JEFF MUSGRAVE Welcome crew to the PT on Ice Daily Show. My name is Dr. Jeff Musgrave, Doctor of Physical Therapy. Super excited to be here with you. Hopefully you have been enjoying the holidays however you enjoy to celebrate over the last few days. Super excited to bring to you really interesting systematic review looking at high velocity resistance training for adults 50 plus. So what we're going to be covering today is you know what are the primary results, what can we learn about dosage when implementing this intervention for adults 50 plus and then we're gonna spend actually quite a bit of time talking about clinical considerations for this type of information and talking a little bit about just the body of research that already exists. So let's get into it team. This systematic review included 25 randomized controlled trials. We had 12 original studies. We had 13 follow-up studies. What they did is they were applying high-velocity resistance training to older adults. People 55 plus and they define this as having a slow eccentric phase with a explosive concentric phase. So in general, we would just reference this as power training, right? Kind of like a broad jump where you're going to slowly load the movement and then you're going to explode. then the other piece of this is having additional resistance with this. So traditionally this is basically just power training. Power training could include jump training, it could be Olympic style lifts like snatches or cleans with dumbbells, barbells, whatever implement you want, kettlebells, any of those type of implements. EFFECTS OF HIGH-VELOCITY RESISTANCE TRAINING ON BONE MINERAL DENSITY So What they did is after they included their studies that met their criteria, they dug in and they had to have pre and post DEXA scans to figure out what their bone mineral density was at the beginning and then also at the end. They also had to have a six-month follow-up One of the studies actually had a 16-year follow-up, which is pretty wild. Being able to get a randomized control trial with a year follow-up is pretty great, but 16 years was pretty wild. So they looked at bone mineral density at the femur, the femoral neck, the lumbar spine, and also the distal radius. Only two of the studies looked at the distal radius to see if there were any changes in bone mineral density. The rest of the studies did not look at that area. Unfortunately, those two studies showed no change. So we'd need to dig into those studies more specifically to look at the loading strategies for those to really try to figure out what happened there because we know Basically, in general, our body's gonna respond to all the load. So if we get proper loading, due to Wolf's Law, we know those osteocytes are gonna start producing osteoblasts, and then we're gonna lay down fresh bone if we get proper loading. So no changes in the distal radius with using high-velocity resistance training. They did, however, find statistically significant results looking at the total femur on the DEXA scan, the femoral neck, as well as the lumbar spine. So there were statistically significant findings there using high velocity resistance training, AKA power training. So that was pretty cool. So we know that that is a modality that would be beneficial. The dosage, if we're moving on from what were the results, so it was beneficial, then the results were the results in the dosage were that twice a week is kind of the minimal dosage to see change in the skeletal system. So at least twice a week is what we should be looking for for dosage. Unfortunately there was so much heterogeneity in our different interventions that they weren't able to conclude a specific loading percentage. We do know just in general when it comes to power training that our percentages are going to be lower than resistance training because we're adding the component of speed. So if we're going to slowly get into that eccentric position to then explode into concentric, it can't be at the same percentages that we use at resistance training. So we know as a blanket statement that it's lower load than resistance training traditionally is. But what that is, there was not any formal consensus found from the systematic review. But they did find that two times a week is the optimal frequency that we're looking for if we're trying to change the skeletal system. they did find because their minimal follow-up was at six months, that if there was no training across that six-month period, that the gains that were created were also lost. THE EFFECTS OF DETRAINING So we want to keep that in mind that detraining, just like for the musculoskeletal system, the skeletal system as well, if you don't maintain those results, you're not going to be able to keep them. A really easy way to think about this is fitness is forever. It's just like brushing our teeth. We don't go to the dentist and say, well, you know, you've done a good job the last 50 years, so you know what, let's just take off the last 40 years. You don't really need to brush your teeth anymore. No, the results are not gonna be sustained and the same thing goes for our skeletal system. So once we get those results, we wanna make sure that we're getting people to be loading their bones at least twice a week. And this to be a thing that it's like, it's gotta be scalable across a continuum, across a lifespan for people, or it's not gonna necessarily be beneficial. We can give them a little bump, but that just makes it so much more important. that we're selling fitness from day one. What are you gonna do once care ends? If you wanna maintain these results, we know we can give you results. We know we can get you there, but you're gonna need to continue this training, kind of indefinitely. So finding fun forms of exercise that's gonna include high-velocity resistance training to help maintain bone density is helpful. Now, where we're gonna spend the bulk of our time is on clinical considerations. So I talked about there being high heterogeneity in our interventions. So the interventions included dumbbells, they included machines, resistance training. I found this very interesting. There was actually a masters football team that was included in this study, which I think is super cool. There were also some Olympic lifts that were being completed. in this study as well. Now, probably the most disappointing part of this study for me was this quote, which I'm gonna read to you. It may be unlikely that older adults are willing to engage in Olympic style lifting or soccer and that performing explosive concentric with slower eccentric movements using machines or free weight style equipment may be more feasible, safe and result in better adherence for the population. Now that was researcher opinion. And I can understand if you've got someone that is super sick, super frail, super deconditioned, it may not be feasible to get them out playing football or playing soccer. But when we're thinking about our active 50, 60, 70, 80 year olds, I mean, we've got people pole vaulting in their 80s. These things are not out of reach for older adults. For them to be doing Olympic style lifting, explosive type movements, Just anecdotally at Stronger Life, we do tons of agility, power, jump training with people all the way up into their 80s with no injuries. So a little disappointed in that statement. I can understand clinical practice, maybe we're talking, you were in the ICU, you're in acute care, you're like, okay, yeah, we're not probably gonna be playing soccer in my sessions. "THE NEEDS OF AN OLYMPIC ATHLETE AND OUR GRANDPARENTS DIFFER BY DEGREE, NOT KIND" But when we're thinking about long-term, we're thinking about strategies for for people that are over 50 like these are not out of reach we can absolutely be doing olympic style lifts and it reminds me of the quote from coach greg glassman who created crossfitted the needs of the of athletes and our grandparents are the same. They differ by degree, not kind. We need these types of interventions for our older adults to help with their bone density. And I would argue that power training, Olympic-style lifting, some of these more explosive-style activities are actually way more fun. I mean, let's think about pickleball, for example. Pickleball has tons of power training incorporated in it. And I would say, although it is becoming more popular in younger populations, I would say 50 plus probably has a market cornered on those style of movements. So the big takeaway there is don't count out power training for our older adults, Olympic style lifting. where they're moving quickly. Now another interesting discussion in there while we're talking about power training is that there were specific adaptations that were special to some of these cutting and power agility type movements that they described as odd stressors. So when we're thinking about the bone, if the load is only in one direction, we're only going to get adaptations, by and large, in that direction. When we start thinking about loading the bone from different angles with different cutting and different movements, then we can get adaptations in different directions, which, by and large, is going to help make our bones more resilient, less likely to fracture if they've encountered load in multiple directions and odd type stressors. POWER TRAINING VS. RESISTANCE TRAINING Now the study was, this systematic review was not strong enough to say high resistance interval training, or sorry, high intensity, high velocity resistance training is superior to high load resistance training. So we can't say power training's better than resistance training. We can't say that those odd type stressors with agility type movements are superior either. So basically this is all modality we should have. It was strong enough results that if you're not doing power based movements, agility, jump style training, Olympic style lifting, you should get that included into your clinical practice for older adults that are trying to improve their bone density. It is clear that it should be part of the approach. Now I will say if you're looking at the overall results, the two different, levels of quality here. We've got a systematic review, which way trumps the randomized control trials I'm about to reference. But if you look at this multi-modal approach, because the systematic review really did not have just high-velocity resistance training, there was strength training, there was balance, there was functional training. There were all these different modalities. It wasn't just high velocity resistance training included in the study. So it was really a mixed modal approach, but a common thread was that high-velocity resistance training was included. Now, some former studies of a lower level of evidence, if we're looking at the Lift-More or the Lift-More-M trials, those are both free access to the public, you can Google those very easily, use this mixed modal approach, but it had a much more specific dialed-in approach to loading. So there was high resistance training, 80% plus of a one rep max included and power training included. That mixed modal approach with a higher percentage of resistance seemed to be very beneficial when we're looking at the Lift-More and Lift-More-M trials. I would say that's one thing that's different from the systematic review is the criteria did not include a minimum threshold of resistance. Now those are my caveats from reading this and kind of thinking about the body of research. SUMMARY So if we're gonna boil this down, we're gonna ask, does high velocity resistance training help build better bones? We would simply say yes. Dosage that we need, two times a week. We know that there's a detraining effect if people stop this training for more than six months. So fitness is forever. We need those training methods, those modalities to continue. Considerations for clinical practice. Can we hang our hat on just high velocity resistance training? No. This was not strong enough to rule out just heavy resistance training. The body of research is larger there for making changes in bone mineral density just in general. It should probably include some power training like Olympic style lifting or agility training as well. That's also going to be beneficial. No clear winner on the type of modality, whether we're going to use dumbbells, kettlebells, barbells, resistance bands. All of those things are on the table, which is actually great because we don't always have those same exercise modalities. So it seems to be more important to hit those thresholds for power training, to hit those thresholds for resistance training, but maybe it's not so important that we just have X equipment in our clinic or at our disposal, which is actually great news. Team, I hope you enjoyed this review. I will have the the DOI listed if you want to look at this article more in depth on your own as well as the ones for the Lift More and Lift More M trials. If you found this interesting and you're interested in coming to see us on the road, I tell you what, live is a great place if you are new to loading bones or maybe you want some new Method styles to load your bones for your older adults. We have a whole impact training lab Lots of resistance training labs where we can help you dial in the dosage for the person in front of you From the ICU all the way up to fitness and masters Athletes, which is wonderful in our older adult live course. The next ones are going to be in Santa Rosa, California That'll be January as well as you can catch us in Marysville, Ohio on the 13th and 14th of January, then we're going to have Clearwater, Florida just a week or so after. If you're looking to continue your journey towards getting your MMOA cert, if you want to catch us in the L1, Previously Essential Foundations, that will kick off on January 10th. In the L2 course, which prior was called Advanced Concepts, is gonna be kicking off on January 11th. I hope you have or are still enjoying your holidays. Love to get your thoughts, comments on this super interesting systematic review. And that is it for now, team. Catch you later. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Rafuse v. Advanced Concepts

It's no secret that almost every step we take is being tracked or recorded in some way. However, plenty of things need to be clarified about what this means for our personal freedoms and safety. Today, David Brin, a world-renowned expert on privacy and transparency, will shed light on these complex issues weighing on our society! David is an award-winning science fiction author, technical consultant, astrophysicist, and public speaker. He helped establish the Arthur C. Clarke Center for Human Imagination at UCSD and serves on the advisory board of NASA's Innovative and Advanced Concepts group. In our interview, we explore fascinating topics like AI, human augmentation, the origin of the Universe, privacy, and the values of a transparent society. Tune in!  Key Takeaways:  Intro (00:00) The notion of the fourth turning (04:18) Artificial intelligence vs. augmented intelligence (12:55) The potential for sentient AI (22:17) Plasma cosmology and the origin of the Universe (27:50) The most compelling theory of the origin of life (34:26) Privacy and the values of a transparent society (40:53) Should we raise AIs like children? (46:27) The upcoming Artemis moon missions (51:51) Outro (57:49) — Additional resources: 

Alan Fredendall // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Fitness Athlete division leader Alan Fredendall discusses the Concept 2 rower, including each key component & how to perform basic maintenance on it. Alan also coaches rowing technique, including how to use the monitor to establish the ideal "drag factor" so that patients & athletes understand their optimal damper setting as well as strokes-per-minute (spm). Finally, Alan discusses how to improve rowing performance, including testing & retesting established benchmarks on the rower. Take a listen to the episode or read the episode transcription below. If you're looking to learn from our Clinical Management of the Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. ALAN FREDENDALL Hey, what's up? Good morning. Welcome to the PT on ICE Daily Show. I hope your morning is off to a great start. We're here early on Fitness Athlete Friday out in the garage to talk about rowing. Fitness Athlete Friday, if you're not sure, we talk all things related to CrossFit, Olympic weightlifting, powerlifting, running, biking, swimming, today, rowing, everything related to the recreational athlete, that patient or client who is getting after it on a daily basis. Before we get started today, let's talk about a couple of quick announcements. Courses coming your way from the fitness athlete division, we have no more courses that you can take in 2023 unfortunately. All of our live courses between now and the end of the year are either done or sold out and all of our online courses are finished or have already started towards the end of the year. Your next chance to catch us is going to be in January on the road for our live seminar Your next chance to catch us online is going to be January 29th for Fitness Athlete Essential Foundations, or February 5th. We also call that course Level 1 Online Now. Your next chance for our Level 2 Online course, previously called Advanced Concepts, will be on February 5th. What are those courses? Those three courses compose the Certification and the Clinical Management of the Fitness Athlete, or known as CERT CMFA. Our level one online course is all of the basics. It is a lecture-heavy course. It is a course heavy on clinical application, not only to the fitness athlete but also taking the principles that we teach, how to properly dose and prescribe load, how to increase the intensity of your physical therapy sessions, taking concepts, not only applying them to the fitness athlete but all of your populations, everybody that could potentially come into your physical therapy clinic. Our level two online course, previously called Advanced Concepts, gets a lot deeper into the weeds with a fitness athlete. So if you're looking to learn about advanced Olympic weightlifting, advanced gymnastics, such as those found at CrossFit, muscle ups, handstand walking, pistol squats, all that sort of stuff, and then a super incredible thorough deep dive into programming, then the level two online course is for you. That is for the person who is looking to regularly work with fitness athletes in the community and be the provider of choice in their region. And then our live seminar is focused almost entirely on moving, about understanding what it means to perform a one rep max or a sub max test to predict a one rep max, what that feels like for you to do it so that you better know how to apply that to your patient population, but also how to program based off of that, how to work different therapeutic exercises together to facilitate both intensity as well as recovery during physical therapy. So those three courses compose the CERT CMFA. So p10ice.com, click on our courses to find the next live or online courses coming your way. And I will say this morning ahead of an announcement that you're going to see via email and social media that our prices will be going up per ticket on January 1st. So you heard it here first. Our ticket price will be going from $650 for the majority of our courses live and online to $695 on January 1st. If you were looking to grab one of our courses in 2024, I would do it now. Save yourself the 50 bucks. So that's what's coming your way from the fitness athlete division. ROWING 101 Today we're talking about rowing. We're here with the rower. I love this piece of equipment. I think it's a very versatile piece of equipment. I've had the chance to spend a lot of time on the rower when I first began CrossFit. Was not really able to run. I was so overweight. Spent a lot of time on the assault bike, and a lot of time on the rower. I've done a lot of endurance stuff on the rower, a lot of different programming on the rower. I've rowed two full marathons. So I want to share today the very basics of a rowing machine, what it is, how it works, and how to take care of it. If you're really thorough with your maintenance, even a couple of minutes per month, this is a machine that could last you your entire career without really needing to purchase any repairs or even possibly replace it. And then we're also going to get into the basics of rowing technique and how to get a little bit better at rowing. COMPONENTS OF A ROWING MACHINE So let's start from the top. and describe the rowing machine and all of the different parts, and also some tips and tricks for maintenance. So first things first, the question that most people have about the rower is how does it work? It works with sensors in the damper, which is a flywheel, with a computer monitor here, and then calculations are performed by the computer every pull to give you outputs of a pace of meters or calories, some sort of output of your work. So there are sensors in the chain and sensors in the flywheel. Starting from the front of the rower and working our way out, we have the damper. This houses the flywheel. This is where the resistance from the rower comes from. This handle on the side toggles between 1 and 10. What that does, is the higher the setting, as you approach 10, you're allowing more and more and more air to flow into the damper and create resistance against the flywheel as you row. So you are in charge of a combination of letting more or less air into the damper and pulling the chain you kind of control how the rower feels. A lighter damper is going to feel like a smooth row on really smooth water and a high damper is going to feel like in a really aggressive row maybe through really rough water or something like that. Far and away the majority of people are going to want to row somewhere with a damper setting between four and six. Now you do get more work awarded for a higher damper setting. That being said, it is much more challenging and fatiguing to pull. So the higher the damper goes, you need to be a stronger human being in general, especially with your pulling capacity, and you need to be a more experienced rower. You'll see folks trying to break world records, row at a 10. That's not the majority of human beings who are using a rower. Most folks sitting down on the rower, especially a longer effort, are going to be somewhere between a four and a six. We can calculate the exact damper setting that is best for each individual using a setting on a monitor called the drag factor, and we'll talk about that in a little bit. Taking care of the damper and the flywheel housing is really simple. Take a vacuum, suck the dust out, blow the dust out of there some way to clear the dust so that the flywheel does not get a bunch of gunk accumulated in there. Very easy to maintain the flywheel. Next is the chain. Pretty simple. When you are storing a rower, even if you're storing it horizontally, Always place the monitor down and release the chain. That takes tension off the chain. That's going to let your chain last a lot longer, and it's going to let the screws that hold your monitor upright last a lot longer as well. The chain is pretty simple. It's a handle attached to a metal chain that again pulls on the flywheel. So normally when we're using it in class, we have it out and racked in the handle, but when we're storing it, put it away and take the tension off that chain. Very easy to maintain the chain. Just keep it away as a solvent, not a lubricant. Find an actual lubricant, something like white lithium grease, to grease up that handle, keep it moving nice and smooth, and keep it from rusting as well, especially if your rower is stored somewhere that's not climate-controlled. A CrossFit gym that doesn't have air conditioning, in your garage or something, where it's gonna be subjected to humidity, keep that thing lubricated so it does not rust. Very easy to maintain otherwise. Our footplates, this is where our feet go, pretty simple. We're going to adjust the foot plane based on the length of our foot such that the strap, we want the strap somewhere about mid-foot. We don't want it jammed up in our ankle crease and we don't want it out on our toes either. We want to be able to plantarflex and dorsiflex our ankles and not be restricted by the straps. Taking care of the straps is pretty easy, they're just fabric, use some sort of fabric conditioner. Maybe in the winter, some fabric conditioner so they don't crack and fray. Once a month, again, a few minutes of maintenance and the machine is going to maintain it. And then just clean the footplates. Keep the footplates clean of junk, dog poop, whatever. Otherwise, very easy to maintain the straps and the footplates. The seat, the biggest thing here is that the cleaner you keep the track, the smoother the seat is going to go back and forth on the track. You can coat this with a little bit of grease as well, but the main thing is, especially if you've jumped on here and you've rowed for a longer distance, the pressure of your butt on the seat is going to kind of grind against the track a little bit. It's going to leave little black particles, and a little bit of residue. If you clean that up, it's going to keep the seat moving nice and smooth. And again, maybe once a month, add just a little touch of grease and work it into the metal of the track. Pretty easy to maintain the seat and track. And then the most important component of the rower, the component that is the most expensive when stuff goes wrong, is the monitor. So the monitor is where we keep track of our work. It is battery-powered. It works a lot like a car. It's got C batteries in the back. As you row, you are transferring a little bit of energy from the battery to the rower, kind of like an alternator in a car. And then just like a car, over time, the batteries will decay. These are C batteries. They will decay a lot faster than a car battery. And you may need to replace the batteries every few months. That's far and away going to be your largest expense with a rower. making sure if you're running low on batteries, that you change the batteries out. Now the rower will run without batteries, but it will only run as long as you are actively rowing. So if you stop rowing at any moment, the monitor will shut off. So not something you want to happen in the middle of a workout, especially a longer row. The biggest thing with maintaining the monitor, do not directly spray any sort of cleaning solvent on the monitor. Just like you would not spray it directly onto a laptop computer, You would maybe put it on a little rag and just kind of wipe it. Make sure that you're not putting a lot of chemicals inside of this. Again, it is a computer. So that's taking care of the monitor. So those are the key components of the rower. MECHANICS OF ROWING Now let's talk about the mechanics of rowing. So I'm going to turn sideways here so you can see my side profile. putting our feet in. We want to have tight straps, but we don't want them to be excessively tight on our feet. Again, we want to have the strap somewhere, maybe midway between our ankle crease and our toes. We want to be able to plantarflex and dorsiflex our toes. Tighten it enough so that if you lift your shoe up, you can easily transition on and off the rower. That's how tight the strap should be. Now the mechanics of rowing are very simple, however, they require knowing that rowing is a leg press primarily. Your legs are doing the majority of work on the rower, not your arms. A lot of folks get on here and they do really short strokes and they really do an arm-heavy stroke. and they find that their arms get fatigued, their grip gets fatigued, that should not happen on the rower, even if you jump on here and you commit to rowing three to four hours to get a marathon. You should not feel like your grip strength is a limiting factor on the rower because your legs are doing the majority of the work. So how we like to coach rowing is we like to say legs, lean, and pull. So as I have the handle, I'm thinking about a big leg press, almost like I'm going to deadlift. Legs, then I'm going to carry that momentum forward, lean, and then I pull with my arms. So full speed it looks like this. Legs, lean, pull. Legs, lean, pull. And that should allow a nice smooth rowing pattern. I'm going to let the damper stop for a second so you can hear me. If you hear a lot of slapping, When someone is rowing, that means that their handle is not moving smoothly back and forth. Something is probably wrong with their rowing form. For some reason, their rowing handle is going in an elliptical pattern instead of a straight line. Just like anything else in physics, Straight lines are astronomized. So we need to fix what's going on. We should be using legs, lean and pull. We should be moving as one continuous unit and that handle should be moving smoothly in and out of the rower. So that's the basics of rowing mechanics. A lot of folks can use a lot of simple peeling or more of a lean- back. We're not excessively extending the spine. However, we do want to use the momentum generated by our legs to transfer into a little bit more posterior chain activation to get a little bit more out of the handle. The longer the handle, the more credit you're going to get meters or calories on that rower. DRAG FACTOR Now let's talk about the drag factor. I'm going to turn this rower around again. Drag factor is a calculation of an imitation of what it would feel like if you were actually in a rowing boat on the water. How much drag would you perceive rowing through the water? An ideal drag factor is going to be 115 to 135. How is that calculated? It's going to be different for every person based on how hard they pull the rower and the setting of the damper. How we get to it, it's going to be in the menu on our rower. We're going to go to more options once the rower is turned on. We're going to go to utilities and it's the setting under display drag factor. So it's going to say row to display drag factor. Now what you're going to do, this is again, this is individual to every person. Every person, based on their specific damper setting, based on their rowing mechanics, based on how strong of a rower they are, it's going to be different, but we're shooting for 115 to 135. So if I get on the rower, I'm just going to start rowing, and it's going to tell me my drag factor. So right now, after a couple of pulls, it's telling me 99. I'm at a dip or a 4. I'm going to bump up to 5. I'm going to do a few more pulls. And now I'm at 121. So I'm between 115 and 135. What does that mean? A damper setting of 5 for me is going to get me right where I want. So the most important thing, especially if somebody's going to be using a rower a lot, for our CrossFitters who are probably going to be rowing every week, For maybe a patient who has a rower at home in the basement, working on drag factor can really help them know when they sit down, no more mystery about where to put the damper setting. You're going to be able to say, you know what? For you, damper four, damper five, damper six. Maybe for a very tall, very strong, very experienced rower, maybe they are at damper seven or damper eight. That's going to be rare, but also not impossible. So drag factor is really going to help folks know when I get on the rower, where should I put that damper based on my mechanics, based on my experience and strength with rowing. MAKING PROGRESS ON THE ROWER The final point I want to talk about aside from the components, maintaining it, mechanics, and drag factor is making progress on the rower. A lot of folks want to get better at the rower. The unfortunate truth is to get better at the rower, much like anything else in life, you should do more rowing. So, rowing is a great accessory thing to add in, especially for our CrossFitters. It's unloaded. It's not going to be as tough on the body as maybe adding in an extra session of Olympic weightlifting or running per week. Very easy to add in an extra maybe 30 minutes of rowing a week to try to get better at rowing. A lot like anything else with monostructural work, with cardio, with running, rowing, biking, The answer to the question how do I get better is where are you weak at on the rower? Are you weak under fatigue in the middle of a CrossFit workout? Are you weak at very short sprint efforts about getting on a rower and rowing 500 meters? Are you weak as the fatigue fall-off factor sets in and you row maybe a 2k or a 5k row as you get into longer endurance rowing? Where is your weakness? If folks say, I don't know, that's a great time to establish some benchmarks. A lot like wanting to know somebody's 400-meter run time, Their mile run time, their 5k run time, we can do the same thing on the rower. We have established benchmarks on the rower. A lot of them are pre-programmed in the computer. What is your 500-meter row time? What is your 2k row time? Your 2k row is going to be equivalent to a mile run. What is your 5k row time? that's going to be fairly equivalent to a 5k run. A lot of folks are going to be faster on the rower than running, but that's about equivalent as well. So establishing some benchmarks, looking and seeing how far speed falls off going from 500 to 2k, from 2k to 5k is going to let you help that patient or athlete better program that accessory rowing to get specifically better at the energy system they need to work at. Getting better at rowing too is recognizing where my paces at. Pacing on the rower is per 500 meters. That's the pace that you usually see pop up on the screen, two minutes per 500, two minutes and 20 seconds per 500, and so on and so forth, and understanding each person needs to learn what is a fast, maybe a PR pace for my 500-meter row pace. If there's a workout that has maybe three rounds of deadlifts, pull-ups, and a 750-meter row, what pace should I look to establish if I want to hit that fast? What pace should I establish if I want to hit a sustainable pace that I can hold for maybe a longer effort, like a 750, and then what does a recovery pace look like? If we have a longer workout that maybe has some 1000-meter rows, we had a workout this week that was 50 burpees, 2000 meter row, a one-mile run, and a much longer endurance-focused workout, what should my 500-meter pace look like on the rower for a longer effort, a 2000 meter effort, and understanding when you get on the rower you settle in what pace am I hoping to hold here based on the outcome that I want. Do I want to get on and off this rower as fast as possible, treat it like a sprint effort, Do I want to get on here and sustain a longer effort, or is this maybe a very long effort, a 2,000 meter row in the middle of a workout, and I'm thinking about primarily using this as recovery until I recover a little bit, and then I can begin to pick up the pace again. So understanding where your benchmarks are at, where your paces are at, and what the goal of the goal we're at. where it is in the workout, it's very important to get on here and not go too slow and give up the workout, but also not jump on here and just burn out and be that person on here that looks totally miserable because you started off way too fast and now you've wrecked yourself and you still have a long way to go. So the rower, the damper, the chain, the seat, the foot plates, the monitor, what they do, how to take care of them. Rowing mechanics, it's a leg press, not an arm pull. Legs, lean, and then pull. Drag factor, different for everybody. Very important to understand to get on there and play with drag factors so that you understand for each person, and they understand for themselves, why and how I'm choosing the damper setting that I am, and then how to make progress. Test benchmarks, train rowing, get more comfortable being on the rower, especially for long distances, and then reassess those benchmarks. So I hope this was helpful. Join us in a couple weeks, we're going to go over some more advanced rowing, how to turn the rowing machine into a skier, and then how to use the rower for adaptive purposes for adaptive athletes, or just for folks who come in the clinic, who maybe can't row because they're only able to use one leg or one arm or both, how to use a bunch of different equipment that you probably already have around the house or the clinic to get those people rowing. So hope you have a fantastic Friday. Thanks for joining us. We'll see you next time. Bye everybody. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Jennifer McArdle is the Senior Director of Futures and Advanced Concepts at CAE USA, where she focuses on applying innovative simulation technology to defense. She is also an Adjunct Senior Fellow at the Center for a New American Security in their Defense Program and Wargaming Lab, and a member of the Editorial Board and Adjunct Professor at the Joint Special Operations University. A former professor, McArdle has served on former Congressman Langevin's cyber advisory committee and as an expert member of a NATO technical group that developed cyber effects for the military alliance's campaign simulations. McArdle holds a PhD from King's College London in War Studies, is the recipient of the RADM Fred Lewis (I/ITSEC) doctoral scholarship in modeling and simulation and is a certified modeling and simulation professional (CMSP). She is a term member with the Council on Foreign Relations and was named an honorary Mad Scientistby the US Army Training and Doctrine Command.EPISODE NOTES:Follow NucleCast on Twitter at @NucleCastEmail comments and story suggestions to NucleCast@anwadeter.orgSubscribe to NucleCast podcastRate the show

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

Alan Fredendall // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Fitness Athlete division leader Alan Fredendall discusses the research, physics, clinical context, and patient input that goes into deciding if mechanics with lifting are "good" or "bad". Take a listen to the episode or read the episode transcription below. If you're looking to learn from our Clinical Management of the Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION ALAN FREDENDALL All right. Good morning, folks. Welcome to the PT on ICE Daily Show. I hope your Friday morning is off to a great start. We're here a little bit early in the garage. We're going to be talking about some double unders today. Welcome to Fitness Athlete Friday. My name is Alan. I'm happy to be your host today. Currently have the pleasure of serving as our Chief Operating Officer here at the company, as well as the Division Leader in our Fitness Athlete Division. We love Fitness Athlete Friday. We would argue it's the best day of the week. On Fitness Athlete Friday, we talk all things relevant to the CrossFit athlete, Olympic weightlifting, powerlifting, bodybuilding, anybody that's recreationally active in the gym. We also talk about our endurance athletes, whether you're running, rowing, biking, swimming, triathletes, If you have a person that's getting after on a regular basis, Fitness Athlete Friday has a topic for you. Some courses coming your way from the Fitness Athlete Division. We have a couple live courses before the end of the year as we get ready to close out 2023. This weekend, as in tomorrow and Sunday, November 4th and 5th, both Mitch Babcock and Zach Long will be on the road teaching. Mitch will be down in San Antonio, Texas, and Zach will be in Hoover, Alabama. Even though it's last minute, both of those courses still have some seats. And then your final chance to catch Fitness Athlete Live will be the weekend of December 9th and 10th. That's gonna be out in Colorado Springs, Colorado, and that will be with Mitch as well. Online from the Fitness Athlete Division, our entry-level course, Clinical Management Fitness Athlete Level 1 Online, previously called Essential Foundations. The next cohort of that class begins November 6th. We love that class. That is a great entry-level experience into all of this stuff if you have not taken it yet. We take you through the very basics, back squats, front squats, deadlifts, presses. We get into some basic gymnastics with the pull-up and introduce you to Olympic weightlifting with the overhead squat. Along the way, we have case studies relevant to athletes with those particular issues that we discuss with those movements. We talk a lot about loading and we get you introduced to basic programming, both for injured athletes and also how to recognize CrossFit style programming, strength style programming to better prepare you for those folks who want to continue on to our level two online course, previously called Advanced Concepts, who really want to drill down into programming, advanced gymnastics, advanced Olympic weightlifting, and truly become the provider of choice for athletes in their region through the clinical management fitness athlete certification. So that's what's coming your way course-wise from us in the CMFA division. WHAT ARE WE DOING WITH THE DOUBLE UNDER? Today we're going to talk about double-unders. This is personally an issue I've struggled with for a long time and probably maybe aside from pull-ups and handstand push-ups, one of the more basic movements we see in the gym that still a lot of your membership base will struggle with, maybe you personally struggle with, and I want to talk about what are we actually trying to do with the Double Wonder, some tips and tricks and cues to think inside your mind as you're going through them. I want to spend some time talking about the equipment involved in jumping rope because I think there's two sides of the equation, people with very basic equipment and people with maybe equipment that they don't need that's maybe too expensive, too advanced, And then I also just want to talk about how to begin to better practice double unders so that you can work towards achieving them and being able to complete them during a workout, in large sets, when the CrossFit Open comes up, or just in your regular workouts at the gym. So first things first, with double-unders. When I ask a lot of athletes in the gym when I'm coaching, when they say, oh my gosh, I just did five double-unders in a row, I say, great, great, what were you thinking about? And overwhelmingly, the majority of the people say, I don't know. I couldn't tell you what I was thinking about. And that strikes me as very different from a lot of stuff that we do in the gym. People usually have maybe one cue or maybe even a couple cues in their mind when they're setting up for a heavy deadlift, when they're setting up for a clean and jerk or a snatch or a handstand pushup. They often don't kick up upside down or go to max out their snatch and tell you that they had nothing going on in your brain. But something about the double under, people think it's just magic, how you learn these and how you get better at them. And unfortunately, it's not magic. Fortunately, it's just physics. So I want to talk about really at a base level, at a nerdy physics mathematical level, what are we doing with the double under? We are translating linear force. We are creating force across the lever that then transforms into rotational force where your jump rope handle meets the bearing. FIX THE SET-UP If your jump rope is nice enough to have a bearing. So a lot of times the setup, even with just the handles is wrong of looking at a jump rope. Again, it's quite a basic piece of equipment. It's got some handles. you to hang on to in a rope. Even a cheap moderate jump rope of $20 should have some sort of bearing set up so that it spins a little bit. We are trying to create force at the end of the handle that as we flip that jump rope it turns into rotation through the rope and that by doing it both hands at a time with that flicking motion we spin the jump rope. What we're not trying to do is physically spin the rope ourselves with our shoulders, right? We're trying to create rotational force through a flick. So the first thing is making sure that you are even handling your jump rope appropriately. If you are cinched down with a full grip, right where the handles meet the bearing, first of all, you can physically block the bearing if you're not careful. If you hold right here with a depth grip, that bearing cannot spin anymore, right? It's going to be extraordinarily difficult to easily create rotational force here and you're going to naturally be that person who has to spin your arms to spin the jump rope. That's exhausting. It's not a great way to do single unders and it's an even worse way to do double unders. So first things first, where are you grabbing the handle? You should be grabbing further down the handle, ideally with a loose grip, as low on the handle as you can get, right? The longer the lever, the more force amplification we have, right? The more force is going to be transferred and transformed into rotation down here versus the higher we grab up towards that bearing. So a nice loose grip, thinking about flicking, creating linear force at the bottom of the handle that creates a spinning force for me up at the bearing. So that's number one of making sure that you're even using the jump rope correctly. The next thing is making sure it's sized correctly. I always laugh when I see people in the gym who I know are taller than me, which is not very useful because most human beings are taller than me, but I know someone is a couple inches taller than me and I see them using a rope shorter than a rope I would use and I think What the heck, why are they using such a short rope? It makes sense why trying to do double unders, they're bringing their knees up to their chest and bending their knee to try to clear the rope because the rope is so short. How do we sign the jump rope? We take the jump rope, we hold both handles, we step one foot, we try to even it out as much as possible, bring it towards our body, and the length of that rope should be at our nipple or maybe a little bit higher. If it's down at our stomach, it's too short. You're gonna have to do some really unnatural jumping things, like piking your hip, or kicking your legs back, or both, just to be able to clear that short rope. Likewise, being a little bit longer is okay, but this thing up to my chin or above my head, I have a lot of slack behind me now. I'm moving a lot of extra weight I don't need to, and that's all the more drag factor on the rope that's gonna mess up my timing as I try to learn double unders. So making sure we're holding the handles in the appropriate place and making sure that we understand how to measure our jump rope. A really nice jump rope will have maybe a nut or a screw here to adjust. This is a typical, what we call a class rope. This is just a $20 rope from Rogue. You'll often see these in the wall at a gym for everybody in class to use. These can't be adjusted. They go based on your height. There should be a table or a chart or the coach should know what color you should be using based on your height, assuming that you know what your own height is, to make sure that you're using a jump rope that is long enough with maybe a little bit of extra slack, but is not extraordinarily short or long. So that's first things first, using linear force to create rotational force, making sure the rope is sized to us correctly, and making sure we're holding the handles in the right spot so that we're not hampering ourselves from creating that rotational force. SOMETIMES IT'S THE WRENCH We have a saying, with jump rope, with most things in life, it's usually not the wrench, right? It's not the equipment, it's the mechanic. But sometimes it is the wrench. A lot of folks start trying double-unders with maybe the class rope they have, and I think that's a great place to start. Now the issue is a lot of folks will start trying double-unders, they'll look at people in the gym who are really great at double-unders, and not recognize that that person probably started with the class rope, and they'll immediately go out and buy a $200 competitive CrossFit game speed rope. There's a couple issues with the wrench itself of making sure you have the right wrench. We've already talked about length. A really nice jump rope, again, will have a way to adjust the length that you can undo a screw or a nut and make it longer or shorter and get it really dialed in. These ropes, again, are a fixed length but making sure the length is exactly correct. The next thing that most people don't consider is that this jump rope has some weight. Yes, the handles have weight, but that's going to be relatively fixed based on the brand that you have. So not considering the weight of the handles, what is the weight of this rope? This is a class rope. This is about 2.5 ounces or so, which I would call a medium weight rope. When we are doing jump rope, In learning double-unders, the best thing you can do is use a rope that's a little bit heavier. null: Why? Two reasons. SPEAKER_01: When you spin a heavier rope, you can hear it slapping on the ground in the gym, even over the loud music. That helps your brain learn the timing. A heavier rope also forces you to develop wrist speed. When we're doing double-unders, it's not about how fast you jump, it's about wrists. And a really light rope doesn't force you to learn that speed because it costs you almost no energy to go through that movement pattern. So for a lot of folks, they're trying to purchase the most lightweight rope ever, and I'm going to show you some different ropes here in a second, when in reality they should probably be working with a heavier rope. Again, this is a class rope. This is maybe two and a half to three and a half ounces, somewhere in the middle. What's going to help a lot of folks Smartgear brand rope. You can buy this from Rogue or from RX Smartgear directly. You can see just by looking at these two ropes, significantly thicker, right? This is a 4.1 ounce rope. The handles are different. Yes, they spin a little bit better. They have a little bit better hand grips. You can see here different spots to put your thumb along the handle. But most importantly, the cable is heavier. This is going to teach hand speed, this is going to build up endurance with the double under, and it's also both the sound and the feeling of this rope is going to help learn timing a lot better for our jump rope. So making sure that we have the right rope. Again, almost everyone trying to get good at double unders immediately goes and buys the $200 speed rope, when in reality they should probably buy this. Now the nice thing about these ropes, as you can see, I'll bring it up really close, is this is just a keychain type carabiner. When I'm ready for a lighter rope, the most expensive part of a jump rope are the handles. The cable is usually cheap or sometimes even free if it gets frayed. If you fray your actual rope, you can email Rogue, you can email RxSmart here, they'll send you a new cable that you can reattach to your handles and you can use the same handles forever. So as you get better, you can detach, put a lighter cable on, make it easier and more energy efficient as you actually start to string together double-unders. But early on, you're going to want a heavier rope, something around four ounces. That's the biggest recommendation I can make to folks who are trying to learn double-unders, and especially to those folks who have 19 different speed ropes at home. They've got a second mortgage on their house full of jump ropes just to pay for them all. and they're going lighter, lighter, lighter, thinking they need a lighter rope, a faster rope, lighter handles, diamond grip handles, when in reality they just need a heavier cable. So when in doubt, go heavier. Again, four ounce rope compared to maybe a two and a half or three ounce rope. Once you can start to turn over bigger sets of double unders, 25, 30, 50, you're able to start doing them in workouts, your efficiency, your endurance with them improves, now you're ready for a cable itself is basically non-existent. This is aircraft grade aluminum. This is about eight tenths of an ounce. So almost 500% lighter than that heavy rope I just showed you. This weighs almost nothing. It is very hard to feel when you jump rope with this cable and it's very hard to hear as well, especially if you're in a CrossFit style gym in the middle of workout with loud music playing. What's different about this besides the cable weight? The handles are so much nicer. They are diamond grip. My thumbs can lock on. I can hold very low on the rope. Again, I want to have as much time for that force to build up and transfer along the length of the handle as I can. I can hold just my index finger and my thumb and really develop that flicking motion. What's also very nice is look at the spin on this handle. right? That thing spins forever. Very, very, very efficient for large sets of double-unders, but only once you can actually do them. So this is kind of the in-stage progression of somebody who looks at a workout that has a couple rounds of 30 or 50 or maybe even 100 double-unders and says, no problem, I got These ropes are about $200. And again, the most expensive part arguably is the handle. If the cable frays, you can replace it. But a very, very, very high quality jump rope intended for folks who have already learned how to do big sets of double unders, ideally using a heavier, cheaper rope. So that is what we would call a speed rope. So that's the wrench. BUT IT'S USUALLY THE MECHANIC Now let's talk about the mechanics. because there are a lot of things we can do, a lot of cues we can give that can very quickly make double unders a lot better. The first thing is understanding, again, in a double under, what changes is my hand speed. Jump, spin, spin, jump, spin, spin. It is a double spin of the rope. It is not an increase in my jump rate. A lot of folks, off the ball of their foot. Because in a single-under, we're only clearing the rope once, we can get away with a very small jump and just clear that rope once. We see a lot of boxers do this. You see a lot of people in the gym who have jumped rope a lot in the past do this with single-unders. They can crank out 150 single-unders in one minute with that very fast, low jump. That's not gonna cut it for a double-under. Why? The rope has to pass twice. A lot of athletes in the gym will ask me, I have no problem getting it over the first time, but it gets caught the second time. The answer is yes. The rope has to come back around again twice and you have to be in the air the whole time. That's why it's called a double under. You're trapping the rope on the second time through, which is why you're not getting your double under. How and why are we trapping the rope? Most commonly, is we do not increase our jump height, we just now try to jump even faster. All we're gonna do there is trap the second pass of the rope that much more quickly. We're just getting more efficient at bad double-unders. We need to consider a smaller, taller, slower jump. We should practice single-unders on the ball of our foot, and we should practice a little bit taller jump, but not try to pick up our legs not jump speed. If you correspondingly increase your jump speed, you're going to trip because you're now trying to basically get in rhythm and jump twice for two rope swings. That doesn't make sense. Keep your jump speed the same. Stay tall, vertical on the ball of your foot, and jump a little bit higher. Practice single-unders that way. When you can begin to turn over 50 or 100 single-unders like that, now you know you have the jump height, the jump speed, to be able to begin to turn over double unders. Remember, wrist speed, not jump speed, and stay on the ball of your foot. A lot of folks will do some really dramatic stuff to get that rope over twice, and they will land on their heel. Again, the rope has to pass twice. If you land on your heel, there is no physical way that rope can pass under your foot for its second time through. You're going to track the rope underneath your foot. So small, short, sorry, tall, vertical jump. PRACTICING & DRILLING DOUBLE-UNDERS Make sure we're practicing wrist speed. A penguin drill is a great drill to give people, to have them practice maybe what's a new jump height and cadence for them. And at the top of their jump, have them slap their thighs twice to imitate the double flick of the jump rope. You'll find a lot of athletes who think they should be able to do double-unders, struggle a lot with that drill. They're used to that short, very fast jump cadence for single-unders. Asking them to slow down and jump a little bit higher wrecks them. It also messes them up mentally when now they have to focus on actually doing something with their hands. You'll find they're probably not as ready for double-unders as they thought they were. So double-unders, not magic, just physics. We are creating force across a lever, the handle of the jump rope. We're holding it as low as possible. We're trying to create rotational force where the rope meets the handle at the bearing. We're holding it as low with as loose of a grip as we can. We're thinking about flicking the wrist, not spinning the shoulders. Sometimes it is the wrench. Make sure the rope is the correct length. Make sure newer athletes who are beginning to experiment with double unders use a heavier rope, something three, four, maybe five ounces, and that we reserve those speed ropes for once we're actually able to string together bigger sets of double unders with a heavier rope. PROGRESSIVELY OVERLOADING DOUBLE UNDERS The final thing is how to progress these. A lot of folks want to be able to do more unbroken sets, Can you just practice more sets of double unders? Yes. The key thing though is that we practice that. We don't try to do it in the middle of the workout under an extreme amount of cardiovascular fatigue and that we consider double unders no different than a back squat or a clean and jerk or a deadlift. That we take principles of progressive overload and we carry it over to our body weight, cardiovascular stuff, especially higher scale, like double unders. How do we do that? Things like a Zeus Rope. or a drag rope are great. A drag rope is literally climbing rope with handles. It has, you can see the same handles as some of the other jump ropes I've shown you. The only difference now, there is no handle spin. The only way I'm going to rotate this rope is by being really aggressive and really fast with my hands. This is a nine ounce, I guess you'd call it cable. Again, it's technically just a length of climbing rope. This is nine ounces. So this is 900% heavier than the speed rope. So if I want to get better at double unders where I can look at a workout that has a couple rounds of maybe a hundred double unders and it has some other stuff in there too that's also going to make me tired from a cardiovascular perspective, how do I know when that workout shows up that I can blast through those with my speed rope? Well, when I go back and take class workouts that maybe have small sets of double unders 20 or 30 at a time, I bring my drag rope to class. And I do smaller sets with a heavier, slower rope that continues to progressively overload my double-unders so that when big sets do show up in different workouts, I can handle those no problem with my speed rope. So it takes practice, intentional practice. Folks are always disappointed that they don't magically learn double-unders 18 minutes into a 20-minute AMRAP. That's not how it works. Sometimes it does, but it usually doesn't. Practicing this stuff at home with a cheap jump rope from Rogue that's 20 bucks, practicing 10 minutes a couple times a week is really going to go a long way. I always tell folks when they're practicing double-unders the same way I tell them when they're practicing things like pull-ups. When you're learning to kip, when you're learning that motion, forget about getting your head over the bar. Just learn the rhythm. That's the most important thing you can do. I say the same thing to folks who are going to be going home and practicing double-unders. Don't focus on actually getting the double under. Focus on doing the mechanics correctly. Use a timer so that you're not just in your garage for an hour and you're breaking stuff because you're so frustrated or the neighbors are worried because you threw your jump rope into the street. Set a timer, do as many as you can, and then take a break for two minutes and do a couple sets of that. Make sure that you aren't treating it as a workout, but that you're treating it as practice and that you use different methods once you actually can do double unders. to continue to progressively overload your double unders. So double unders, not magic, physics, make sure your wrench is set up, but make sure your mechanics are dialed in as well. And make sure if you want to get better at these, that you actually spend diligent time to practice and make sure that it's actually practiced and it doesn't turn into a second workout that day. I hope this was helpful. I hope you have a fantastic Friday. If you're going to be at a live course this weekend, we have 10 of them going on, I believe. So I hope you have a fantastic weekend. We'll see you all next time. Bye everybody. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. 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Dr. Dustin Jones // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult division leader Dustin Jones discusses the difference between sarcopenia (the loss of muscle mass) and potentiapenia (the loss of muscular power). Dustin reminds listeners that performing functional outcome measures & then creating a treatment plan based on functional deficits uncovered during assessment is the most important thing in ensuring patients receive the individualized care they need: "Assess, don't assume." Dustin also discusses the utility of using functional outcomes to assess & track progress so that insurers like Medicare will continue to pay for treatment. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 - DUSTIN JONES All right, welcome y'all. This is the PT on ICE Daily Show brought to you by the Institute of Clinical Excellence. My name is Dustin Jones, one of the lead faculty within the older adult division as we call MMOA. We're going to talk today about a really interesting topic. We're going to name the enemy and that is potentiopenia. We're going to name the enemy particularly when we're working with older adults and that is potentiopenia. This is brought to you by a listener question, a commentary that they wrote and I want to dive into the topic of power, strength, Sarcopenia as well. What should we really be focusing on? How can we screen? Before we get into the goods, I want to mention about some upcoming MMOA live courses. MMOA live is a part of the cert MMOA curriculum. Part of that curriculum is a live course. Also our MMOA level one online course, which was formerly called MMOA essential foundations. And then MMOA Level 2, which was formerly called Advanced Concepts. You complete all three, you get your cert MMOA. We have three upcoming weekends where you can go to that live course. We're gonna have Annapolis, Maryland and Central South Carolina. This upcoming weekend, November 11th, we're gonna be in Wappinger's Falls, New York. And then right before Thanksgiving, November 18th, that weekend, we're gonna be in Westmont, Illinois. So if you are looking to get some Con Ed before the end of the year, be sure to check us out. PTOnIce.com is where you can find all that. POTENTIAPENIA All right, so naming the enemy, potentiopenia. So this is a term you probably have never heard about because it's not been coined, it's not been researched, it's not been agreed upon in literature. This is a word that was made up by Dr. Ronald Michalak. So Dr. Michalak is an orthopedic surgeon that's been practicing for roughly 20 plus years that has quitting his surgical practice to go back and pursue his PhD in Rehabilitation Science. Dr. Michalak is an avid listener to the PT on ICE Daily Show, so I want to take the time to shout out to him, but also for all of y'all that listen to this show that aren't our typical physical therapy crowd, right? The OTs, the speech-language pathologists, the other healthcare providers. I know we have some PAs, some NPs in here, but we're really grateful for y'all tuning in because we're starting to see we have a fitness-forward army clinicians that are trying to solve the same problems. This is one example. So Dr. Mitchell like you know 20 plus years doing orthopedic surgery you start to see some patterns right? You start to see the issues with focusing on the tissue, right? Of focusing on, oh, that bone-on-bone, we should probably just go ahead and replace that whole joint, and that will solve all your problems, right? There's some issues to that, that when we focus so much on the anatomy, the structure, that we apply surgical interventions to non-surgical problems, that creates issues, right? And so over his career, he started to see, man, the biggest issue is not the quote-unquote bone-on-bone, it's the fact that these folks are deconditioned, they're weak, they're not able to do the things that they want to do and it leaves them susceptible to some of these medical situations that I'm often performing surgery on. What can I do to prevent them from even having surgery? And so we started to dig into the research and science and what he has come to the conclusion of is we are really missing the boat to where we're focusing on the wrong things and what we need to focus on particularly with this population is their lack of power. hence the term potentiopenia, the lack of muscular power. So, I want to give some context for this discussion because I think it's really interesting of how much progress has been made in this area, particularly in geriatrics and geriatric rehabilitation. SARCOPENIA So, sarcopenia, you've heard us talk about this so many times on the PT on ICE Daily Show. If you've taken any of the MMOA courses, you've heard this term. Sarcopenia was first coined in 1989 by Dr. Rosenberg, and at the time, the definition, the accepted definition of sarcopenia was age-related loss of muscle mass. That we thought, oh man, these folks are losing muscle mass, therefore, they are losing their strength, they are losing their ability to do what they need to do. This is a big issue. It's age-related, but we may be able to do something about it. As this was studied more and more, and just this whole concept, was being critically you know thought about that the term of sarcopenia or the definition of sarcopenia was missing a little bit right because you can have someone that is losing muscle mass but may still be really strong or you may have someone that does have a good bit of muscle mass that is rather weak or they're not able to produce their force quickly aka they have low power So, in 2008, Dr. Clark really started to push against this definition of sarcopenia and say, hey, this isn't the issue. The issue is the lack of strength, the age-related loss of muscular strength. And he coined the term dynopenia. That was a back and forth, back and forth. And now in terms of the term of sarcopenia, what we're seeing is that it's starting to incorporate some of the things that Dr. Clark really was pushing for. And now you're often going to see sarcopenia defined as the age-related loss of muscle mass and strength. That's what we speak to in the MMA course. And so a lot of the screens that you're seeing of being able to identify folks that have sarcopenia are mass related screens of actually measuring muscle mass and having cutoffs based on certain age groups and so on and so forth. But then there's also functional measures, right? Gait speed is one, grip strength is another one, the SPPB, the short physical performance battery test can indicate that someone is at risk of sarcopenia. Sarcopenia has changed a ton over the past few decades. Now, what's interesting is that the amount of research, which is so massive in this particular topic, that we have really good evidence to show, man, if this person scores below one meter per second, for example, on the gait speed, that this individual is at risk of sarcopenia, also a host of negative health outcomes. It's very predictive. We have a lot of data to show that poor performance on some of these outcome measures is a big issue and very predictive and warrants medical treatment or physical therapy, if you will, or occupational therapy, some of these rehabilitation-based services. Now, here's the issue. Here's what I think Dr. Michalak is going towards, is a lot of these screens that have been used to say, hey, this person has sarcopenia, age-related muscle mass and strength, that these screens may not actually be measuring what we think, right? If you think about gait speed, normal gait speed, for example, is that a measure of strength? Not really, right? Is it a measure of, let's say, power, the ability to produce that strength quickly? Potentially, right? Definitely, if it's a fast gait speed, or if we're looking at gait speed reserve, the difference between max gait speed and normal gait speed. Think about the 30 second sit to stand test, where we're standing up and sitting down 30 times. Is that a measure of strength? You can make a strong argument that, no, not necessarily, but it's more of a measure of how people can use that strength quickly to perform that transfer. Same thing could be said for the five times sit to stand. And so these outcome measures that are often tied to quote-unquote sarcopenia, the age-related loss of muscle mass and strength, isn't really measuring that. We can say that those tests are very predictive of some of these negative health outcomes. That's not what we're talking about. What we're talking about is do these tests actually measure, indicate what they're saying that they measure, right? Now, here's the, I think the important part about this is that if I am performing a five-time sit-to-stand test or a 30-second sit-to-stand test and think that, oh, this indicates that this person has impaired lower extremity strength and I focus on strength-based interventions, right, I'm just worried about getting them stronger, not necessarily trying to help them get stronger, produce force quicker, aka power. THE NEGLECT OF POWER-BASED TRAINING And so what Dr. Michalak is really proposing is that our focus on age-related loss of muscle mass and strength, the focus on strength has resulted in the neglect of power-based training. We need to really think differently about these terms and ultimately what they result in. I think we should have a new term, potentiapenia. That was his argument. This is all in a beautiful commentary that I loved reading that I'm going to link in the notes. So here's our take on this. I agree that… we have really dropped the ball on power-based training, right? That we often neglect that in this population for many reasons. One is just we haven't named the enemy as one. Two is that we often have ageist assumptions about what people can handle, right? That, oh, that's too intense for them or they will get hurt. It's not as well studied as strength-based training. There's a lot of reasons that go into that, but I do agree that we have really dropped the ball there. A new term, creating a new term, and everything that's associated with that, I don't know if that's the answer, but I do think we need to continue to be critical of the term sarcopenia and what that actually represents. It's already changed to age-related loss of muscle mass and strength, which is lovely, and I would love to see that conversation continue to include power as well. Clinically, here's what I think is really important for us when we think about some of these deficits that folks are undergoing and we're throwing around some of these terms. STRENGTH VS. POWER TRAINING I think the big thing that needs to be focused is we're diving into the weeds of strength versus power and you know reps and sets and volume and all that type of stuff that when first one is when we're working with individuals that are relatively sedentary or inactive and Movement is king. I don't care what they do. The fact that they are moving is ultimately important, right? We got to get people moving first and we need to be less picky of what that looks like, especially with sedentary and active individuals. That's the first thing. The second thing is we need to really think about our assessments and challenge our assumptions with this. This is why in our courses we always say assessments over assumptions. It's very easy for us as clinicians, when you're doing an assessment, you're doing the five-time sit-to-stand test, 30-second sit-to-stand test, to assume, oh, this person needs to do more lower extremity-based strength training, right? That's a very common thing for us to correlate. Now, that test may not be and probably isn't testing pure strength, right? There's other ways to do that. One rep max testing, estimated one rep max testing. We can use dynamometry as well. There's other methods to test strength. These functional and very practical outcome measures may be more a testament to someone's power ability. So when we use these tests, particularly the 30 seconds sit to stand, five times sit to stand, I think is a great example. that we need to be thinking probably about strength training, but we also need to be thinking about power training. Can they produce that force quickly? Because it ultimately is an indicator of power, the ability to produce that force quickly and do that transfer. So what your outcome measures tell you, we need to be very careful of how that informs the intervention, right? And ultimately what we're often going to find, I think this is not an or conversation, strength training or power training, in the realm of ice, you will hear this so often, it is and not or, right? Probably both, strength and power, we can do both. In reality, when we do get people stronger, you often see, especially in folks that are untrained, you are gonna see an improvement in power production. You could do specific power training, where you're doing force movements quickly, you're probably using lighter loads, and you're probably gonna see an improvement in strength, right? That's gonna happen with a lot of untrained individuals. But I think in the context of rehab, in the context especially of One Rep Max Living, that we probably want to do both. Heavy loads are really good. Heavy loads provide an amazing stimulus to promote muscle mass, our strength, but also the strength of our bones, also our soft tissue remodeling. It makes us more resilient individuals. But fast loads are really good too, right? They give us that type 2 muscle fiber stimulation to prevent some of that preferential decline. in those fibers. That quick speed is so practical for so many things that we do in the real world and also in high-risk situations. It's an and conversation. We want to do both. Now, Dr. Mitchell, I had two specific questions that I also wanted to hit on. Could referrals be written or phrased better from the physician end to encourage PTs to try to help get these individuals moving toward fitness? Now, I want everyone to listen here, and by and large, the PT on ICE Daily shows largely physical therapists, physical therapy assistants. Think about what this physician just asked. This physician is basically saying, where are my fitness forward clinicians, right? Where are my fitness forward clinicians? Where are the people that I can trust with my patients? I love this question. I think from our angle, from kind of the rehab fitness side of things, Let it be known. What are you about? Lock arms, lock shields with us, the ICE tribe, the ones that are really pushing this fitness forward message because there are healthcare providers looking for you. Now, Dr. Mitchell, from the physician's standpoint, I do think it is helpful to make it clear as a physician that you have that fitness forward approach. And oftentimes, we don't see that on referrals, right? It's the diagnosis and treat, which you love as a PT, to be honest, but if you do run a 30 second sit to stand and acknowledge that it is under or below a particular cutoff let it be known and let it be known what you are thinking about that it is a potential loss of power production potential right and let the PT do the job of assessing to determine is this a bigger power issue or a bigger issue of just producing force of strength. FUNCTION-FORWARD HEALTHCARE PROVIDERS But let it be known, I love it whenever I see another healthcare provider perform some type of screen, like a 30 second sit to stand, a timed up and go is another one, that tells me that this is a function focused healthcare provider. And we're speaking the same language, especially when we're coming from the MLA tribe. We speak function, we speak that fitness forward mindset, include some of that information and that's really going to get the point across particularly to the fitness for clinicians. I would also say Dr. Michalak is go to PTOnIce.com, look at the find an ice clinician map and build relationships with that person that is local. The second question that he asked was, are there any insights into Medicare billing or reimbursement that would allow them to do so and actually get paid for their expertise? So the question here is mainly looking at, he's interacted with some PTs where he sent the referral that was not pain based, where these clinicians said, I can't get this covered, right? I treat pain, I get paid to treat pain. That is not correct, right? So you can definitely get reimbursed to have the fitness forward approach when you use appropriate outcome measures. When you can demonstrate medical necessity through the performance of these validated outcome measures that we cover extensively in our MMOA level one online course, and a little bit as well in our MOA live course, when we're using those outcome measures to demonstrate, hey, this person has a score, which based on the literature is showing that they are at a higher risk of whatever, negative health outcome, usually it's a fall, that that warrants your services. It is medically necessary. So we can have fitness-forward physical therapy. This is what we often see in the context of home health. We treat more function than pain in the context of home health. Outpatient, not so much. It's more of a pain driver, but you can still have a fitness-forward approach in the context of outpatient. These outcome measures are absolutely key because they demonstrate medical necessity. Multiple outcome measures I should say great conversation. So what I want y'all to do if you like this topic I want you to come to Instagram and I'm gonna drop a couple links. You could also send me a direct message At Dustin Jones dot DPT and I'll send you the links as well because it's a really great conversation. I think by and large Yes, we need to get people stronger We're already really pushing forward with that and I love that but we may need to take it to the next level of power based training In terms of a new name, potentiopenia, I don't know. I'll let the really smart people debate that and discuss that, but I'm going to keep pushing the message that we need to build people's resilience. We need to end one rep max living and really show that people may be quote unquote old, but not weak. Also that they may be quote unquote old and not slow. Y'all have a good rest of your Wednesday. I'll talk to you soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Christina Prevett // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult division leader Christina Prevett discusses that the fountain of function is muscle mass and estrogen in the aging female. Christina breaks down these two areas for function, and what we have physical therapist can do to help encourage both muscle mass and estrogen preservation. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 - CHRISTINA PREVETT Hello, everybody, and welcome to the PT on Ice Daily Show. My name is Christina Prevett. I am one of the team within our Modern Management of the Older Adult Division. In our division, we have three courses in our geriatric curriculum. We have our eight-week online Essential Foundations course. We have our eight-week online Advanced Concepts course. And we have our two-day live course. We have a couple of courses that are left in the remainder of the year. We have a course coming up in November in Chandler, North Carolina. We have another course coming up in South Carolina. And we have a course coming up in Texas in December. So if you are near those courses or you are looking to get in some content before the end of the year, I encourage you to check those courses out. and you'll be able to get in with some of our faculty before, you know, we ring in 2024. 01:18 - THE FOUNTAIN OF FUNCTION Today I'm going to talk about the fountain of function. And so this is a reframe that I think is really important. And we're going to talk about what those fountains of function are. You'll notice that I did not say fountain of youth. We have this idea in our society that youth is the goal, to not feel like we're getting older in any way, to not show signs of age on our faces. And don't get me wrong, I see my aging face, I was like, oh, my face doesn't look like I am 21 anymore, and I look at the wrinkles on my face, and I have those emotions. But the idea for my life is not to try and get younger. It's to try and optimize my reserve and try and live the way that I want to live with the most amount of function possible into my 30s and 40s and 50s and 60s and hopefully all the way up to 100. Because at MMA and within ice in general, Aging is a privilege. It is something that I am very thankful for because the alternative is not that great. We're not gonna be able to reverse back time, but we can have a really successful aging process, especially when we put in the steps to live the way that we want to live, whatever that filter means for us. So I'm not looking for the fountain of youth. I am looking for the fountain of function. And so the two types, the two areas that are the fountain of function in aging women, so I'm going to talk about female anatomy, is muscle mass and estrogen. And these two things, especially when taken together and optimized to the best of our capacity, is going to allow us to have more function towards the end of our life. So let's talk about muscle mass. You have not been following the Institute of Clinical Excellence in any ways if you don't know that LODE is our love language across all of our division, across all of our faculty, and that is absolutely true in the geriatric curriculum as well. And I love it so much that I did an entire PhD on the influence of resistance training in an aging body. When we look at resistance training, we are accumulating a growth and a continuation, a plethora of education and research that looks at the impact of resistance training on health outcomes. And I just posted a paper that was a narrative review from Stu Phillips, who is one of my committee members on my PhD. 04:18 - THE COMING OF AGE OF RESISTANCE TRAINING And he talked about the coming of age of resistance training and how we are starting to see some accumulation of evidence that is mirroring and is just as strong as literature that we're seeing in aerobic training to prevent stave off different chronic diseases, including some cardiovascular diseases. And so there means that there, as of course, we're going to target the aerobic system. This is not to say to not do cardio in stead, just do resistance training, but it's showing that there is a continual and persistent growth of literature talking about the impact of resistance training on health outcomes. So what we see is that those who have more muscle mass tend to have lower all-cause mortality. They are less likely to develop cardiovascular conditions. They are better able to manage diabetes. They're less likely to get diabetes. We know that muscle mass is protective around things like osteoporosis, right? Tensile strength of the bone is important and we need impact, body weight movements, resistance training across the lifespan in order to optimize that. We see that individuals who are stronger or less likely to have sarcopenia, right? Sarcopenia is clinically relevant amounts of muscular weakness that are preventing a person from completing their day-to-day tasks. It's a totally important output of frailty. Fried's physical phenotype of frailty talks about physical reserve and physical capacity as an output of individuals seeing these constellations and signs and symptoms that lead to vulnerability to external stress. That external stress includes things like hospitalizations and being able to withstand different stressors with respect to immune system insults, including things like COVID-19, pneumonia, and the flu that allows individuals, while they are sick, to have that reserve and resiliency to lean back on in order for individuals to be able to get back to baseline or improve past baseline, post-hospitalization, or acute insult. All this to say, we know that individuals need to be trying optimize their muscle mass in their earlier life and then hold on to it for as long as possible. If you are in a setting where you are not working with individuals who have optimized their muscular mass, we also know that muscular mass can be developed and we can see improvements in physical function with resistance training at any age when we start including in our 90s. The mechanism at which strength develops is a little bit different. We're looking a lot more at neuromuscular efficiency. However, we can absolutely see that it can improve function. And so whether you are 30 or you are 85, muscle mass is a fountain of function and it allows us to withstand stress. 12:24 - ESTROGEN FUNCTION & MENOPAUSE  Now let's kind of talk about this second piece, which is estrogen. I've done several podcasts on menopause, but I want to talk about the influence of estrogen around female physiology, because I think this is really important. So when we are going through the menopausal transition, on average, individuals will start menopause between 50 and 51. Definition of menopause is when you've gone a full calendar year, 12 months without a menstrual period. That is your menopausal transition. But individuals can be experiencing perimenopausal symptoms that are indicators of dwindling or are coming down of estrogen status for up to 10 years prior to the transition into menopause. And so individuals who are in their early 40s can start to see the influences of loss of estrogen on their body. And then that influence is persistent as individuals get older. When we're talking about menopause, we often are putting this into two camps. So we have vasomotor symptoms, which are these symptoms that occur because of an acute withdrawal of estrogen. These are things like night sweats and hot flashes. As individuals transition through menopause and we get into our later life, into our 60s, 70s, 80s, and beyond, those symptoms tend to decline. So those vasomotor symptoms that occur as our body transitions to reductions in estrogen status they tend to go down as our body gets used to this new state of equilibrium that occurs without estrogen. In the opposite direction, the second kind of camp that we speak about when individuals are going through menopause is genitourinary syndrome of menopause or GSM. And that is signs and symptoms across the female physiology that are responding to losses in estrogen. and anywhere where there is an estrogen receptor within our body, they are going to experience changes when individuals transition through menopause. And we oftentimes will, in the pelvic health space, talk about changes to our reproductive anatomy, which are unbelievably relevant, but we have to also extrapolate that out and talk about different areas where estrogen is influencing female physiology and how, if you are working with an aging female, they are experiencing changes because of that change in estrogen status. And so within the reproductive track, we see that there is changes in ligamentous stability around the pelvis. And I hate that word stability, but it's a change in the turnover of the way that our ligaments are restructuring. So we have a little bit more ligamentous breakdown than buildup, right? That turnover rate is different. And so we have this shift between static support in the pelvis to the requirements or dynamic support around the pelvic floor. We see that individuals start to have vaginal atrophy. We see that the vaginal microbiome starts to change. We don't have the same cervical mucus secretion. And so things like chafing and redness can be more prevalent in a person who is postmenopausal. We can see fusing of the labia minora and majora. and this can lead to increased risks for pelvic floor dysfunction. So when we are in estrogen low states, rates for pelvic floor dysfunction go up. This includes anal incontinence, urinary incontinence, pelvic organ prolapse, dyspnea, or painful punitive intercourse, and other aspects of the reproductive tract. We also see, because of this change in the vulvar anatomy, that we have an increased risk for things like urinary tract infections, that increased risk for urinary tract infection also influences individual's physical function. We know that recurrent UTIs can be a cause of changes in cognitive status for our aging females. And so something that is extremely relevant for our aging women. Other things that we see is that as individuals go into an estrogen depleted state, increased risk of cardiovascular disease goes up. Individuals as they transition through menopause, we see that in general, men tend to be more impacted by cardiovascular disease. That is shifting for a lot of different reasons, but that risk profile increases when individuals are in an estrogen depleted state. We see a change in central adiposity where weight starts to increase. Adiposity accumulation can increase, especially visceral fat accumulation, which has a risk profile in and of itself for different chronic diseases. And then we see, for example, in our bone microarchitecture that the influence of estrogen allows for continual bone regeneration and that profile again starts to switch and there's an increased risk for things like osteoporosis in an estrogen deficient state. So there's a lot of things that get impacted, right? Our skin gets impacted, our breast tissue gets impacted, our urinary tract, all of our mucosal membranes, not just in our vulva, but across our entire body, and this has impacts. And so when we are thinking about working with these individuals, one of the things that is starting to become really recommended is topical estrogens. And there's a lot of debate about this because of a study that had been done a little while ago that looked at increased risk for sex-related cancers, breast cancer, endometrial cancer, cervical cancer, et cetera, with systemic estrogen. However, what we are starting to see now and many of our menopausal experts like Dr. Mary Claire and Dr. Rachel Rubin are really trying to have this public health approach to medicine saying that we are not doing our females a service when we are saying that there is a risk profile when subsequent studies have not been able to substantiate or replicate those findings. And so there's been a big shift in the last five years to the need for or the desire for many women who are really suffering with genital urinary syndrome of menopause to be able to take things like topical estrogens in order to really significantly reduce their symptom burden. And I'm not just talking about their pelvic floor, which is an extremely important part of their sexual health, also a vital sign of aging, but also, you know, all of these other physiological signs of estrogen deficiency that are impacting our outcomes, right? We see that individuals with that combination of muscular mass, we are seeing individuals with negative consequences of osteoporotic fracture. if we were able to be preventative in this approach where we are talking about estrogen supplementation when these symptoms start to arise, especially when they hit a threshold of bother, where there's going to be this spectrum, some individuals are very bothered and very impacted by the signs of vasomotor symptoms and genital urinary syndrome of menopause, and then some individuals are not, but for those individuals with bother, is this something that should be taken? Is this something that they can talk to their physician about? Is there this literature to support these topical estrogens? And we are starting to see this mounting of evidence that is starting to come up to help individuals in the aging process. So many of our aging adults are being told that this is just what they should be living with. This is because they're going through menopause. Deal. We saw this in the peripartum space where there's a lot of advocacy still happening with respect to not having this thought process that as soon as you have a baby that pelvic floor dysfunction is just something that you should live with. We're starting to see this rise up in our perimenopausal and postmenopausal population, where they are not accepting that this is what they should be doing. They're not being dismissed anymore for these symptoms, and it's super important. When we take this lifespan approach, this education becomes extremely relevant. Talking about the peripartum space, I truly believe that that is where we start to tell females that they are not resilient, that they are somehow fragile, that they need to be concerned for their organs falling out and all these different pelvic floor dysfunctions. And then they are not encouraged to be as resilient as they could be by taking part in heavy resistance training or impact activities or things at higher intensities. We start bringing that intensity down and the idea of, ooh, be careful or, oh, monitor this or, oh, if you have these symptoms, it's time for you to stop participating in those activities. We are seeing this shift and what this shift is going to do earlier in life is it's going to set up are aging individuals with this mindset that pelvic floor dysfunction one is not inevitable two that reserve is protective when it comes to muscular reserve and three they're going to be advocates for their own health and that includes their hormonal health and that includes not accepting that some of these symptoms of menopause are things that they just need to live with, but things that can be medically managed. Genital urinary syndrome of menopause is a syndrome condition. It is a medical diagnosis, and therefore it is something that we can be treating. As physical therapists, us being educators and conduits of that knowledge translation is extremely important. And then we are going to optimize function for these individuals. Last point that I'm going to make, because I ended up being a lot more long-winded than I thought I was going to be, is that we are now seeing this interaction between menopause, genital urinary syndromes, and long-term health outcomes. We are seeing that individuals with higher physical activity, combination, aerobic resistance, or both, are having a much lower GSM burden than those who are not. And so again, it comes back full circle, whether this health promotion is extremely important, that not only are we gonna optimize a person's muscular reserve, we're gonna make that fountain of function be extremely relevant, but we're also going to make the quality of that function a lot better because their quality of life is better because we are not allowing them to just live with these symptoms and be dismissed by our medical system, us included, that just expects this to be the way that it is. And so this advocacy piece is extremely important and it's something that we are going to be screaming from the rooftops. All right, everyone, I hope you have a wonderful week. I'm going to be diving a lot more onto my page and I'm going to be collaborating it with ICE and MMOA around hormone therapies for individuals with GSM. I am not a medical physician, so I encourage you to reach out to your urogynecologist and urologist in your area. Get that relationship with them so that you can start having these conversations and we can start talking about risk profiles. All right, have a wonderful week. If you are not on our MMOA digest, I encourage you to sign up for those newsletters. Otherwise, have a wonderful week and I will talk to you all again soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult faculty member Julie Brauer emphasizes the importance of executing obstacle courses in a specific, dynamic, objective, and progressive manner. The purpose of these obstacle courses is to prepare patients for the chaos of their daily lives and help them confidently overcome these challenges. To make obstacle courses specific, Julie suggests replicating the functional demands of the patient's specific goals. This means creating exercises and challenges that directly mimic the movements and tasks the patient needs to perform in their daily life. By doing so, the patient can develop the skills and confidence necessary to navigate these challenges effectively. In addition to being specific, obstacle courses should also be dynamic. This involves incorporating a combination of exercises and layering dynamic challenges. By introducing variability and unpredictability into the obstacle course, patients can improve their ability to adapt and respond to different situations. This dynamic nature of the obstacle course helps simulate real-life scenarios and prepares patients for the unexpected. Objectivity is another crucial aspect of executing obstacle courses effectively. Julie suggests leveraging subjective and objective outcome measures to make the obstacle course objective. This means using measurable criteria to assess the patient's progress and performance. By having clear and measurable goals, both the therapist and the patient can track improvement and make necessary adjustments to the obstacle course. Lastly, obstacle courses should be progressive. This involves gradually increasing the difficulty and complexity of the challenges as the patient improves. Progression ensures that patients are continually challenged and can continue to develop their skills and abilities. It also helps to keep the obstacle course engaging and motivating for the patient. Overall, executing obstacle courses in a specific, dynamic, objective, and progressive way is essential for helping patients develop the confidence and competence to effectively navigate the challenges in their daily lives. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 - JULIE BRAUER Welcome to the Geri on Ice segment of the PT on Ice daily show. My name is Julie Brauer. I am a member of the Older Adult Division, and we are going to be talking this morning about obstacle courses and leveling up our dynamic gait training. So I've been really passionate about creating meaningful obstacle courses for a really long time, and I've become even more excited about this topic since our live course has gotten this massive revamp where we spend an entire lab focusing on dynamic gait challenges and how to layer. So I'm so excited to dive into this today because obstacle courses can be a really challenging, fun, creative way to implement dynamic gait training into our plans of care. With the purpose of preparing our patients for the chaos that is their daily lives, right? We want them to be able to move confidently through the chaos of their lives. And if we really think about it, What better exercise could we give our patients than a combination of exercises, a combination and layering of dynamic challenges that exactly replicate the functional demands of their specific goal, right? However, I think we many times really missed the mark here on executing this in an effective way. And when I say executing in an effective way, I mean in a way that is specific and dynamic, objective and progressive. So when I reflect back on the past eight years of my practice, 02:37 OBSTACLE COURSE LIMITATIONS When I think about all the obstacle courses that I have seen throughout various settings, most of them are variations of stepping over cones, or stepping over hurdles, or many times it's stepping over canes. Many times it's one rep, the patient goes through that obstacle course forwards, and then the next time they go through it sideways. Many times it's weaving around cones as well as stepping over them or maybe stepping in and out of an agility ladder. And when we think about that, we have to realize it's pretty unidimensional, right? It doesn't exactly look like real life. Most of these patients are not on a clock. We aren't often capturing our PE while the patient is going through the obstacle course, right? Like I could go on and on about a list of things that are wrong with our typical obstacle courses that we see in our clinics, in our profession. And while stepping over cones and navigating around them is a really solid place to start, we really have to start thinking about moving beyond that, right? I consider stepping over cones and navigating around cones very similarly to our other underdosed exercise. I will go as far as to say that I think that cone stepping is the ankle pump of dynamic gait training. Stepping over cones is the ankle pump of dynamic gait training. And so why? So let's unpack that. Because many of you would probably say, like, what do you mean stepping over cones is challenging for my patients? And I'm going to respond with, well, yeah, I mean, tandem standing is challenging for a lot of my patients, but I'm sure as hell not going to waste multiple weeks of a plan of care with my patient in tandem stance, right? The question becomes, is it the right challenge? Is it the right challenge? Similarly to tandem stance, Do the demands of stepping over cones match the entirety of the chaos and the dynamic demands that comprise our patients' lives? We have to realize that stepping over cones only hits one aspect of dynamic gait and balance, right? It only hits on anticipatory balance. And we know that balance can break down in multiple different areas. And there's so many other components of balance and dynamic gait that we want to pay attention to. we have to realize that stepping over cones is not super specific, right? It doesn't look like real life. Our older adults are not moving around in an environment where these very bright orange cones are sticking out to alert them they need to step over that thing, right? And then also, you know, just thinking about If I am able to get my patient really competent and confident in stepping over cones or weaving around cones, does that actually translate to our patients feeling incredibly confident to take on the adventures in their world? 06:08 ROOM TO GROW WITH OBSTACLE COURSES So we have to first reflect on why there's just a lot of room to grow when it comes to our typical obstacle courses, all right? So now that we've set that framework, let's talk about how to level up our dynamic gait training from assessment to implementation and creating in dialed in workouts, focusing on how to make these obstacle courses specific, objective, dynamic, and progressive. All right. And we're going to put this in the framework of focusing on two different types of goals. And these were goals and dynamic eight challenges that students who were part of our MMOA live course a couple weeks ago in Oklahoma came up with. absolutely stellar students who came up with really awesome dynamic challenges. So I'm going to share some of these with you. So these two goals that we'll be talking about back and forth, um, that many of you can relate to with your patients are the goals of one, being able to independently navigate through the airport and board an airplane independently to be able to go on vacation. And then two, to be able to independently tend to a garden. All right. So two goals that are very common among older adults. And we'll talk about how to make it specific, dynamic, objective and progressive. All right. 10:21 SPECIFIC OUTCOME MEASURES So starting out with making our obstacle courses really specific. This is where we need to dig deep. So if you're part of our MMA crew, you hear us talk about our formula, make it meaningful, load it, dose it all the time. So this is that make it meaningful part, right? So we need to dig deep into what that goal actually looks like. I want to peel back all the onion layers. So if my patient is telling me, well, I want to be able to go on vacation. I am having my patient take me through from start to finish. I want to know exactly what that looks like for her or for him to go from getting out of that car into the airport through the airport onto the plane into into their seats right so I am asking question after question after question because I want to visualize what that goal looks like, right? If it's gardening, I want to know exactly what the functional movements are that comprise that goal because there is where I'm starting to create my obstacle course. I am in my head taking mental notes about what are all the pieces and parts that are going to comprise this obstacle course to make it very specific for the patient. Now, sometimes going seven layers deep with our patients is really, really difficult, right? They just, they have a hard time answering these questions or having that conversation with us. This is where we can leverage our outcome measures such as the PSFS or the FES and the ABC, right? Those are going to give us some insight into some components of their daily lives that are really scary or they feel like they're going to lose their balance or fall or components that they're actually really confident in. So you can use those outcome measures when perhaps the conversational part and you're asking a million questions and digging deep, is a little bit difficult for your patient. And then we want to really leverage our objective outcome measures, right? So our mini-best and our DGI, because that's going to give us very, very, very specific information. If our patient is telling us that, yeah, I'm having a difficult time because I'm afraid people are going to knock into me at the airport, well, I'm sure as heck gonna want to look at their reactive balance with their mini best, right? So we wanna use both digging deep, asking the questions, using those subjective outcome measures, and then definitely using those specific objective outcome measures to see where perhaps the balance is breaking down, right? So to give a couple of specific examples, If our patient, maybe in their PSFS, are saying that lifting that suitcase over their head is really the part that is limiting them from feeling confident and being able to go on that trip, maybe it's a strength component that we really want to focus on. So maybe I'm going to look at a press or a push press and see what that looks like in isolation and maybe coach that up, right? But then I know that I'm going to add a push press or a press into my obstacle course, because maybe it's not that the strength component of that push press is the big issue, but more that they are so fatigued after going through the entire airport that they just don't have the energy to get that suitcase up into that overhead bin, right? And so, again, to bring it back to the balance component, if they're telling us, I am so scared of getting bumped by someone at the airport, because I'm afraid it might fall, I want to know, hmm, what does their reactive balance look like? I want to look at forward. I want to look at backwards. I want to look at lateral. And then to put that into the obstacle course, maybe I can do something like our stellar students did a couple of weeks ago, where they use TRX straps. And as the patient's walking, they swing those TRX straps at spontaneous times, to see how the patient reacts to that, right? Or you could do something like as your patient is walking, you offer an external perturbation and see what their stepping strategy is. All right, so that's how to make your obstacle course as you're figuring out what the pieces and parts are very, very specific to what they're telling you and what you're finding throughout your assessments. Next, we have to talk about how to make it dynamic. And what I mean by dynamic is not just the patient is moving, right? Like, you know, I can see a lot of you being like, well, yeah, well, you know, stepping over cones or hurdles like that is dynamic. But we have to think more about just the patient moving, right? Yes, that is dynamic, but we have to remember that we need to mimic a dynamic environment, not just our patient being dynamic and our patient moving, right? And in addition to that, what I mean by dynamic is layering. 14:21 MIMICKING REAL LIFE CHALLENGES We want to combine anticipatory balance, reactive balance, vestibular fitness, strength, power. We want to combine all of those things together in our obstacle course, because that's real life. And that's when balance breaks down, when we were trying to navigate through all these different components. Remember that older adults are not waking up in the morning. And for the first two hours of their day, they're only doing a single task. And then the next two hours of their day, they're doing a dual task in reactive balance, right? Like they are constantly moving in and out of forward gate, sideways gate, making 360 degree turns, reactive balance, anticipatory balance, cognitive tasks, motor dual tasking. All that stuff is happening constantly. So we want to mimic that type of chaotic environment. We want to layer all of those challenges on. So what would that look like? Let's think about our gardening example. So if we're thinking, and our patient is telling us, okay, so I have to pull the hose, right? And I have to pull the hose and walk along the grass. And so you're thinking about this, hmm, how can I mimic that? Could I have my patient pull a rope? Could I also then have them do head turns where they're looking behind their shoulder to make sure that their hose isn't totally annihilating all of their flowers, right? You're making it that specific, but you're layering on challenges. What about for the individual who wants to go on vacation, they're really scared about stepping onto the escalator with their suitcase, right? So how do I replicate that? Can I step onto a variable terrain, like stepping onto a BOSU ball, while I'm lifting a weight or doing a suitcase deadlift, right? So now we have that sensory orientation, we're adding in that vestibular fitness, we're adding in the strength to step on and get stability on a moving object while also having the strength to lift an object. If we think about our gardening example, think about the act of pulling weeds. Maybe we're getting our patient down into a half kneel and we're doing a rowing exercise for strength. Or maybe it's more of the balance component our patient is worried about when they go to pull those weeds. So we do something like utilize squigs or we get a really heavy dumbbell and we tie a TheraBand around it and we have them pull the TheraBand and release. or we put a resistance band around them in half kneeling, and we go ahead and give them perturbations. So we layer on all different types of challenges, anticipatory, reactive, vestibular fitness, strength, power. That is how we layer. And we want to layer and layer and layer because that is what real life is like. Next, we have to find a way to make this objective, right? We have to dose it appropriately. We have to find a way to progress our obstacle courses. So we got to think about our goal, right? If we think about gardening or the airport example, if the goal is to be able to continuously move through, let's say 20 minutes, because let's say it takes 20 minutes to get through the airport. Gardening usually takes 20 minutes of time to do all those tasks. Okay, that's our long-term goal. So maybe we start out by, we want to see how many rounds you can get through when you continuously move for six minutes. That's more of the short-term goal. And we're recording how many rounds did they get through? How many breaks were required? Or if you have someone who, for example, gets to the airport really, really, really last minute, which just, like, my anxiety goes up even thinking about it, and you know they're going to be racing through the airport, maybe you want to design the workout so that that intensity is really, really high. And maybe you're doing something like three rounds of that obstacle course for time. We also want to be tracking our PE and using that to progress our goal. So if our patients, you know, capacity is really struggling, for example, you know, within three minutes of the obstacle course, it feels like an RPE of seven or eight, then maybe one of our goals is that it takes eight minutes of doing that obstacle course until that RPE of seven to eight come up. If we're focusing on balance capacity, are we using something like the balance stability scale to ensure that the variable terrain that you have mimicked, right, by perhaps having them walk on foam is enough? Or do we need to progress that by maybe underneath the foam, putting in some ankle weights or some other objects or having stepping stones to increase that balance challenge. So it actually elicits a step reaction, which maybe we saw in our mini best that we want to improve. If our patient more has a strength deficit, right? So that push press to get that suitcase in the overhead bin or the deadlift, maybe to get that mulch up from the ground or like a clean up from the ground to the shoulder and up overhead. Are we looking at our patient's estimated one rep max and making sure that we're working them at least 60% of that so that we can elicit positive strength adaptations? We have to make sure that we are dosing appropriately and that we have ways to progress this. Putting a patient on a clock is the easiest, easiest way to do it. Getting that RPE, really making what you're measuring be specific to what their goal is. And then the last part here is we can really utilize part practice of this big obstacle course to even more specifically dial in where our patient is having trouble, right? And it allows us to be very efficient because to create a big obstacle course can take a lot of space and a lot of time. So what we can do is as we're assessing and looking at this patient going through an obstacle course, we can see the pieces and parts that they have the most difficulty with. We can be asking them again from our questions and our subjective measures, like where are they having the most difficulty or where do they feel the most confident? And then we can pick out those pieces that we see and that they tell us and create like an EMOM or an AMRA. right? Making it very, very, very dialed in. So this is where I would take like three to four functional movements that comprise the goal, that comprise that entire obstacle course. So if we look at our gardening example, minute one, we, for an EMOM, we could do a sled push, or that could be a walker or resistance band, right? And we could be trying to mimic pulling that hose. Minute two, we could have our patient do some quadruped rows. So thinking about being down on the ground and doing some weed pulling or picking up different gardening tools. Minute three, we could be doing some external perturbations while they are in half kneeling. That could be mimicking pulling that weed and having to really catch themselves as they move backwards. Minute four, we could do something like a clean and press that could mimic trying to get that heavy bag of mulch from the ground up to the shoulder or up overhead. So that's how you can take your entire big obstacle course, pick out the important parts and create a workout that is much more succinct and easier to set up and doesn't require a whole bunch of space. Okay. That is what I got for you all today to come back around and wrap that up. When it comes to our dynamic gait training and creating obstacle courses, think about how you have to dig really, really deep. Leverage your subjective and objective outcome measures to focus on making your obstacle course specific, objective, dynamic, progressive, and then utilize EMOMs and AMRAPs to dial in the components that they are specifically having difficulty with. Now, talking about all this obstacle course stuff, I know it's getting some of you excited to think about dynamic gait training and all the different things you can do. You've got to come see us on the road to one of our live courses and check out our new revamp where, like I said, we spend an entire lab just on dynamic gait training and showing you all how to add in a lot of these layers. So on the road, there are tons of opportunities in October. My gosh, yes, it's October already. We will be in Virginia, California, and New Jersey. And then in November, we are in Maryland, South Carolina, New York, and Illinois. Plenty of options across the country to catch us out on the road and check out that super cool fun lab. On the flip side, our online courses, both Essential Foundations and Advanced Concepts are starting, gosh, next week. So October 11th and October 12th. Head to ptinice.com, message any of us. We'll be happy to answer any questions for you. We hope to see you on the road or online next week. Have a good day, guys. OUTRO  Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to PTOnIce.com and scroll to the bottom of the page to sign up.

Dr. Dustin Jones // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult division leader Dustin Jones discusses evidence based recommendations on shoe wear for older adults. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up, everybody? Welcome back to the PT on Ice Daily Show. Before we jump into today's episode, let's chat about Jane, our show sponsor. Jane makes the Daily Show possible and is the practice management software that so many folks here at ICE utilize. The team at Jane knows how important it is for your patients to get the care they need. And with this in mind, they've made it really easy and convenient for patients to book online. One tip that has worked well for a lot of practices is to make the booking button on your website prominent so patients can't miss it. Once clicked, they get redirected to a beautifully branded online booking site. And from there, the entire booking process only takes around two minutes. After booking an appointment, patients get access to a secure portal where they can conveniently manage their appointments and payment details, add themselves to a waitlist, opt in to text and email reminders, and fill out their intake form. If you all are curious to learn more about online booking with Jane, head over to jane.app.physicaltherapy.com. Book their one-on-one demo with a member of their team. And if you're ready to get started, make sure to use the code IcePT1MO. When you sign up is that gives you a one month grace period that gets applied to your new account. Thanks everybody. Enjoy today's show. 01:43 DUSTIN JONES Welcome folks to the PT on Ice daily show. My name is Dustin Jones and today is Wednesday where we're going to be talking about all things older adults in particular. shoe recommendations for the older adult population. Shoe wrecks, heel drop, doesn't matter, barefoot, minimal, conventional shoe, what the heck's the deal with the toe box, what in the world is a shoe last, we're gonna talk about all these things, what the evidence says, and then what we're kind of seeing out in the real world, right? Many of us are seeing in clinical practice or in the context of fitness. Before we get into the goods, just a few quick announcements. Our online MMOA Modern Management of the Older Adult courses are going to be striking up here within the next couple weeks. So Essential Foundations, that is our foundational online eight-week course, is going to be starting October 11th. And then our Advanced Concepts course is going to be starting on October 12th. That's just for folks that have taken Essential Foundations. We've got a bunch of live courses coming up through the fall across the country. The one that I really want to point your attention to is Falls Church, Virginia. That's going to be the weekend of October 7th. 02:51 SHOE RECOMMENDATIONS All right, shoe recs. This is a topic that I really enjoy digging into. I've got a decent amount of experience around shoes. I used to sell shoes right out the gate of PT school. I was working in outpatient PT clinic and then working in the first kind of barefoot style shoe store in the country. Two of his treads out of Shepherdstown, West Virginia, currently in Charlestown. And just had a lot of, made a lot of mistakes, learned a ton, met a lot of interesting folks that were in this space that were really challenging a lot of conceptions. around shoes and what is good for individuals. And I was very dogmatic at one point and I've kind of come to the middle a little bit in terms of what I perceive to be beneficial and the evidence is starting to show that as well. 03:55 THE OLDER ADULT FOOT So when we talk about recommending shoes for older adults, I think the first thing that we need to acknowledge is that the foot is different in an older adult than when you're younger, right? We see age-related changes typically in the older adult population that warrant us to really question the shoe that they're in, right? The reality with the footwear industry is that many of the shoe lasts, lasts being the shape of the foot where they basically create the shoe from. The shape of that shoe last largely mimics what you may see in a younger individual, not necessarily the common things that we will see in older adults. What do we see in older adults? Typically, you're going to see a larger circumference of their midfoot. larger circumference compared to when they were younger, you typically will see a lowering of that arch in many older adults. We often do see that the angle, the toe angles of that first and fifth toe typically do go in, which we're well aware of all the issues associated with that. And we see these changes yet 99% of the shoes out in the market are looking at a younger foot and creating the shoe around that as opposed to an older adult individual. So we need to acknowledge these changes because that is what's going to influence the current evidence-based recommendations. So what I'm going to go through is kind of what the current evidence says, the most recent systematic review looking at shoe recommendations for older adults, and then I want to dive into the whole minimal barefoot shoe versus conventional shoe debate, particularly for this population. So what do we know to be true in terms of some key characteristics of shoes that are gonna be helpful for older adults. One, and probably the biggest issue, is that it fits. I know it sounds super simple and silly, but if you check the fit of many of your patient's shoes or your client's shoes, you will see some very ill-fitting shoes. Whether it is the shoe is too big, there's a lot of wiggle room, their foot is moving a lot within that shoe, or it's the opposite, right? The shoe is way, way too tight for that individual, and that creates a whole host of issues related to skin breakdown related to performance breakdown as well. And so we want to be very aware that it fits well, all right? So that's the first thing. Next thing is that it has fixation. A shoelace system, for example, we could say Velcro as well, but laces are typically better, is that if that shoe is properly fit and it's fixated to that foot, that is going to allow them to do what they need to do when they need to do it, all right? The second thing, third thing is going to be a firm supportive heel counter. So I've got a shoe here. If you're listening on the podcast, you can come to YouTube or Instagram to see the video. So this is just a Reebok Nano. I can't remember the model of this one, but back here, you know, is a pretty solid heel counter. So it's this back portion of the shoe. And so you want this to be firm and supportive. and snug when people put this on so you don't want a ton of room around the heel with this heel counter you want to be nice and snug and that's why trying shoes on is super super important. Next thing is around a 10 millimeter heel drop and this is where some of y'all are going to say no Dustin it needs to be just a zero drop shoe Current evidence shows that 10 millimeters around that range that older adults do really well there. If you start to go above that, particularly above 15 millimeters, you see an objective change in their balance performance through different outcome measures and their postural stability as well. If you're not familiar with heel drop, it's the difference of the thickness of the heel to the forefoot. This information can be hard to find on most websites when you go to look up shoe specs. That's why you want to look up the reviews of that shoe. Typically, a running world, there's a bunch of running related sites that will do all kinds of shoe reviews and they will give you some of those specific specs. When we worked at Two Rivers Treads, we would literally get a demo product and then we would cut the shoe right down the middle and we would measure the heel drop because a lot of those numbers weren't being published. We found some really interesting things. What the trend in the heel drop realm You know, 20 years ago, it was very, very common to see heel drops north of 10. You know, you'd be going, you know, 14, 17, 18 range in a lot of running shoes in particular. And over the past 20 years, particularly the past 10 years, that that average has gone down and down and down to where it's pretty normal to see a four to five millimeter drop from the heel to the front. That was not the case 20 years ago. So that has changed tremendously in the footwear industry. So around 10, excuse me, around a 10 millimeter heel drop. Next is a firm midfoot. So when we're looking at kind of the sole that it is relatively firm, you will typically see firmness in the midfoot and the forefoot is going to, excuse me. All right now, the forefoot is going to be a little more flexible. That allows for, you know, terminal stance, that we have a lot of extension, big toe extension is a big one, but that midfoot, a kind of firm, medium thickness is a good thing for older adults. In terms of the traction, a slip resistant sole that's multi-directional and tread. There's not a lot of evidence to support, you know, super thick, aggressive tread like you would see in something like a trail shoe. but some tread that is going to allow them that slip resistance in several directions, not just anterior to posterior. The next thing that you are going to want to look at is the beveled heel and then a rocker angle. All right. So this is really important for older adults that you typically want to see around a 10 degree beveled heel. So towards the back of the shoe, when we're going towards the very back of the heel, there's kind of that upward curvature. So it's not completely flat, but there's a little upward tilt around 10 degrees is really great. This allows or decreases the amount of them kind of catching their heel, especially during that swing phase. On the other side of the shoe, the front of the shoe, we have our rocker angle. You also hear this referred to as a toe spring. Now, not the fact that there is a spring in the toe or the front of the shoe, it just references that upward slope that you will see towards the front of the shoe. around a 10 to 15 degree rocker angle or toe spring is really good for older adults. The reason being is that when you're going into that terminal stance, you need a good bit of big toe extension, right? Some more ankle dorsiflexion as well. Usually you need about 45 to 65 degrees of big toe extension. And if you don't have that or it is painful, then having that upward slope basically gives you some artificial big toe extension. It can be really helpful with walking, but particular activities that require a lot of big toe extension, think going uphill, think lunging or getting to and from the ground, that rocker angle is priceless. And then last but certainly not least, we want an anatomically shaped toe box and this has changed dramatically over the past 20 years as well that we typically saw the shoe last kind of curve inwards and now you're starting to see that wider toe box to where the widest part of the shoe is almost towards the very end of the shoe or the front of the shoe. Now don't mistake a wide toe box to be a loose fitting shoe, because you will have a little bit of room to wiggle your toes in a properly fitted toe box. But if you have good fixation, particularly around the waist or the middle of the shoe, it is not a problem to have some wiggle room in the toe box. So we're talking length, but we're also talking width as well. so that is really important so when you look at all these characteristics hopefully you're starting to say oh my gosh that's a lot to think about this is why it is so so important for two things one to have a good relationship with A local, particularly running stores are usually the best around town. If you have an awesome local running shop to where you can send your folks, they have a solid fit system and they have some solid recommendations that can meet some of these characteristics. you're going to refer your folks and they're going to be in good hands, right? But it's also important to encourage folks to not just go to Amazon, to not just go and buy the shoe online, but you need to try this on. These characteristics, but then also that shoe feeling comfortable is very, very important. All right, so those are kind of the current recommendations. That is based on a systematic review that was released in 2019. I'll drop the citation for that in particularly the Instagram post. I'll do that there. 12:39 MINIMALIST SHOES: PROS & CONS All right, now let's shift gears a little bit and let's talk about the whole minimal shoe, barefoot shoe versus conventional shoe debate. Once again, I will say I was so dogmatic about this. I was the guy that ran half of a marathon without any shoes whatsoever. And the first half I wore Vivo barefoot because we were running on gravel, right? Like I was that guy. I drank the Kool-Aid hard, um, and then learn some valuable lessons along the way. And I've changed my stance a little bit. I'd say a lot actually on this, but let's talk about some of the pros and cons of particularly older adults wearing a barefoot style shoe. The first one is, there is evidence that a barefoot style shoe, when I say a barefoot style shoe, some of the key characteristics, typically it is a zero drop shoe. What I'm holding now is a Merrell Vapor Glove. I've bought three pairs a year of these things ever since they came out back in the day. I love these shoes. So it's typically a zero drop, a very flexible sole. So if you're not watching the video, I can roll it up like so. and it typically has a wide toe box. So the widest part of the shoe is going to be towards the front. That's kind of the typical characteristics of kind of a minimal barefoot style shoe. It also has a very low stack height in terms of how high it is off of the ground. So there are a couple studies, particularly with older adults, looking at how that's influenced some different parameters. And what they found is that when they wear a barefoot style shoe compared to a conventional style shoe, is that it does improve their postural sway. How does it do this, right? So think about the somatosensory input. You get a lot more input from that system whenever there's less stuff between your foot and the ground. You also have a lower center of mass, which can be very helpful for balance. And also, without that heel slope or heel drop, it doesn't shift your center of mass anteriorly. And so based on a couple studies, postural sway was improved significantly compared to conventional shoes when wearing those minimal shoes. So less sway, less postural deviation when folks were in static and dynamic situations. 15:07 CHANGES IN WALKING GAIT The next thing is that when folks put on that barefoot style shoe, they adapt their walking gait, running gait as well, right? Like we'll have the endurance crew talk about that all day, but I'm mainly talking about older adults in particular with walking. Their ambulation parameters will typically change. What we typically see is that we see a shortened stride length, we see an increased cadence with their walking, and the big one is that they have a decreased stance time. So they're moving their feet a little bit quicker and their stance time is a little bit shorter. Now, this is really important because let's think of if you have some type of external perturbation, you lose your balance. You try that ankle strategy, that hip strategy, it ain't working. You got to do that step strategy. When you're taking short strides, you have that increased cadence. When you have a relatively lower stance time, you are much more agile and adaptive to be able to take whatever stepping strategy you want to take. That is a big one, so that is a big reason why these barefoot style shoes can be helpful for older adults. What are the cons to wearing these with these individuals? One is that there's hardly any rocker angle. If you look at the video, there's a slight upslope for these shoes, but if you wear Xero shoes, Vivo barefoots, for example, you don't see any upslope or rocker angle towards the toe. and very little support in that area. And if you have limited big toe extension, if you don't have at least 45 degrees, for example, terminal stance of your gait is gonna be pretty tough, especially if you're symptomatic at in-range big toe extension. So these rocker angles can be helpful for individuals, especially if they're on uneven terrain, going uphill, limited big toe extension, they want that rocker angle. It's helpful for them, get them in one, all right? Though also the cons are the zero drop for many individuals, that life requires some ankle dorsiflexion to navigate the world, especially if you are going uphill, stairs as well. If you don't have hardly any ankle dorsiflexion, zero drop shoes are very difficult and what ends up happening is you end up shortening your stride even more. increasing your cadence even more, and ambulation can become less efficient. What that also does, especially when you're going uphill, if you're wearing a zero-drop shoe and you have limited ankle dorsiflexion, when you're going uphill, you max out your dorsiflexion, you don't have anywhere to go, so you start to see different deviations, and you also start to see a lot of pressure on the forefoot and the ball of the foot. If you have skin breakdown issues, neuropathy for example, this could have a whole host of complications. So there's some drawbacks to having a zero drop shoe for particular individuals and we need to be very aware of that. Now with all that being said, I, this is me, Dustin, anecdotally speaking, I am definitely for most individuals to be in some type of minimal barefoot style shoe. I think by and large, for many of the things that we do throughout our lives, it's a really good thing, but there's a lot of times where you want a solid shoe, right? You want some stuff between your foot and the ground. You want some help with that big toe extension. You want some help with that ankle dorsiflexion. So when I'm thinking about recommending barefoot style shoes to older adults, I'm thinking about three main things. And this is kind of a checklist that I want you to think about. 18:28 PROTECTIVE SENSATION One, and maybe the most important one, and this is probably one of the bigger mistakes that I've made in this realm, is that they need to have protective sensation. They need to have protective sensation. You need to get your monofilament out, your Seams 1C monofilament out. Check that protective sensation because if they do not have that, I highly recommend not recommending a barefoot style shoe because you will have lots of bumps, lots of bruises, stepping on gravel, you can create some trauma, if you will, and if they don't have that protective sensation, they may not be aware, and most individuals are not regularly checking the bottom of their foot to see if they're having any issues. I learned this one the hard way. I was treating someone that had type 2 diabetes and recommended, at the time, Altra, A-L-T-R-A, made a lot of barefoot style shoes, and I recommend the Altra Atom. You can look that up. It's one of my favorite shoes and basically gave this person a foot ulcer from some of the trauma that they received over several, several days. So learn from that mistake. Number two, you want at least 45 degrees of big toe extension. That's kind of the minimum for most individuals through ambulation, particularly through that terminal stance. So 45 degrees of big toe extension and also kind of symptom-free big toe extension. A lot of folks will have painful in-range big toe extension. So you need to be aware of that. If they don't have that, then you want a shoe that has some bit of a rocker angle. And I'm not saying you go to some like maximal style shoe, but even a relatively, I wouldn't call it nano, a minimal shoe, but the stack height isn't anything crazy. The heel drops three to four millimeters from the back to the front. And it has somewhat of a rocker angle. Something like that could be helpful for individuals and not putting too much between their foot and the ground. And then last but not least, their ankle dorsiflexion. At least 10 degrees of ankle dorsiflexion. That's kind of the minimum that we're looking through throughout gait. They need more than that when they're navigating uphill, when they're trying to do squatting, for example. But that's kind of the minimum. And I'd be very clear of when they want to wear these. When they're doing activities that don't require a lot of dorsiflexion or big toe extension, rock those barefoot shoes. But if you know you're going to be getting to and from the ground a bunch, if you're going to be guarding and kneeling, if you're going to be doing a bunch of squatting and lunging, then you probably want a solid heel drop. You probably want a nice rocker angle to support some of those deficits. So, I know that's a lot. I'm going to drop all these studies that I'm referencing in the comments of the Instagram post, but I think we need to be clear that we have evidence-based recommendations for older adults. I went through them at the beginning of this. I would say they're rather somewhat outdated, especially as the evidence is starting to evolve of looking at some of these different styles of shoes. But we're starting to see some early evidence supporting a minimal or barefoot style shoe in older adults. But we can't just do a blanket recommendation. Everybody gets Vivo barefoot. Everybody gets Xero shoes. That's not the case. We need to have that checklist, protective sensation, 45 degrees of big toe extension, 10 degrees of ankle dorsiflexion, and you're probably going to put someone in a good position. All right. Thank y'all. Y'all have a lovely Wednesday. I'll talk to you soon. 21:41 OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

The Cognitive Crucible is a forum that presents different perspectives and emerging thought leadership related to the information environment. The opinions expressed by guests are their own, and do not necessarily reflect the views of or endorsement by the Information Professionals Association. During this episode, Mr. Kevin Gates discusses IPA's accomplishments over the past few years during his tenure as IPA's President. He also discusses IPA's search for his replacement. Find a link for more information about IPA's President search on IPA's homepage; applications are due no later than 15 Oct 2023. IPA will announce the new President in Dec 2023. Research Question: Kevin Gates suggests an interested student examine how strategic culture affects our approach to operating in the information environment (MISO, persuasion, deception, marketing, everything)? Resources: Cognitive Crucible Podcast Episodes Mentioned #76 Yuval Levin on the Constitution & Institutions #62 Jonathan Rauch on the Constitution of Knowledge Global Psychological Conflict by Ralph Sanders and Fred R. Brown A Psychological Warfare Casebook by Professor William E. Daugherty Cooperation and Competition Among Primitive Peoples by Margaret Mead Cocaine and Rhinestones podcast with Tyler Mahan Coe Propaganda Universe Youtube Channel Link to full show notes and resources Guest Bio: Kevin Gates is a Professional Staff Member with the Senate Armed Services Committee since March 2022, with a portfolio that includes DoD S&T programs and acquisition policy. Prior to that since December 2017, Kevin Gates was serving as the Vice President for Advanced Concepts at Strategic Analysis, Inc, a professional technology services and consulting company. In that role, he is responsible for managing a corporate division with contracts across the Navy, Defense Health Agency and Office of the Secretary of Defense. He had day-to-day responsibility for managing contracts and workforce across the division, as well as articulating and pursuing a strategy for maintaining high standards of customer service, and growth into new technology sectors and customer sets. He also provided direct client support to the Director of the Defense Laboratories & Personnel Office in USD(R&E), the Defense Science Board, and the Naval Surface Warfare Center Crane in the areas of microelectronics, spectrum warfare, hypersonics and strengthening the innovation ecosystem.  Prior to that role, he worked as a Professional Staff Member for the House Armed Services Committee since March 2007, responsible for the Information Technology (IT) and cyber operations portfolio, as well as the Science and Technology (S&T) portfolio. He previously worked for 8 years at Strategic Analysis, Inc of Arlington, Virginia for a variety of clients within the DoD science & technology community (including DARPA, ONR and the Defense Science Board), as well as the Homeland Security Advanced Research Projects Agency within DHS(S&T) and the intelligence community.  He graduated from the University of North Carolina at Chapel Hill with BAs in History and International Studies, and has a MA from Georgetown University's Security Studies Program. He is the co-author of a chapter on critical infrastructure protection in Volume III of Homeland Security: Protecting America's Targets, James Forest (ed.), 2006. He also served as an industry advisor to the Acquisition Innovation Research Center (since January 2021), a member of the Laboratories Assessment Board for the National Academy of Science (since March 2021), Engineering and Medicine, and President of the Board of Trustees for the Information Professionals Association (since December 2018), a 501(c)(6) supporting education and workforce development for the information warfare and cognitive security community. About: The Information Professionals Association (IPA) is a non-profit organization dedicated to exploring the role of information activities, such as influence and cognitive security, within the national security sector and helping to bridge the divide between operations and research. Its goal is to increase interdisciplinary collaboration between scholars and practitioners and policymakers with an interest in this domain. For more information, please contact us at communications@information-professionals.org. Or, connect directly with The Cognitive Crucible podcast host, John Bicknell, on LinkedIn. Disclosure: As an Amazon Associate, 1) IPA earns from qualifying purchases, 2) IPA gets commissions for purchases made through links in this post.

Dr. Joe Hanisko // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Fitness Athlete lead faculty Joe Hanisko stresses the need to maximize preparation and recovery for a successful competition. He emphasizes the importance of preparing for the week before the competition, the competition day itself, and even the week after the competition. Joe encourages individuals to focus on their game plan, proper nutrition (including carbs, protein, and electrolytes), fluids, and electrolytes. Additionally, He highlights the importance of keeping the body moving between events to avoid stiffness and stagnation. The ability to warm up, maintain a good heart rate, and perform at a fast 100% effort is crucial for success. On the day of the competition, Joe advises sticking to one's game plan and not letting others dictate it. He mentions that CrossFit is about being able to adapt on the fly, but it's important to trust one's strategy and see where it takes them. Joe also emphasizes the importance of nutrition during competition day, stating that eating is necessary and what one eats matters. He provides the example of an elite athlete who consumed multiple Snickers bars for fast carb and glucose intake to replenish muscles, but notes that this strategy may not be applicable to everyone. After the competition, Joe discusses the importance of the follow-up week. He suggests focusing on recovery during this time and allowing the nervous system to recover and do what it needs to do. He highlights the significance of giving oneself time to recover, as it is an important part of the overall competition process. Overall, the episode emphasizes the importance of preparation, execution, and recovery in the context of a competition. It highlights the need to have a game plan, trust one's strategy, focus on proper nutrition, and prioritize recovery to maximize success. Take a listen to the episode or read the episode transcription below. If you're looking to learn from our Clinical Management of the Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO Hey everybody, welcome to today's episode of the PT on ICE Daily Show. Before we get started with today's episode, I just want to take a moment and talk about our show's sponsor, Jane. If you don't know about Jane, Jane is an all-in-one practice management software that offers a fully integrated payment solution called Jane Payments. Although the world of payment processing can be complex, Jane Payments was built to help make things as simple as possible to help you get paid. And it's very easy to get started. Here's how you can get started. Go on over to jane.app.payments and book a one-on-one demo with a member of Jane's support team. This can give you a better sense of how Jane Payments can integrate with your practice by seeing some popular features in action. Once you know you're ready to get started, you can sign up for Jane. If you're following on the podcast, you can use the code ICEPT1MO for a one month grace period while you get settled with your new account. Once you're in your new Jane account, you can flip the switch for Jane Payments at any time. Ideally, as soon as you get started, you can take advantage of Jane's time and money saving features. It only takes a few minutes and you can start processing online payments right away. Jane's promise to you is transparent rates and unlimited support from a team that truly cares. Find out more at jane.app.physicaltherapy. Thanks, everybody. Enjoy today's episode of the PT on ICE Daily Show. 01:26 JOE HANISKO Good morning, everybody. It's PT on Ice, daily show live. It's Friday, I would say September 22nd, getting close to October already. It is Fitness Athlete Friday. I'm Joe Hanisko. I'll be your host today. One of the lead faculty of the clinical management of the Fitness Athlete crew. Today we want to chat about competition. So CrossFit competition prep 101. Just the basics. We get either personally ourselves or some of our clients who are signing up for local or online competitions and we want to make sure that we're preparing them and that they understand what their expectations are for getting into that competition. the week before, the actual date of, and then even that week after, like making sure they maximize their preparation and their recovery for a successful event, especially when really all that we typically have to see in comparison is these elite athletes who are going to be doing things similarly, but also different because of the amount of training they've put in and just the fortitude that they've built up in terms of an athlete and the resilience that they've earned in an athlete. We'll talk about that CrossFit Competition Prep 101. Before we get going, I want to make a couple of call outs to the CMFA Live agenda that's coming up for the rest of the year. Both of our Essentials and Advanced Concepts course took off online in the last week or so. So those are going to be going through until the end of the year and we'll get those going again at the beginning of 2024. But in terms of live courses, we have a handful coming up in the next few months to close out the year. So if you're looking to get into any Con Ed courses, we are going to be in California. Washington, Alabama, the state of Texas, down in Florida, New Orleans, and Colorado, all before Christmas. So from now until Christmas, we have six or seven CMFA Live courses that will be out there. So grab a seat if you're looking for that. Hop on to theptnis.com and you can find all of our courses there. All right, CrossFit Competition Prep 101. 03:45 PREPPING FOR COMPETITION WEEK  Let's talk about the week of. So you're going into this weekend of competition. What do we do that week before? I would say that at this point, We're not talking about the prior weeks and months of training. That's a whole other conversation. But at this point, whatever you've done to earn your right to sign up for this competition, you've done it, you've earned it. You can't really gain a whole lot more in one week of training, but you can lose a lot in that one week. So we want to make sure that we take that week leading into competition pretty seriously. If we're assuming maybe competition day is on Saturday, which is most common for a lot of local events, I would say that those first two to three days of that week, Monday, Tuesday, Wednesday, per se, I would focus on training as normal. Keep things consistent. If you guys have specialized programming through your gym and or you're using some sort of online platform like Mayhem, Days one, two, and three can stay pretty consistent. We don't have to change a whole lot about that. It allows us to stay moving, feel good, test some things out, and it's not until day four and day five that we really start to maybe change some things there. Day four, I would say, is a great opportunity to just take a complete rest day, figure out how the body is feeling, let things calm down. Maybe we focus on just a nice walk outside, maybe we do some mobility work and some soft tissue work to kind of prep the body but I'm cool with day four-ish in that time frame being a complete rest day if that works out into your calendar. It gives us time for the body recover for the nervous system to recover and then it gets us to day five the day before competition. I would suggest that the day before competition you don't do absolute rest. I think it's kind of nice to low level prime the body for movement especially when you're about to do something at a pretty high intensity the following day. So this could be super easy, like moderate EMOM style work, where you're doing a lot of body weight or simple movements. This could be just a zone two kind of monostructural day where we hop on the erg, sorry about that light there, hop on the erg, get some of our heart rate into that zone two level and just do a nice 20, 30, 40 minute cruise control type of workout. But I like the idea of the day before competition, moving the body and taking that rest day, maybe a day or two before competition. opposed to resting right up until that point there. So in terms of our basic agenda, days 1, 2, and 3, you can stay pretty consistent. Day 4-ish, probably 3 or 4-ish, we're going to take a complete rest day and let the body completely recover, maybe focus on soft tissue mobility. And then day 5, we want something smooth and easy, get the body feeling good. If you have any you know problem areas we're doing a little bit of accessory work to tune those up but we're not hitting a hardcore CrossFit style event the day before that competition. A couple other things that I would maybe not do in that week before is I would not go above 75 80 percent of your maximum volume in terms of load so if your programming calls for deadlifts, squats, whatever it might be, some heavy loaded exercise, no matter what, keep that in that moderate, upper moderate range there. I feel like being in that 60, 65, 70, maybe 75% range at the most gives you an opportunity to load those tissues, feel like you're getting something out of it, but also not blasting the nervous system. Our nervous system is probably one of the most undervalued parts of our recovery because it's hard to sometimes assess until you go and perform. But when the nervous system is down, our actual performance will be down as well too. And typically what drops the nervous system is high volume training and high loaded training because we only have so much of the tank to give before we need to recover. So I would avoid hitting heavy, heavy weightlifting the week of. Keep those 75-ish percent or lower. That being said, too, another thing I've seen a lot and had a lot of education on is if your event calls for some sort of weightlifting complex, like a hang snatch to overhead squat to hang snatch complex, I'm just making something up, don't go out and test that thing at max capacity over and over and over again. One of the biggest flaws that I see with our novice CrossFit athletes is that it's something new. It's like, oh, I haven't done this exact complex. I don't know exactly what it's going to feel like. Well, go and test it at that 50%, 60%, 70% maybe. but I see so many people the week or two prior doing it three or four times and what they're doing is depleting their nervous system and when it matters on that Saturday when competition is there, you may in fact lose some by having tested that so often before. So I would, I'm not saying don't trial it to see what it feels like, but I'm saying you should have a good understanding now with all the training you've done before to earn your right to be in that competition, roughly what your capabilities are, and then testing that complex at lower to moderate weights will give you a little bit of an insight to where you think you can be, but you are not going to get stronger by practicing that over and over again in a week or two before that event. So get familiar, but don't blast yourself with those complexes. Yeah, and then the other thing I was gonna say is just don't, in terms of testing, going a little farther, don't test all those workouts that you're about to do at max capacity multiple times either. I'm on board for learning, for strategizing with team, if you have a team event, I think that is great, but do those several weeks in advance. Don't go and blast your body the week of testing an event that you're probably gonna do because that's where we'll see decreased performance and potentially injury risk that will increase when we're doing that stuff there so recap of the week of the week of you're going to train as usual for the most part days one two and three Day three and or four, we're going to take a rest day and let that body completely recover. Just focus on mobility, recovery style stuff. Day five, we want to move a little bit. Lightweights, bodyweight style exercises, throw that into an EMOM format. Get yourself on a ERG machine and do some zone two monostructural work. We want to avoid max effort loads throughout the week to keep our nervous system healthy. We don't want to test everything over and over again. Save yourself for Saturday. You will not lose by not training, but you can lose by overtraining in that week before. All right, so now you're in the day of. Day of competition. This looks a little bit different to everybody, but a few little pointers that I have, some of them will be obvious, but just reminders, is that just stick to your game plan. Hopefully you've thought your process through and trust it. You know yourself as an athlete, your team hopefully has connected, or your training partners, and you know each other fairly well. Don't let other people dictate your plan. Stick to your plan. CrossFit's all about being able to adapt on the fly, which you will have to do sometimes, but don't go in constantly thinking that you have to change your strategy. Trust your strategy and see where things take you. 10:37 NUTRITION ON COMPETITION DAY  In terms of nutrition during competition day, I feel like we need to be eating. I think that's an obvious thing to say, but what we eat matters. We see people, Matt Frazier was a good example, who would just slam multiple Snickers bars in a day of competition because he was looking for fast carb glucose intake to replenish those muscles. It's actually not a terrible strategy, but we're not Matt Fraser either. There's got to be probably some moderation to that. I do believe having easily digestible carbohydrates, which may include some sugar and that's fine. A couple little gummy worms here or there, some fruit, maybe some of those protein bars or energy bars that have some carb in it, built in it. things that taste good and that are easy for you to digest are probably best. We need carbs to replenish our muscular glycogen system and just our overall metabolic system. I think getting some protein in is fair, but we don't need to heavily douse protein. We don't need to be eating like multiple burgers that will sluggishly kind of slow you down. So lean proteins, beef jerky, a little bit of pulled chicken, something like that can be a fairly easy type of protein to digest. And then I would say a third thing being fluids and electrolytes. So this is where getting salt waters of some kind, like a element for an example, or your own homemade version of that, getting that electrolyte balance into our body is crucial. You're going to be pumping fluids out, And you can get really scientific with this and weigh yourself before and after an event like some of these higher level athletes do. But I don't think that we have to be at that level. But do replenish your fluids. Be drinking water. Get some sort of electrolyte back into that system. And I think these are going to be two really crucial things in terms of adjusting fluids that are important there. Some of these sports drinks, just read the back. Get smart with these guys. Like read the back of some of these labels and you'll realize that you could make yourself a way better balanced electrolyte style drink than the marketed ones that have virtually nothing inside of them. So get online. figure out how you could dose in some table salt with some other electrolytes and just make something that is gonna help you retain fluids, especially if you're doing this in a hot, humid environment where you know you're gonna be sweating a lot. And then I think the other thing in between events is don't just sit and do absolutely nothing. Take some time, five, 10, 15, 20 minutes at the most to recover and chill, but as you're leading up into that hour before your next event, try to move. walk around, hop on a bike if they have one. This is where I will actually, in some circumstances, support things, simple things like massage guns. There is some anecdotal and potentially actual structural evidence that would say that the vibration and impulse is a good way to just kind of prep that nervous system and keep those tissues a little bit more aware of what they're about to be doing. I'm game for it. Whatever you gotta do to stay agile and feeling like you're at your best is what we need to be focusing on there. So day of, stick to your game plan, proper nutrition, including carbs and protein predominantly, and then electrolytes is big as well, fluids and electrolytes, and then find some way to keep that body moving in between events that you're not stiff, stagnant, going in. The ability to warm up, keep your heart rate at a good level, and then hit a fast 100% effort event is crucial to success. We don't wanna be going in cold. Even if you're feeling a little tired, you gotta find a way to keep that heart rate moving. 14:17 TAKING REST AFTER COMPETITION All right, final thing is our final prep, I should say follow-up week, the week after your event. So you've done your week before, you've completed your event, congratulations. Sunday, Monday, Tuesday, leading into the next week, what do we do? Be okay, I'm gonna say this again, be okay taking more than one day of rest. I have an event coming up this weekend that has for sure three main events that all are at least 18 to 20 plus minutes in domain plus five like mini events. And then if you are lucky and fortunate enough to earn your right into the championship event, that would be four main events. So four main events plus five mini events. I don't train for that. Nope, not many novice athletes do. Elite athletes, yes, they are prepping with four to six hours of training on average per day in a week. We don't do that. Not many of us are doing that. So if we are going to go out and sell our soul in this event on a weekend, be okay taking Sunday, Monday, and maybe Tuesday and doing little to no major physical activity. It doesn't mean you have to be a couch potato. Maybe you are again going for hikes, walks, little bike rides, whatever it might be. Find some enjoyable sport that you like, like golf to get out and just stay active. I'm not asking you to be lazy, but I'm asking you to respect the amount of volume that goes into some of these CrossFit events. I see a lot of people who go and smash it on Saturday and then are at the gym on Sunday working out or Monday doing a, you know, high level, uh, online programming that is consisting of two plus hours of training. to each their own at the end of the day, but it's okay, I'm giving you permission to let your body recover. At the end of the day, for me, I'm reminding myself that this is not about today and tomorrow, this is about 20, 30, and 40 years from now. I am building my fitness to be a better, older adult. So be okay taking some time off. Use the next week to just sort of assess the body. Did anything tweak? Are you sore? Are you stiff? Focus on those areas. This is where getting your clients maybe back into your clinic that following week and just prepare for that. Say, hey Johnny, I know you got an event coming up on Saturday. Why don't we make sure that we have a day to meet on that following week just so we can talk about how it went and be sure that we're doing some good recovery things and I can help you better game plan that following week as well if I can see you early on that week. So take time to assess the body. And I would suggest again, similar to the week before, keeping loads in that 75, 80% or lower before we get back on track with your normal training. Just allow again that nervous system to recover and do what it needs to do, so. Hopefully that was helpful, guys. Again, either for yourself or for clients that you're having, but I love the fact that people are dedicating themselves to fitness and that they're willing to put their body, their soul, their personalities, their mentalities, their identities on the line and go sell it on a weekend or online competition. We are training for a purpose. We have short-term goals. We can go test those out. We have long-term goals. All this is leading to that direction. So preparing yourself for that competition is really important. Executing on the day of is really important and making sure you give yourself time to recover afterwards is also important. Hopefully it's helpful. If you have any questions, comment on the videos. Otherwise, take a look online and see if you have any interest in getting into our CMFA live courses coming up across the country. They are filling up. So let's get on those and enjoy the end of our year together. I will talk to you later. Have a great weekend. 17:46 OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Jeff Moore // #LeadershipThursday // www.ptonice.com   In today's episode of the PT on ICE Daily Show, ICE CEO Jeff Moore discusses the concept of excessive humility and being overly open-minded, discussing how it can hinder individuals from taking action and being useful. While acknowledging the importance and benefits of open-mindedness in considering different perspectives and possibilities, Jeff also points out that excessive open-mindedness can render one unable to take stances or make decisions, rendering it useless. Jeff emphasizes the need to strike a balance between open-mindedness and the ability to take a stance. He cautions against being so open-minded that one loses their ability to make decisions and take action. Excessive open-mindedness, according to Jeff, can lead to a lack of direction and clarity, making it difficult to make progress or contribute effectively. Similarly, Jeff addresses the issue of excessive humility, particularly in relation to feeling inadequate to take action due to a lack of knowledge. While it is important to acknowledge and respect the limits of one's knowledge, Jeff argues that excessive humility can be detrimental. Constantly waiting for more information or certainty before taking action, they assert, can result in paralysis by analysis and prevent individuals from being useful in their professional careers. Jeff encourages individuals to have a level of humility that allows them to act even in the presence of uncertainty. Jeff highlights the importance of being willing to make choices and decisions, even if they may not always be perfect. By embracing the imperfection of action and remaining focused, individuals can gather data and fill the gaps in their knowledge. This approach allows for continuous improvement and growth while avoiding the pitfall of doing nothing. Take a listen to the podcast episode or read the full transcription below. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 JEFF MOORE Okay, team, what's up? Welcome to Thursday. Welcome back to the PT on Ice Daily Show. I am Dr. Jeff Moore, currently serving as a CEO of Ice, and always thrilled to be here on Leadership Thursday. I cannot wait to jump into this topic about choice and the need to make one. Before we do, it's Gut Check Thursday. Let's not ignore the workout. Let's talk about it. Let's take it on head on. It's a doozy. We've got five rounds for time, okay? We've got 12 handstand pushups, nine toes-to-bar in six squat cleans. Okay, it's gonna be at 155, 105, so a little bit heavier than we usually encounter our cleans in Gut Check Thursday, but the volume's a little bit lower there on that set. Five rounds of that for time, bang that out, you're probably gonna have some rest on the handstand push-ups and the heavier squat cleans. Try to keep moving steady, make sure you tag Ice Physio, hashtag Ice Train, we love tracking those videos. Get it in, it's Thursday, get the work done. All right, upcoming courses, I want to highlight CMFA Live this week. We've got Newark, California coming up. I think there's only two spots left in that course. That's with Zach Long and crew. It's going to be September 30th, October 1st, so in a couple of weeks over in California. We've got Linwood, Washington coming up October 7th, 8th, and then down in Hoover, Alabama, November 4th, 5th. So if you want to get out on the road, learn all things barbell movements, get into some basic gymnastics, talk about programming, demystify a lot of things around resistance training. That is the course you need to be in. It is, of course, part of our CMFA certification, which includes Essential Foundations, Advanced Concepts, also known as Level 1 and Level 2 on the fitness athlete side. And, of course, during that live course, you get testing in person if you want to obtain that certification. So hit that up. PTonICE.com is where all that good stuff lives. 02:16 YOU HAVE TO CHOOSE Let's talk about the topic. You have to choose. Team, it has always driven me nuts. From the very, very first entrance into my professional career, this comment or idea of more research is needed has always driven me crazy. Now, I don't mean from the actual research side. Like, I get the idea of why that statement is made, at the end of papers, like, hey, to get to a certain level of statistical significance or confidence, we have to have more data, right? Totally understand where that comes from in the research world. But the ridiculous incorporation or discussion of that into patient care has always blown my mind, right? So you see so many folks saying that, we don't know, we don't know, we don't know, as though we can't do anything. This is absurd from a patient care perspective. Like, I always imagine these people, like, are you really sitting in front of your 8 a.m. and saying, hey Lynn, I know your shoulder's really bugging you. Problem is, the jury's still a little bit out on the best rehab for this until we know, we're gonna pause here, I'm gonna have you come back. Like, are you really doing this all day, every day, every 30 minutes with a new patient? Of course not, it's absurd. To be of any use, we must decide and act in the presence of uncertainty. This is true literally everywhere in our lives. It is obviously true in patient care, right? We've got to do something for Lynn, right? We know it's not gonna be perfect, but we've gotta act with the knowledge we have and do our best. We have got to decide and act in the presence of uncertainty. And this goes so far beyond patient care. This is true in every aspect of our professional journeys and lives. We've gotta be willing to say, we've gotta be willing to choose to say, From what I've learned and experienced thus far, I currently believe X. I don't care what domain you're talking about. I don't care if you're talking about business, sports, hobbies, patient care, nothing moves forward with waiting. I was thinking about this last weekend. So for those of you who haven't followed my recent journey, I'm getting into enduro motorcycling, right? So I'm signing up for some races next year and I'm terrible at it. So this weekend I'm up in the mountains and I'm flying down this trail, moderately out of control per usual, and having to choose lines in real time, right? So you're coming up on obstacles, going relatively fast, thinking I've got to do something in real time in this moment. I have to choose. Now, knowing full well in that moment that if I was to go back to that same trail two years from now, I have no doubt that I would choose a different and by different I mean better line because I'll be better at the activity. But that does not mean right now I don't have to choose. I just have to choose, thinking with the experience that I have, what is the best way to move forward, knowing full well it isn't going to be perfect. In a couple years when I come back, I'll choose something different. This is the process. Just because you know down the road, you will know more and do better, doesn't mean right now you do nothing. not in patient care, not in business, not in sport. Yet, people are always trying to remain neutral and I want to discuss a few of the reasons why they do this and I want to challenge them a little bit. So, number one, people are often proud of themselves for being open-minded. What I would say is excessively open-minded. Being open-minded is great. Always remaining vigilant that better options are out there and keeping an eye open that you're not missing them because you're so tunnel-visioned, that's great. But being excessively open-minded to the point where You say, yeah, I'm open to that, I'm open to that, I'm open to that, I'm open to that, I'm open to everything. 06:23 “AT SOME POINT, BEING SO OPEN-MINDED IS HAVING NO MIND AT ALL” Well, at some point, being that open-minded is having no mind at all. And having no mind at all isn't useful to anybody. Being open-minded is great. Being excessively open-minded to the point where you can't take any stances is useless. And you've gotta be careful of which side of that line you're on. Number two is excessive humility about what we don't know yet. People love to say, yeah, but we aren't sure yet. We will never be sure. That's the nature of the game. So while, again, some of that humility is useful, so you're not excessively betting on something that you truly don't have the requisite data for yet, understanding that we are never gonna hit a point where we say, we are absolutely certain about this, Knowing that and owning that will allow you to act even in the presence of some level of uncertainty. So this excessive humility of, we never know enough to do anything, again, simply isn't useful. Number three. People don't wanna be seen as falling into a guru camp, and there's some good reasons for that. Looking back historically, and again, speaking to physical therapy, it's the area I know the best, there have certainly been plenty of extremists in guru camps that have led the collective astray, no doubt, but don't be one of those. You don't have to be an extremist in a camp to go in and say, hey, I think most of what's going on here is pretty useful. There's no reason you can't go into it with that frame of mind. But people are so afraid of being labeled, of being in this camp, or that camp, or that camp, that they stay, again, doing nothing. And unfortunately, doing nothing doesn't serve anybody. Number four, they don't want to step on toes. Once you say, hey, I believe this, you are naturally going to rub some people the wrong way because now you've committed a bit. You've said, I kind of looked at everything that I could and I'm going to go this direction. I think this makes the most sense. Well, other people that made other commitments are going to be rubbed the wrong way by that. If that is not happening, you are not doing anything of merit. If you are never rubbing anybody the wrong way, I can promise you, you aren't moving anything forward in a relevant fashion. So reflection point number one of this episode is are you doing that? In the past couple years, have you rubbed some folks the wrong way? I mean, give this some serious thought. Like really think, have your stances, have your actions bothered some folks? If that answer is no, you're not standing for anything. And if you're not standing for anything, you're not being useful. So just give yourself a little pause today and really think, like, am I committing enough that people who have made contrary decisions are a bit bothered by that? That should be a constant in your life. As you're working through decisions and emerging and making choices, some people aren't gonna love those, and if you aren't feeling some of that pushback, I think you're holding yourself back and trusting yourself and making commitments that actually allow you to decide and move things forward. But the number one reason is I look at folks who are forever trying to stay in this kind of neutral ground that I really feel this static posture doesn't get anybody anywhere is because they don't want to be wrong. They don't want to be wrong. They don't want to look back in two years and know the line they took on that motorcycle trail was the worst one they could have chosen. They don't want to be wrong. They're perfectionists. Team action is always imperfect. Action is always imperfect, especially in hindsight. There is not a single action you are ever gonna take that you're gonna look back with five more years of data and say that was perfect across every domain. That's never going to happen. So if you can't embrace that you're gonna be wrong, at least in some percentage, every single time you make a choice, You are forever going to be paralyzed. It will be paralysis by analysis for the rest of your professional, business, patient care career. You've got to get over that. You've got to embrace that every single action will always be looked back as imperfect, and that is a beautiful part of the process. That's what allows you, as you recognize that, to alter it, shape it, and make it better. This is the process. 10:55 “IF YOU CAN'T CHOOSE IMPERFECT ACTION, YOU CAN'T CHOOSE ACTION. PERIOD.” But if you can't choose imperfect action, you can't choose action, period. And that's a problem if you're trying to be useful as you're moving forward. Bottom line is this, the people that I've observed who have been the most useful, and of course, the most useful meaning the most successful, because these two things tend to go together. You provide a lot of value, you're useful, success follows, are always those who took really deep dives. They said, I think this makes a bunch of sense, I'm going all in. Like I'm gonna learn as much about this as I can, I'm gonna try to replicate it, I'm gonna try to leverage it, I'm gonna try to use it. But as they're doing that, they're aware and okay with acknowledging the shortcomings of that model. So that they can in real time be seeking out solutions to fill those gaps. They're learning through action, which necessarily followed decisions, choosing. You have to do anything besides nothing. You have to do anything besides nothing, because if you don't get out there and go, you can't evaluate the shortcomings, because you aren't doing anything. The people that I see that act with the most, again, it's not arrogance, it's not even confidence, it's out of necessity to act. They know they have to say, I know this isn't perfect, but I have to go anyways. Those people that are willing to be in that space, first of all, provide the most value, and absolutely learn and refine at the highest rate of speed, simply because the data's now coming back at them because they're out there. And because they're out there, it's a bit vulnerable and emotional, and you tend to learn a ton in those phases. Now, all of that being said, Your decisions should always change. This is a critical part of this conversation, right? Your decisions should always change with emerging data. If they aren't, you're just being arrogant. And now you're falling into the other side of the problem, which is not having one eye open. If your decisions aren't changing consistently, if that's not just a part of your growth and process, where you look back and say, ooh, shoot, should've done, now that I know better, I'm definitely gonna do better because that was imperfect. If you are not regularly doing that, you are also going about this process wrong, but on the other side, right? Remaining blind and over-trusting your actions. So reflection point number two of the episode is have they? In the past couple years, Have you reversed course on a couple of key philosophies, beliefs, decisions, directions? If not, I think you're erring on the other side, where you're not keeping one eye open. You think your action's perfect. You aren't aware of the imperfection and looking for the gaps. You're going in blind. This is every bit as errant, maybe even more dangerously, than the former. In this case, not only are you probably not being as useful as possible, but you're probably leading folks excessively astray by not being aware of what's emerging. So reflection point number two is are you every couple years realizing something you believe strongly had some pretty significant flaws and are you willing to incorporate emerging data to change them? Team. If you aren't willing to embrace that action's always imperfect, you're never gonna choose, decide, and move forward. If you don't do that, you can never get the data that fills the gaps of what we don't know that you're so concerned about, it's holding you back from action to begin with. Trust that your intentions are good. Remain focused. Humble in the face of everything emerging, so you're not totally just tunnel visioned in one direction. Allow that to shape your actions, but make sure that you're actually playing the game. So when you get information, you can modulate in real time, forever become better, but always stay away from the pitfall of doing nothing. 14:49 “PARALYSIS BY ANALYSIS IS THE ONLY WAY TO ENSURE YOU'RE USELESS YOUR ENTIRE PROFESSIONAL CAREER.” Paralysis by analysis is the only way to ensure you're useless your entire professional career. Do anything besides nothing, stay humble, be ever evolving, but be willing to choose. You'll be wrong. I guarantee it. Me too. Let's be wrong bravely and let's adapt in real time. You have to choose. I hope it makes sense. Hit me up with questions, comments. Thanks for being here on Leadership Thursday. PTOnIce.com where everything lives. We'll see you next week. Cheers, team. 15:28 OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Jeff Musgrave // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Jeff Musgrave discusses the book "Radical Candor" by Kim Scott as a valuable resource for improving patient care and leadership skills. Jeff highlights the book's teachings on radical candor, including its definition, common pitfalls, and practical application in patient care. Jeff emphasizes the significance of caring personally for patients and challenging them directly. Caring personally entails demonstrating genuine concern for the patient's life and goals, while challenging directly involves establishing and upholding standards and expectations that contribute to the patient's success. Jeff believes that this book is relevant to patient care and can assist clinicians in becoming better leaders for their patients. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up, everybody? Welcome back to the PT on Ice Daily Show. Before we jump into today's episode, let's chat about Jane, our show sponsor. Jane makes the Daily Show possible and is the practice management software that so many folks here at ICE utilize. The team at Jane knows how important it is for your patients to get the care they need. And with this in mind, they've made it really easy and convenient for patients to book online. One tip that has worked well for a lot of practices is to make the booking button on your website prominent so patients can't miss it. Once clicked, they get redirected to a beautifully branded online booking site. And from there, the entire booking process only takes around two minutes. After booking an appointment, patients get access to a secure portal where they can conveniently manage their appointments and payment details, add themselves to a wait list, opt in to text and email reminders, and fill out their intake form. If you all are curious to learn more about online booking with Jane, head over to jane.app.physicaltherapy.com. Book their one-on-one demo with a member of their team. And if you're ready to get started, make sure to use the code IcePT1MO. When you sign up is that gives you a one month grace period that gets applied to your new account. Thanks everybody. Enjoy today's show. 01:43 JEFF MUSGRAVE Welcome to the PT on Ice Daily Show. My name is Dr. Jeff Musgrave. I'm one of the faculty with the Institute of Clinical Excellence in the Geriatrics Division. We call modern management of the older adult. Super excited to talk to you about a book that I recently read called Radical Candor, written by Kim Scott. This is a great leadership book, but it has some direct correlation to ways that you can improve your patient care, okay? So super excited to talk about radically candid patient care with you this morning. But before we get into that, just a couple things going on in the MMOA division. If you're looking to continue on to get your MMOA cert, Our next cohort of Essential Foundations is going to be on October 4th. If you've already had Essential Foundations, you're looking to get into Advanced Concepts, you're going to want to hop in the cohort October 10th, and if you want to see us on the road, there's still some spots in Oklahoma City for this weekend. 02:55 RADICAL CANDOR IN PATIENT CARE So, this book, Radical Candor by Kim Scott, what does it have to teach us? The things we're going to cover is what is radical candor. We're going to talk about some of the ways we sometimes miss a mark. This is going to hit home for me because one of these downfalls is something that I have succumbed to time over time and have been working to improve. And then how to apply this well in patient care and some things to consider. So, what is being radically candid? What does that mean? So, Kim Scott defines this in the book as two factors. Two factors to being radically candid. You've got to care personally. You've got to care personally. I think oftentimes, if you're listening to this podcast, you're someone who cares personally, because you're trying to get better. You're trying to level up. The second piece of this, where I think oftentimes we miss a mark as clinicians, is to challenge directly. to challenge directly. And for me personally, this was something really difficult to learn is how to challenge our patients directly to hold the line. We've got to hold the standard. We've got to say, this is what it takes. and we're going to hold the line until we get there. Or we're gonna make referrals to other people, we're gonna bring in whatever parts of the medical team it takes to get you to this standard, because this is what it takes to reach your actual meaningful goal, the thing that you really want to do. So that's what radical candor is. You've got to care personally and challenge directly. Some of the ways we see this go wrong, the first bucket is the one I fell into over and over and over again, and that was ruinous empathy. So ruinous empathy is defined as you care personally, but you don't challenge directly. You care about your patients, they know you care about them, but you don't challenge them directly. They may give you a really bad rep or any effort and you just say, that's so great, that's amazing, that's exactly what I wanted. And you know in your heart of hearts, that wasn't it. You didn't hit the mark. That's not anything like what I told you to do, and we did not coach them up. We want to be really effective coaches, really effective coaches, set people up for success, and we challenge them directly. We give some room for them to struggle. So ruinous empathy is the first bucket if you miss being radically candid. That is, you care personally, but you don't challenge directly. We're congratulating every attempt, whether it's actually a progression or not. Now that being said, I will tell you one of the factors that we use, one of the principles we use when we're working with older adults is we do intentionally underdose. We do make things a little bit easier so we can hit success. So we make the challenge a little bit easier so that we can get some successful reps early on, and that is important. But over time, we ramp up that challenge pretty quickly because we don't have time to waste, particularly with older adults. If we're not getting them strong, we're going to see them decline very quickly. 04:05 RADICAL CANDOR & FEEDBACK So to circumvent that, to make sure that they can be successful and we can be honest when we're giving them that feedback, we make sure the challenge is appropriate. And sometimes we'll make it just a little bit easy at the beginning, but we very quickly ramp up so that we are directly challenging our patients because that is where they're gonna get better. So maybe you're not being ruinously empathetic, Maybe you've fallen into this other category that Kim references as obnoxious aggression. And that could represent the burned out clinician here. I've had periods in my career before I found my passion where I was doing work, too much work, not saying no, and found myself completely overwhelmed with work. where you don't care personally about this patient, you've not connected on a deep level to be empathetic to what their experience has been, but you do challenge directly. So that could look like you being obnoxiously aggressive in your feedback. Like, nope, that's not it. Nope, nope, nope, nope. Instead of just being quiet, letting those improper reps happen, we like to have people start some of these new movements that we're teaching in such a way that they're not gonna get hurt if some ugly reps happen. We can let those ugly reps happen, and then once we see a good one, we'll be like, yes, that's it. that can help you circumvent if you tend to be obnoxiously aggressive in your feedback. So that is when you don't care personally, but you do challenge directly, and there's a mismatch there. And that can do a lot of damage when we're trying to build a relationship with our patients so that they trust us. If they don't think we care about them, then they're probably not going to come very long, they're not going to take our instruction well, probably not going to be very beneficial of a therapeutic relationship with that client. So that's the basics of radical candor and how we can miss a mark by being ruinously empathetic or obnoxiously aggressive. What I want to do now is just lean into what it looks like to truly care personally for our patients. So I truly believe that you cannot give world-class care, you cannot give the best care if you don't care about your patient. If you don't know enough about your patient to know how their problem is impacting their life, you just can't do it. If you don't know how it's impacting their life, you're never gonna dig deep enough to even get a good goal. And if you don't get a good goal, you don't really know what movement to work on. To give you an example of this, say someone is having knee pain. You've got an older adult coming to you for knee pain, and you just take that at surface level. Okay, I'm just gonna figure out why your knee hurts, and I'm gonna give you exercises for your knee. But maybe you've not dug deep enough to find out why the knee hurting, why that even matters. Why does that matter to this patient in their world? What impact is this having? If that knee pain is keeping them from taking care of maybe their favorite pet. We like to talk about Fluffy a lot. A lot of our older adults have pets. And we say, okay, why does it matter that you have to get in the ground, get on the ground to take care of Fluffy? Or maybe they need to kneel down to clean the kitty litter. It's like, well, I live alone. I have no help whatsoever. And Fluffy is my only emotional connection. Fluffy's the only person in my world. I'm completely socially isolated, and if I can't take care of Fluffy, I'm gonna have to get Fluffy away. And my fear is that my only social connection, my only being that I can connect with is going to leave me, just like maybe family members that have passed away. 10:53 CARING PERSONALLY FOR PATIENTS Man, if we have dug that deep into our patient's goals to know why it's important that they get their knee better, First of all, we're going to set a better goal because their knee may feel good and they may have better manual muscle testing. But if we don't ever bridge the gap back to them being able to get in the floor or take care of Fluffy, we've not really done our job. We've not dug deep enough to even get a good goal to care for them. And if they don't know how important this is, they're not going to trust us. like they would if we dig deep enough to know that we really genuinely care. And that trust is going to allow us to do the second part very well, which is to challenge them directly. We've got to challenge them directly. So what we've got to do is set very clear expectations of what success, what it's going to take to get to success. This client may have been dealing with this problem for decades. And if we tell them, oh yeah, I can get you better, in three weeks, even though we know this problem has been coming on for decades and decades and decades. When the reality may be that we are in more of an acute setting, someone just had a fall, they're in an acute or subacute setting, and the reality is to get back to getting into and out of the floor or getting their own groceries, it may be a year-long process. And if we just tell them, oh yeah, you know, I'm gonna give you a few exercises to do and if you do those for a week or two, you're probably gonna be better. That's not it. That's not truly challenging directly. That's being ruinously empathetic. 12:01 SETTING REALISTIC EXPECTATIONS We care, but we're not setting realistic expectations. We're not challenging directly. That patient needs to know this journey is gonna take you a long time, but you can get there. The tools, the resources are out there. I'm gonna get you started on your journey. I'm gonna plant the seeds of the fitness that you actually need. to hit these big goals and I'm going to make a referral to someone who can take care of you. So if you're in a more acute setting your job is going to be planting some seeds and you're going to send them to a fitness forward clinician on the next step down the line so they can hit those big goals after you've uncovered them. So This may take one referral, maybe you're an outpatient, it may take several referrals. Maybe their medications are off, maybe they need different shoe wear, maybe they need to go to a podiatrist or an optometrist. If we dig deep enough, we do a really good job on the front end and get this information, we need to set realistic expectations of all the people that may be involved and how long it's really gonna take. Our older adults know when we're not shooting them straight. They know. When you hear, I've not been active for 40 years, and I've got a goal that requires a lot of activity and strength I've not had for 40 years, they know immediately if the goal is not realistic, and they've already lost trust with you. They may show up and get what they can, but they're not going to open themselves up to the challenge that they're really gonna need to reach their goals. So that's what I've got for you team. I think that this book by Kim Scott was very beneficial. It is a leadership book, but is very relevant in our ability to be leaders to our patients. And the two main goals here is we have got to care personally for our patients. It's got to be clear to them that we actually care about their life, that we've dug deep enough on that first visit to find out what their true meaningful goal is. And then our second job is to challenge them directly. We've got to set and maintain the standard. We've got to set realistic expectations that's actually going to lead to their success. If you've read this book, if you've got questions, comments, concerns about what I outlaid out here, I would love to discuss it. Leave me some comments. Otherwise team, have a wonderful Wednesday. We'll catch you soon. 14:29 OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.  

In this episode, Ed Frawley shares a question from the Ask Cindy database. Today's question is about a Terrier that has been working on the retrieve for the past two months and has started from the very basic. He will pick up the PVC pipe and the dowel but he won't pick up the Dumbbell. The owner wants to know what she can do to fix the habit and make him pick up the dumbbell. | Links mentioned: Training the Retrieve with Michael Ellis https://university.leerburg.com/Catalog/viewCourse/cid/72 | Advanced Concepts in Motivation https://university.leerburg.com/Catalog/viewCourse/cid/102 | Relationship Games https://university.leerburg.com/Catalog/viewCourse/cid/1

In this video, Ed Frawley shares a question from the Ask Cindy database. Today's question is about a Terrier that has been working on the retrieve for the past two months and has started from the very basic. He will pick up the PVC pipe and the dowel but he won't pick up the Dumbbell. The owner wants to know what she can do to fix the habit and make him pick up the dumbbell. ========================= Links Training the Retrieve with Michael Ellis Advanced Concepts in Motivation

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com    In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Julie Brauer discusses setting expectations with patients as a home health provider, learning when to "fire" patients in order to "hire" patients who are better able to utilize your time & services. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody, welcome back to the PT on ICE Daily Show. Before we jump into today's episode, let's chat about Jane, our show sponsor. Jane makes the Daily Show possible and is the practice management software that so many folks here at ICE utilize. The team at Jane knows how important it is for your patients to get the care they need and with this in mind, they've made it really easy and convenient for patients to book online. One tip that has worked well for a lot of practices is to make the booking button on your website prominent so patients can't miss it. Once clicked, they get redirected to a beautifully branded online booking site and from there, the entire booking process only takes around two minutes. After booking an appointment, patients get access to a secure portal where they can conveniently manage their appointments and payment details, add themselves to a waitlist, opt in to text and email reminders and fill out their intake form. If you all are curious to learn more about online booking with Jane, head over to jane.app slash physical therapy, book their one-on-one demo with a member of their team and if you're make sure to use the code ICEPT1MO when you sign up as that gives you a one-month grace period that gets applied to your new account. Thanks everybody. Enjoy today's show. 01:33 JULIE BRAUER Hello, everyone. Welcome to the Geri on ICE segment of the PT on ICE Daily Show brought to you by the Institute of Clinical Excellence. My name is Julie Brauer. I am super excited to be talking to you all this morning all about setting expectations with your patients and I'm going to focus this on the home health setting in particular. Okay, setting expectations with your patients. I think we can all agree that really successful relationships are built upon effective communication of setting expectations. Think of arguments you've had with friends or your partner, relationships you've been in. I know I've been here where when you come out on the other side, you think, man, if I just would have communicated what I wanted or if I just would have set that expectation, maybe things could have been different or you say, man, like if I knew that that's what you wanted, if I knew that that's what you expected of me, maybe things could have been a little bit different. Like I definitely can reflect on a lot of relationships I've had or arguments I've been in and that would have saved a lot of heartache if those expectations were laid out in front, if they were communicated up front. And what I think we should be doing when we are starting a plan of care with our patients is to remember that we are entering a relationship with our patients and ideally they are going to have expectations of us and we are going to have expectations of them. We should level set those expectations and we then can hold each other accountable. When we are introducing a plan of care to quote Jeff Moore from his process lecture, you are coming to a mutually agreed upon plan where you pitch optimal and then you agree on acceptable, right? Like these are ways in which that relationship can really thrive. Unfortunately, and I've been here, we get really burnt out from being in long term shitty relationships with patients. Long term shitty relationships. I know you guys have been there, right? I mean, think about it, especially in a home health situation, you get that patient on your caseload and right away you know, you're like, this patient is going to be an absolute pain. You're already thinking like, oh my God, I have to deal with this patient for eight weeks. You dread seeing them. They dread seeing you. They're not motivated. They don't follow your HEP. They don't want to be there. You don't want to be there. You kind of sandbag your treatments because this person is just sucking all of the life and joy out of you. They don't answer when you try and schedule. They cancel on you all the time. You have been so frustrated for weeks on end, but you didn't say anything to begin with. You know this relationship is going nowhere, right? You are dreading running that outcome measure at the end of your plan of care because you know that it definitely hasn't improved at all. You feel this frustration. However, we have as clinicians, we have this feeling that we don't want to upset our patients. We really prioritize just keeping the peace. We don't want our patients to fire us. We want our patients to like us so much. We want to be liked. I think a lot of times we have the pressure from our companies to show progress and we're just afraid to have those hard conversations. 07:18 ENDING RELATIONSHIPS WITH PATIENTS We're afraid to just tell our patient that this relationship isn't working. And I want you all to reflect about, you know, how much heartache and time and effort could have been saved if we level set expectations and had those hard conversations right out of the gate? How much time could have been saved if we really discovered if this person was appropriate for therapy services to begin with in the very beginning? If we discovered if we were actually a good match for our patient and our patient was a good match for us? Instead of thinking that having those hard conversations and maybe discharging that patient early as a failure, like think about the opportunity that you can create when you discharge a patient. You end that relationship instead of dragging out a plan of care for eight weeks that is going to go nowhere. I think we have to remember that like ending a relationship with the patient, discharging them, whether it's because they're not appropriate for therapy services, they're not meeting the expectation, they're not being compliant, or maybe they're just not a good match for us in particular, right? They could be a good match for a colleague, but maybe for us in particular, it just doesn't work. We have to reflect it and realize that that's okay. That doesn't mean we don't bring value as clinicians. That just means that this relationship in particular was not a good match. And that's a good thing that you can find that out early. 09:52 STARTING RELATIONSHIPS WITH PATIENTS & SETTING EXPECTATIONS So instead of thinking about discharging a patient early, ending that relationship as a failure, I want you to think about it as an opportunity because there are so many patients out there who need our services, who want our fitness forward services. We want to find those people and we are not going to be able to find those people if we are staying in bad relationships with other patients where this is just not a good match. We need to remember that we have a choice, right? We have a choice to have hard conversations, to level set expectations, and we have a choice to end that relationship. Every single patient now that I approach with my home health patients, I think, is this someone that I want to enter a relationship with? Is this person a good match for therapy services? Is this a good match between just my personality and their personality, right? I know, like, hey, if this person isn't willing to put in the work, I can go be like LeBron James and take my talents elsewhere to someone else who is rearing to put in the work and get on board with therapy. So that is the first thing that I want you all to be thinking of as you walk into your patients going forward today and the rest of the week. So I am going to give you a couple ideas of expectations and how to make sure that you are getting the right person to go with your patient. I am going to give you a couple ideas of expectations that I have set with my patients and things that I have said that have been really helpful in starting that relationship out on a good foot and knowing pretty clearly right away how this plan of care is going to go, if this is going to be someone I keep on my mind, I am going to give you a couple ideas of expectations that I have set for you. So first of all, I want you to know that you don't get into this situation where your week is in and it is not going anywhere and you are frustrated and you are getting burnt out, right? And the patient, too, on their part, they are getting frustrated. This isn't even anything that they wanted to begin with, right? These are some ways that I have kind of nipped that in the bud with my home health clients. Many times home health patients have no idea what home health is. So the very first thing, the very first conversation I am having with them in level setting in terms of expectations, what the heck is home health? What does it look like? What can they expect, right? So I am talking about things like frequency of visits in a week. I am talking about things like duration of a visit and intensity of a visit that there is one person coming in their door, not multiple. These are things that patients who are in acute care should already know. And for any of you acute care therapists who are out here listening, I mentioned this before in a previous podcast, for the love of God, please level out these expectations first and foremost so that when that home health, when that clinician, home health clinician goes to see the patient, they already know what to expect. But like I said, many times patients who are, patients in home health have no freaking clue what they are in for. Many times they are coming from, for example, acute care where they are used to two people coming in, maybe a clinician and a tech and they bring in the ultra move or they bring in big pieces of equipment. And we know in home health that is not realistic. So setting expectations like that, there is one clinician going to be coming in to see you. I don't have fancy equipment and I don't have the extra sets of hands. Setting the expectation that I'm at most going to be seeing you two times a week. However, you are going to be having other clinicians, most likely nursing, OT, maybe speech, who are coming into your home throughout the entire week. Right. We know that a home health client could have, my God, five visits in one week. That can be incredibly overwhelming for a patient. That's something that we want to tell them about right out the gate. So just setting those initial expectations of what they can expect from home health services in general can go a long way. Many times that first week patients are so overwhelmed because they didn't know that people were going to be calling them constantly. Multiple clinicians were going to be coming in the door. They're thinking that they're going to have, you know, extra sets of hands to stand them up if they're like a max assist. We need to level set that immediately. Okay. So you get like the bare minimums out of the way. What is home health? What is it going to look like? 13:23 PUNCTUALITY IN HOME HEALTH Next, I am telling them what they can expect from me. And the very first thing I start with is that I tell them I am going to be here on time. Punctuality is incredibly important. If you talk to a lot of patients who are in home health, that is, and they've had other home health services before, that is one thing that bothers them a lot. Clinicians don't show up. Clinicians show up late. They want to know that they can rely on me from a punctuality standpoint. They want to know that I'm going to show up. So I put that out there right away. I am going to be here on time. You can count on me for that. If I am going to be late, I am going to call you as soon as possible. I appreciate your flexibility, but I know that you are able to cancel our session without penalty if your schedule cannot accommodate it. So right away, I am holding myself accountable. I am wanting them to feel like they can rely on me. Then I want them to feel that I am here for them. I am going to do everything in my power to show up for them in terms of helping them get to where they want to go. I want them to feel like, whew, this person gives me hope. So I am going to say something to them like, I will do everything in my power, in my capacity to advocate for you. I'm going to meet you where you're at, and we are going to work as a team to move towards a healthier, stronger, more purposeful life. Okay? I am going to tell them, I am going to hear your concerns. I am going to actively listen. If I cannot help, if I cannot solve your problem, I will do everything in my capacity to find someone who can. I right away want them to realize that I am trying to be that resource dealer. If I cannot solve the problem, I will find someone who can. And then lastly, I am holding myself accountable again. Hey, if I am not meeting these expectations I just laid out, please bring it to my attention right away. Right out the gate, right? I am setting expectations of things that they can expect from me and I am giving them the power to hold me accountable. That is so incredibly powerful when it comes to building a strong relationship with your patient. Okay, so next, I used to really lay in about what I expect from the patient in terms of bringing this fitness forward approach. They're going to have to work really hard. They're going to be sweating, da da da da da da. And I realized that that was way too much. That was coming on too hard and heavy. I saved that conversation about really expecting them to work hard and you're going to sweat and you may be sore. I saved it. Saved it for the next visit with them. When we're really getting into loading them up and putting them through an EMOM or an AMRAP or something like that. So I wouldn't, please learn from my mistake and don't throw that out at them right away. It's too much too early. What I do lay the expectation of is my visit time and scheduling compliance. And I'm very strict about this because too many clinicians in home health get the run around. They are exhausted because their patients are late or they're late. They're with patients for too much time. They're asking to be seen at crazy times. That burns clinicians out all the time. You have to set barriers and you should be doing that day one. So what has been successful for me is that I am telling my patients that they will have a 30 minute visit time. I know that's very unorthodox for acute, I'm sorry for home health because usually you're seeing patients for various times. However, I approach it as if it's outpatient. You get 30 minutes, not any more, not any less. They expect that. And how I have made that 30 minute visit work is that I am laying the expectation that I will be following up with you on with a phone call on my drive to your home. We are going to talk about what's happened this week. We're going to get a plan in place. I have a whole podcast that I talked specifically about that that I'll put in the comments here, but I'm giving them 30 minutes so they know when I walk in that door, we got to get to work because I'm only going to be there for a 30 minute time period. The next expectation I lay is that if there are more if there are three non medical cancels, we're done. I'm discharging them. If there are three non medical cancels, right, we got to give a lot of grace to these patients. They're freaking sick. Many times they go back to the hospital. They got a lot going on, but we have to hold them accountable as well. When our patient cancels, it screws up our day. We don't get paid for that patient, right? It affects all of our other patients and our scheduling. We have to hold them accountable. So I give them three strikes and then they're out and I'm discharging them. So those are the main expectations that I am saying to them they can expect from me and the things that I am saying. This is what I expect from you. Next, when we get further into conversations about goal setting, right, I am digging into their meaningful goal. If you listen to the MMOA crew, you know that we talk about make it meaningful, load it, dose it. I want to visualize exactly what they want out of this relationship. What are they trying to reach? What is that goal? What does it look like? I want to visualize it. When we are getting into that goal setting, I am asking them a very important question that helps dictate our plan of care and gives me a lot of info. I am asking them, how long do you think it will take to reach that goal? And what do you think it's going to take to get there? That is going to tell me a whole lot of information. Is this someone who is like come to me three times a week? I will do anything. I will do all my homework. I am. I am just willing to put in as much effort as I possibly can. Or is this someone who's going to be like, you are not coming into my house more than once a week. No way. And there is no way that I'm going to do any sort of therapy after that. Right? You have to approach those two people very, very differently. It's going to dictate your plan of care. What is the frequency that you start out with? What type of HEP do you start out with? Is this somebody that you have to give one very, very simple exercise to? Or can you give them a very simple exercise? You are going to get an idea of how compliant this individual is going to be right off the bat. So you're already thinking this may not be an eight week plan of care. This person is nowhere near ready to put in the work. So I'll do my due diligence and maybe see them for the first two weeks. And then we can reevaluate the plan to see if they're going to be able to do that. So I'll do my due diligence and maybe see them for the first two weeks. And then we can reevaluate the plan to see if we're going to continue. Incredibly important question to answer that it really helps dictate your plan of care. Okay, that's it. That's all I've got for you guys to recap. Really realize that you are entering a relationship with your patient. And just like any other relationship, you get to break up with them if you want. Right? If you're able to fire you, you're able to fire your patient as well. It's a relationship that you can have control over. Next, a couple things to start level setting those expectations. First off, what exactly is home health services going to be like? Next, lay the expectation of what the patient can expect from you. You will be there on time. You are going to advocate for them. If you have not solved the problem, you are going to find someone who can. Then you are going to lay the expectation of scheduling. I will be there for 30 minutes. You can expect that I will be there on time. You are going to give them three chances of three non-medical cancels before you discharge them. Then you talk about your goal setting. You get an idea of where they are at. What are they to put in the work? That's really going to help you develop that plan of care and know what this relationship is going to look like. All right, y'all. I hope that was helpful. Go ahead. I would love to hear you all, what you think about this. Try some of these expectation level setting when you go into your patients today and for the rest of the week. I'd love to hear comments, questions, and thoughts that you have. I will leave you with courses that are coming up in the MMOA division. We are all over the globe. Not the globe. We are all over the US. In September and the fall, we are super, super busy. In September, we are on the road. We have a course here in Charlotte and Colorado this weekend. These are open courses. We have more, but some of them are private. Then we are also in Oklahoma for September and October. Our eight-week online Essential Foundations and Advanced Concepts is starting up. Then we are also in Virginia, California, and New Jersey in October. Plenty of chances to catch us on the road or hit up one of our online classes. All right, guys. Have a wonderful rest of your Wednesday. 23:47 OUTRO Hey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review. Be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CUs from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up. Thanks for watching.

Brandon Stewart, CEO at Nereus Systems is our feature interview this week, interviewed by Frank Victory. News from Teriyaki Madness, DISH, Echostar, Ball Corp, Blazy Susan, Ping Identity, Coalfire, and a lot more. Support us on Patreon! Fun swag available - all proceeds will directly support the Colorado = Security infrastructure. Come join us on the new Colorado = Security Slack channel to meet old and new friends. Sign up for our mailing list on the main site to receive weekly updates - https://www.colorado-security.com/. If you have any questions or comments, or any organizations or events we should highlight, contact Alex and Robb at info@colorado-security.com This week's news: Join the Colorado = Security Slack channel Denver-based fast-casual chain rolls out new tech to be 'faster than a drive thru' Here's what execs say will come from a Dish Network, EchoStar merger Behind the deal: Here's why Ball Corp.'s CEO says it sold off its aerospace business 134 Colorado companies rank among the fastest-growing in America, according to Inc. As VC funding slows in Colorado and the West, it's rising elsewhere Colorado receives $1M grant to allay cyberattacks and threats Pikes Peak Small Business Development Center, National Cybersecurity Center, and University of Colorado Colorado Springs Unite to Drive Impactful Cybersecurity Initiatives with $927,236 Grant - National Cybersecurity Center Thoma Bravo Merges ForgeRock with Ping Identity How Fortune 500s are building brand value by communicating security posture Twelve Planning Tips to Avoid Complications with the SEC's Cybersecurity Disclosure Rules: Part II Job Openings: Ibotta - Director, Compliance RingCentral - Director, Security Programs Western Union - Senior Manager, Information Security Holland & Hart - Information Security Manager Astroscale - Security Manager/FSO Charles Schwab - Information Technology Asset Manager Risk Governance Flexential - IT Security and Compliance Analyst Quantinuum - Senior Cybersecurity Engineer Krayden - Cybersecurity Analyst Modivcare - IT Governance Analyst Upcoming Events: This Week and Next: ISSA Denver - September Chapter Meetings (DTC and Downtown) - 9/13 ISACA Denver - September Chapter Meeting: Getting Started in Blue Teaming & Advanced Concepts and Testing Strategies for Auditing SAP - 9/14 CSA Colorado - September Chapter Meeting: The API Security Landscape and what we are seeing in the field - 9/19 SecureWorld Denver - 9/19 Let's Talk Software Security - Operating Models for Modern Software Security - 9/21 ISC2 Pikes Peak - September Meeting - 9/27 ISA Automation and Leadership Conference - 10/4-6 ISACA Denver - ISACA CommunIty Day 2023 : Denver Parks: Preparing Wash Park for Fall/Winter - 10/7 View our events page for a full list of upcoming events * Thanks to CJ Adams for our intro and exit! If you need any voiceover work, you can contact him here at carrrladams@gmail.com. Check out his other voice work here. * Intro and exit song: "The Language of Blame" by The Agrarians is licensed under CC BY 2.0

Dr. Dustin Jones // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult Division Leader Dustin Jones discusses recent changes to the Modern Management of the Older Adult Division and its mission to help clinicians provide the best possible care to older adults in their community as the provider of choice. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO   What's up everybody, welcome back to the PT on ICE Daily Show. Before we jump into today's episode, let's chat about Jane, our show sponsor. Jane makes the Daily Show possible and is the practice management software that so many folks here at ICE utilize. The team at Jane knows how important it is for your patients to get the care they need and with this in mind, they've made it really easy and convenient for patients to book online. One tip that has worked well for a lot of practices is to make the booking button on your website prominent so patients can't miss it. Once clicked, they get redirected to a beautifully branded online booking site and from there, the entire booking process only takes around two minutes. After booking an appointment, patients get access to a secure portal where they can conveniently manage their appointments and payment details, add themselves to a waitlist, opt in to text and email reminders and fill out their intake form. If you all are curious to learn more about online booking with Jane, head over to jane.app slash physical therapy, book their one-on-one demo with a member of their team and if you're make sure to use the code ICEPT1MO when you sign up as that gives you a one-month grace period that gets applied to your new account. Thanks everybody. Enjoy today's show. 01:33 DUSTIN JONES We are live on Instagram. We are live on YouTube. Welcome to the PT on ICE Daily Show brought to you by the Institute of Clinical Excellence. My name is Dustin Jones, one of the faculty members within the older adult division. This is Older Adult Wednesday. Today we are going to be talking about what is MMOA? What is this division? What are we about and what are we trying to achieve? We are going to spend some time diving into this because we have so many new folks that are new to the ICE community. We want to make sure that you're crystal clear on what MMOA is about and if you'd want to join forces with us. Before we go into the goods, I want to mention a few courses we have. We have a few live courses coming up in the next couple of weeks. We're going to be in Southern California this upcoming weekend with Alex Germano. I'm going to be in Windsor, Colorado outside of Fort Collins on the 9th, so the weekend after Labor Day. I believe Julie Brower is going to be down in Fort Mill, South Carolina, so you can catch MMOA live on the road the next couple of weeks. 02:43 MODERN MANAGEMENT OF THE OLDER ADULT What is MMOA? Modern Management of the Older Adult. Our division, we just went through our big live revamp, so our MMOA live course is all new material and we're spending a lot of time reflecting on what we are about as a division. What are our goals? What is our mission? How can we get to that mission and what traits do we want our MMOA team to really demonstrate? I want to share this publicly just so you all are very clear of what we're about, so our goals and where we're headed and to propose that you join forces with us to achieve that mission of really changing the game for physical therapists, occupational therapists, fitness professionals that are working with older adults. So MMOA, Modern Management of the Older Adult, it really grew out of a big problem that we still see that we're still fighting. That older adults by and large in our society are underserved in so many areas, but in the context of rehabilitation, in the context of fitness as well, that most individuals, most professionals that are working with older adults will look at a date of birth. They'll look at medical diagnoses. They'll look at the medications that they're on and make assumptions about what that person is able to do. And when those assumptions don't line up with reality, we have a very, very unfortunate situation where people are not being served appropriately. They're being underdosed. They're being handled with kid gloves and we're not getting the results with these folks, the life changing results with these folks that we can get. That is a huge issue that pains every single MMOA faculty to see and we are on mission to try and solve that problem. How do we solve that problem? It is you. It is you that is watching this on Instagram, on YouTube, that is listening to this on the podcast. It is you, the rehab or fitness professional that has, we believe, has the most qualified skills to influence this population compared to any other healthcare provider. And we mean that. When we look at the research of how we can really influence older adults, it continually points back to that fitness forward approach. That exercise, that movement is such a big lever that we can pull to change these people's And you all watching and listening to this are the best professionals in the context of healthcare to administer this to this population that we love so dearly. Another big problem that we see that we're trying to solve is we have so many clinicians, so many fitness professionals, especially coming up in their training that they think, man, I want to work with the athletes. I want to work with the sports teams. I want to do the fun, sexy outpatient ortho clinic. And we go through our training and our training talks about a lot of things, but by and large, not a lot about older adults and how to best serve these individuals. And then we get out into the real world and what happens? You wanted to work with the sports team. You wanted to work with athletes, you know, from 8 a.m. to 5 p.m. or whatever. And who are you working with? By and large, on average, over half of your all's caseload, everybody watching this or listening to this, over half of your caseload is likely someone that is on Medicare, someone that is over 65 years old. And are you equipped to serve that person? And what happens when you're not equipped and yet you have these folks as the majority of your caseload, there becomes a big mismatch, right? It can be frustrating. It can be challenging and could lead to a lack of fulfillment and enjoyment in your work. And we're trying to absolutely crush that, to show you, the clinician, the fitness professional, of the life-changing impact you can have on these folks. When you use your skill set and you embrace that old-not-weak mindset, that you give interventions that actually meet that person where they're at to drive change, that it can be some of the most fulfilling work that you can do in the context of rehab and fitness, that you can change someone's life in a matter of weeks in certain situations with this population. And that has really driven a lot of the MMOA faculty. And we just want to spread that and share that just far and wide, as much as we can through many different means. So those are the big problems. The solution that we are trying to provide is we're trying to create an army. We're trying to create a community of like-minded clinicians that are locking shields to really fight ageism, to fight the under-dosage in our profession, and to show people what is possible when we serve these folks with an evidence-informed, fitness-forward approach. We do that through many different avenues. We'll do that through this podcast that you're watching or listening to, the PT on Ice Daily Show. We also have an MMOA podcast that's specifically older adult material. We have a Facebook group of about 5,000 clinicians from across the world that serves as a resource for so many individuals in terms of certain research cases. So much good conversation is going on in that group. We have our MMOA Digest. It's a bi-weekly email where we're sending out all the relevant information related to geriatrics. And then we have our courses, our certification. 07:49 CERT-MMOA Cert MMOA. This is the certification that is our promise to clinicians. That if you go through our certifications, three courses, MMOA Live, our two online courses, Essential Foundations and Advanced Concepts, that you will confidently be able to serve that person, that older adult that walks through your door, or you walk into their home, or you walk into their hospital room. It's also a promise that when you see those letters behind someone's name, you can trust them. Our goal is that cert MMOA means I am 100% confident that my mother, that my father, that my grandmother could go to you and you are going to deliver an evidence informed and a fitness forward approach to my family member. That is what we're trying to do, selfishly trying to do to ensure that that cert MMOA holds some weight and you've got the goods. And so there's a group of 10 individuals from across the country that are working towards trying to solve these problems and providing the solution through those different means. We absolutely love what we do and it is such an honor to serve you all and to interact with all the students when we're out on the weekends and live courses and the online courses as well. And this team, this team of 10 all-stars of folks that really embrace that old not weak mindset that have been through our curriculum are spreading this information far and wide to try and equip you, the rehab and fitness professional, to better serve your older adult patients or clients. And each member is going to demonstrate three main traits. We call this our DNA. And what we're going to do over the course of the next couple of weeks on our MMOA channel or Instagram account, we're going to go live and really dive into what these DNA traits are and the specifics of them and how we may see that play out whenever you come to a live course, whenever you interact with us online as well in essential foundations or advanced concepts. These three DNA traits that we're all going to embody is that we're all leaders. Regardless of your role on the team, we're all leading someone and there are certain characteristics and traits of leaders that we embody. We're also teachers. We understand this material, but we're also methodical in how we relay that information to our students so you can use that come Monday. And then last but not least, we're performers. We are performing. We're trying to entertain you so to continue to engage and learn. And whenever we're having fun and you're having fun, we know learning goes up across the board. You will never come to an MMOA course and see someone read off of a PowerPoint presentation for three straight hours while you're sitting in your butt getting a pressure ulcer. That ain't happening, right? We're going to have fun. We're going to get the music cranking. We're going to be moving. It's going to be an absolute blast. So over the next couple of weeks, we're going to dive in. What does it mean to be a leader? What does it mean to be a teacher? What does it mean to be a performer? And how are you going to see that within the MMOA division? So tune in there. We'll be posting over there, but I just want to take this opportunity just with all the folks on here now, I just want to say a big thank you. We've had a lot of change as a division, a lot of growth as well. We're interacting with so many of you all in person on Instagram, you know, in our courses as well. And it is an absolute honor to get to do this, to get to share our passion with you all through these means. And you all just really fill our cup up. When you share, when you execute, you know, that particular tip or intervention, or you just share, man, I got to use this on Monday after this course, that makes it all worth it for us. So we're just incredibly grateful for you. All right. If you have any thoughts on that, or if you've experienced some of this in our course, we'd love to hear in the comments, but just wanted to share this, put it out into the world, and we're going to continue to break down our DNA leaders, teachers, performers over on the MMOA account. We're grateful for y'all. You have a lovely rest of your Wednesday. Talk to you soon. 11:46 Outro Hey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CUs from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

In this episode, Ed Frawley shares a question from the Ask Cindy database. Today's question is about a 15 month old Parson Russell Terrier is very possessive when he has a ball, frisbee, or tug. The owner wants to make sure what things she can do to fix this behavior. | Links mentioned: Basic Dog Obedience https://university.leerburg.com/Catalog/viewCourse/cid/5 | Intermediate Dog Obedience https://university.leerburg.com/Catalog/viewCourse/cid/81 | The Power of Playing Tug with Your Dog https://university.leerburg.com/Catalog/viewCourse/cid/88 | Advanced Concepts in Motivation https://university.leerburg.com/Catalog/viewCourse/cid/102 | Relationship Games https://university.leerburg.com/Catalog/viewCourse/cid/1 | Leerburg Foam Ball with Leather Strap https://leerburg.com/foamball-strap.php | Leerburg Foam Ball with BioThane Strap https://leerburg.com/foam-ball.php

Dr. Kelly Benfey // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Fitness Athlete faculty member Kelly Benfey discusses her experience competing at the 2023 CrossFit Games, the role of rehabilitation providers in competitive sport, and the capacity of the human body for exercise as it ages. Take a listen to the episode or read the episode transcription below. If you're looking to learn from our Clinical Management of the Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody? Before we get rolling, I'd love to share a bit about Jane, the practice management software that we love and use here at ICE who are also our show sponsor. Jane knows that collecting new patient info, their consent and signatures can be a time consuming process, but with their automated forms, it does not have to be. With Jane, you can assign intake forms to specific treatments or practitioners, and Jane takes care of sending the correct form out to your patients. Save even more time by requesting a credit card on file through your intake forms with the help of Jane Payments, their integrated PCI compliant payment solution. Conveniently, Jane will actually prompt your patients to fill out their intake form 24 hours before their appointment if they have not done so already. If you're looking to streamline your intake form collection, head over to jane.app slash physical therapy, book a one-on-one demo with a member of the Jane team. They'll be able to show you the features I just mentioned and answer any other questions you may have. Don't forget, if you do sign up, use the code ICEPT1MO for a one month grace period applied to your new account. Thanks everybody, enjoy the show. 01:33 KELLY BENFEY Good morning and welcome to the PT on ICE Daily Show. It's Fitness Athlete Friday and my name is Kelly Benfey. I just wrapped up an amazing CrossFit season where I got to compete at the CrossFit Games. And so what we're going to get to talk about this Fitness Athlete Friday is going to be a couple takeaways from the CrossFit Games that I think are relevant in the rehab space. Before we jump into that, though, within our Fitness Athlete crew, we have a couple of online courses coming up that I just want to bring to your attention. So we just wrapped up an awesome cohort with our clinical management of the Fitness Athlete Essential Foundations course online. And so our next course is going to be kicking off in a few weeks on September 11th. That course always fills up. So if you're thinking about it, please jump in with us, grab your spot right now. And then if you've already taken that and you're looking to continue developing your skill set, our Advanced Concepts course that's only offered two times a year is also starting September 17th. So rarer opportunity to hop in on that one. So if you've been looking to take this course, that's going to get started quite soon. And then we have a handful of live courses for the remainder of the year. So all of that information is going to be on PTice.com, PTonice.com. So we hope to catch you live on the road. I'd love to see you all. So we'll be getting back on the road for the remainder of this year to finish strong. So let's get into our topic. Of course, I could talk about this stuff all day if you know me. So we're talking CrossFit Games takeaways. A couple of things that I experienced and found were relevant in the rehab space. This is Fitness Athlete Friday, so we get to geek out on all things, CrossFit Games, CrossFit competition, all that good stuff. So number one, I have five different things that we'll kind of work through. 03:35 HUMAN CAPABILITY So number one, I always leave the CrossFit Games feeling absolutely motivated and inspired by what the human is actually capable of doing. So I really it was it was just such an honor to be on the same field as some of these amazing, amazing athletes, be behind the scenes and all that good stuff. So a couple highlights that I saw now just to I competed in the team division. So it actually didn't allow me to watch as much as the individual competition. I'm still working through catching up on that all the live the live coverage that they had. But I got to be within the team division. So one of the athletes in the team division, she clean and jerked 250 pounds and then a couple hours later ran a 5K, 4.5 ish K, 5K in under 20 minutes. So it just always impresses me that people can excel in things that I also excel in the strength events, yet also push their aerobic capacity and monostructural skills to an insane level as well. So it was just absolutely mind blowing to see athletes also just I know how hard we worked on my team and just having other athletes really push the boundaries. I find to be super inspiring as a competitive athlete. And then moving moving towards almost even debatably more inspiring. 04:11 OLDER ADULTS PUSHING BOUNDARIES  The age group divisions are always just such a blast to watch. I wish they had a little bit more coverage because arguably that's more these are more the athletes that are relatable and even more inspiring. For example, the 60 plus division, I believe the 60 60 to 64 division, both men and women had bar muscle ups in their last event. So these are our older adults crushing it, doing high skill level at a very high competitive level. Just absolutely amazing. And like I had the opportunity, my mom came and watch. She's going to watch me and have a blast, obviously, but she's not necessarily going to see like watch me and think, oh, wow, that's something I can do. She's going to see something in her age division and then become inspired of, hey, maybe I'm going to start my barbell class in my gym, for example. So I just think the human capabilities, even in our older adult divisions, is just as important as what the individual and team athletes are doing. The professional athletes, if you will. And then we also have the adaptive visions that are starting to grow and the upper extremity adaptive athletes were performing rope climbs. Rope climbs are hard enough when you have two upper extremities to grip onto the rope with. They were doing it with one and we're also sealing our lower adaptive lower extremity adaptive divisions, doing things like box jumps and maxing out their clean and jerk and snatch and really just taking no opportunity to have an excuse to not push their fitness forward and continue to be athletic and competitive in their sport. So I absolutely love seeing those. I wish I got to see a little bit more of it. I wish we got to view a little bit more of it on the broadcast, so hopefully we'll be able to continue pushing that forward. I just saw a couple posts of highlighting those athletes, so keep keep those in the forefront of your mind. That's what's really inspiring to more people, I think, in this world, in our country. OK, so the next three points that I want to kind of work through all kind of build off of each other. 09:20 INJURY RATES & PROGRAMMING So one thing that I thought was really relevant this year at the Games was the programming. And like I said, I have paid attention a lot to a lot more detail of our team division programming, but I just wanted to bring your attention as a rehab professional, as a movement specialist that's working with athletes all the time. I think it was important to note this. So just a couple examples. So in our competition, we had four days of competition. On day one, we had overhead squats at 135 pounds and 95 pounds. Then day two, we had a one rep, one rep max snatch. And then on day three, we had more snatches at 185 pounds and 135 pounds with running. So that's back to back days that we're seeing a barbell shoulder stability type exercise that is very demanding on the shoulders. In general programming, we would probably look to spread the frequency out of when we're doing things like overhead squat and snatching. Being able to do those back to back days can challenge the shoulder and challenges your ability to recover and perform repeatedly. Another thing that I noticed as on our day two, we had a strict ring muscle up to a front support hold. So going through that pole to deep press and hold at the top of the unstable rings is really challenging for the shoulders. And then right into day three, we had 30 synchro ring muscle ups on the long straps, which are tough. And then 63 more parallet bar dips. So that's a lot of vertical pressing for the shoulder to get through back to back days. And so I've personally experienced issues with pressing with shoulder pain. I've worked with a handful of athletes that recently have been that's a common theme in our clinic that I'm working with. So that is I remember if I was in the middle of having a flare up of that shoulder pain presentation, it would be really hard to be able to do that back to back days because you can always push through one workout. Adrenaline is a really strong drug, I would say that helps you get through it. But the next day when you wake up and things are a little bit inflamed, it's really hard to be able to repeat those motions. So that was just one thing I noticed that was not necessarily what I would have expected in programming, just how frequently the same movement is tested. And it's one thing to test the fitness of it, but it's also one thing to test the tissue capacity. So those are things that the my rehab mind was kind of evaluating while I was going through it, which brings me kind of into that next point I want to bring up was injury rates this year. I'm not sure if I just noticed more injuries and pain happening. A lot of KT tape being thrown on our limbs because I was in the background. But there did seem to be a lot of withdrawals from individual and team, excuse me, team athletes this year. We know the injury rates in CrossFit, the highest injury rates that we're seeing are in the shoulder joint. And based on that programming, it kind of makes sense. It makes sense that we're seeing a lot of shoulder issues. And so just from an athlete's perspective, it's absolutely devastating. It's so upsetting to have to withdraw from an injury, whether it's yourself, whether it's a teammate. We put so much time, money, effort and dedication to an entire long season. This started in February. So working day in and day out, making decisions based on that this specific weekend. It's just an absolute shame to see an athlete have to pull out of competition because of shoulder pain or whatever issue they may have. So I know I got to talk to a couple of the teams that had to withdraw. And the common theme that they were telling me was like, oh, yeah, I had this lingering issue for a while. I just retweaked it about two weeks ago. So they weren't necessarily the Roman Krenikov situation where they just, unfortunately, came down and rolled an ankle and had a new injury. This was a couple of these things were like lingering elbow issues that are really tested in the moment of competition with all the stress on board. Exposing to really deep positions of that dip position. If we have lingering shoulder stuff going on when you're pushing to 150 percent of your capacity, it's not likely that you're going to come out OK sometimes. So as soon as some of the workouts were announced, these athletes were like, well, I'm not feeling too great about this. So I take it's just such a shame because I think as rehab professionals, we need to have the skill set to be able to address these issues that our competitive athletes are experiencing and make sure that we're not just getting them back to be able to do a ring muscle up and take an ibuprofen. That's a whole other issue. We don't want our athletes to be doing that, obviously, but we want to be able to get them back to baseline and then beyond baseline because that originally that shoulder with that skill set got injured. So it's definitely up to us to be able to have the resources and provide rehab for these athletes that they find valuable. Not every single one of these athletes has a team of physical therapists that are top notch, that are traveling with them, that are on like on them 100 percent of the time. And so it is very likely that you may come across a CrossFit Games team athlete that's going to need to go through four days of competition with repetitively dips and butterfly pull ups and pulling, pulling whatever it may be. All these really challenging things for our shoulder girl to be able to tolerate. So that just I walked away being thankful that I came out unscathed, essentially, because if you followed any of my CrossFit career, I've had issues with my shoulder before. And strength always is super protective against injury. And I feel really lucky, essentially, to have all the knowledge that I have to put myself in the best scenario. Even within my teammates, we had a shoulder issue that we had to train around a little bit where we couldn't our best choice wasn't to continuing to do 30 muscle ups the week before, for example. But we rehab the crap out of it and put ourselves in the best situation possible to be able to come away without withdrawing by any means and putting up a pretty good performance over the course of the weekend. So that just brings me to want to plug our courses just one more time. So I mentioned the beginning, we have a couple of online courses coming up. I would say 75% of the clinical decision, clinical decisions I'm making on a daily basis are all things that I learned from these courses. The other 25% is probably all the other stuff I learned from my ice courses. So I know I'm biased, but I promise I'm not lying. If you at any point would feel nervous, nervous if I came into your clinic saying I can't do ring muscle ups, help. Please hop in one of our courses. It's really a fun, fun way to spend your eight weeks online. And so the last point I wanted to make kind of along the same theme was the importance of stress and recovery. So if you are an ice in the ice world, I'm sure you have heard us talk about the importance of stress and stress that the body takes on and how it helps us or doesn't help us recover well. 11:04 COMPETITIVE ATHLETES & REHAB And competing in the CrossFit Games this past weekend really made this become like full picture for me. I prioritize sleep, I prioritize what I'm putting in my body, and I prioritize managing stress as well as I can with all of the training that we were doing. But at the CrossFit Games, I will say I was probably at a peak stress level in my life. I don't live there on a daily basis, but the couple of weeks leading up to it, highly stressed and enduring also highly stressed. For example, day one, the volume wasn't really high. We were coming off of two sessions a day, up to two hours per session. So training heaps, I would say. And day one, all I did was three leg assault climbs, 30 overhead squats and then four laps on the bike track, which was aerobically really challenging, but not high impact. And the next day when I woke up, my fitness tracker is showing me my heart, HRV is plummeting. I felt like I did probably triple that amount of volume at minimum. And I was really surprised because volume wise wasn't crazy, wasn't out of my realm. But I felt the I think what I was feeling was the high level of stress that competition brought on. So and just to circle back a little bit, if you're having lingering shoulder pain, it's probably not going to get better with how much we're ramping up as far as volume in the eight weeks leading up to the CrossFit Games. 15:10 HIGH STRESS IN COMPETITION And then in the high, high stress environment, it's also going to be asking a lot to be able to recover and repeat these highly demanding movements like snatching, overhead squatting into ring muscle ups, to fatigue into dips where we're highly fatigued and moving at 150 percent of our capacity, essentially. So it just really is that's another way that I think bringing like stress and managing our recovery is just too important to ignore as the physical therapist, because we all know that person that's chronically stressed, chronically in that sympathetic state that maybe they are going into the gym and adding more weight. More stress onto their body. It's I absolutely can understand how they probably don't feel well at the end of the day, day in and day out. And so you have the ability as their rehab pro to help change their foundation of what they feel on a daily basis, too. So don't forget those things when you're dealing with any type of person that comes into your clinic. Stress management can really hit hard on so many levels and prevent maybe just set them up to rehab even better with all the good rehab skills you're doing with them in the clinic. And then lastly, I just wanted to share a couple of highlights because I feel like I had so many so much amazing support from our ice community. So just a quick couple personal highlights. Having been a spectator of the CrossFit Games for the five or six years or so has been in Madison. It was just such a cool opportunity to be able to push the Bob to do ring muscle ups with the long, long straps on the Zeus rig to use that four person axle bar for the deadlift. Those are things that you just never would see in a norm or any other CrossFit competition that's really only going to be at the CrossFit Games. So I remember pushing the Bob to the finish line and just reflecting on North Park, like, how cool is this? I've always wondered how it felt. So that was a really cool personal highlight that was really motivating throughout the weekend. Another personal highlight was our one rep max snatch. I have had some issues with shoulder pain and snatching and tweaked my elbow before from kind of poor movement patterns. So all season I was in a bit of a snatch funk. I'm sure you can relate if you are an athlete that tries to snatch frequently. It's sometimes good, it's sometimes not good. And so just about two or three weeks before the CrossFit Games, everything kind of clicked and I was able to hit a PR and perform really well on stage. So as an athlete, it just felt really special to be able to showcase the hard work that I put into that movement all season. And then lastly, I just had the best time with so many friends and family that were there to support at the CrossFit Games. I had my gym community from Milwaukee, my gym community from Chicago when I lived there, my ice community was there, our onward community. We had such a large cheering section, essentially. And trust me, that helped us get through that whole weekend. So thank you so much for everybody that was there, that sent messages, that supported us. It was such an honor to be able to represent this crew and we had a blast doing it. So thank you, thank you, thank you. So those are my takeaways from the CrossFit Games. I would like, like I said, this is stuff I can talk about all day, every day. So if you have any thoughts on programming, injury rates, anything you noticed from your spectating view, I would love to chat about it. So feel free to comment and tag me on this post, send me a message. Other than that, have a wonderful weekend and we will see you next or on Monday with our PT on Ice Daily Show. Have a great weekend. 19:06 OUTRO Hey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CU's from home, check out our virtual ice online mentorship program at PT on Ice.com. While you're there, sign up for our hump day hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to PT on Ice dot com and scroll to the bottom of the page to sign up.

Challenges bring together new teams with fresh ideas to solve problems. And many students report that their involvement in a NASA challenge helped them refine their career choice.

Dr. Guillermo Contreras // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Fitness Athlete faculty member Guillermo Contreras discusses how manipulating reps within a set can alter the intended stimulus of the set to bias towards power, strength, hypertrophy, or endurance gains. Guillermo discusses new research highlighting that depending on population, some individuals may still experience strength gains at lower loads & higher rep counts and that most individuals will improve hypertrophy regardless of rep dosage.   Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn from our Clinical Management of the Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody? Before we get rolling, I'd love to share a bit about Jane, the practice management software that we love and use here at ICE who are also our show sponsor. Jane knows that collecting new patient info, their consent and signatures can be a time consuming process, but with their automated forms, it does not have to be. With Jane, you can assign intake forms to specific treatments or practitioners, and Jane takes care of sending the correct form out to your patients. Save even more time by requesting a credit card on file through your intake forms with the help of Jane Payments, their integrated PCI compliant payment solution. Conveniently, Jane will actually prompt your patients to fill out their intake form 24 hours before their appointment if they have not done so already. If you're looking to streamline your intake form collection, head over to jane.app slash physical therapy, book a one on one demo with a member of the Jane team. They'll be able to show you the features I just mentioned and answer any other questions you may have. Don't forget, if you do sign up, use the code ICEPT1MO for a one month grace period applied to your new account. Thanks everybody. Enjoy the show. 01:32 GUILLERMO CONTRERAS Good morning, crew. Welcome to the PT on ICE Daily Show. Welcome to one of the best days of the week, if not the best day of the week, Fitness Athlete Friday. I am with you. My name is Guillermo Contreras, part of the teaching team with the fitness athlete crew of the Institute of Clinical Excellence, talking all things delightful and super interesting, such as the rep continuum. So I'm going to leave you a little bit guessing as to what that means and dive into some fun stuff as in where are we going to be over the next couple of months? Where can you catch us on the road before the year ends? For our live courses, we have more than a handful coming up here in the next several months, starting in September on the weekend of September 9th and 10th. We'll be in Bismarck, North Dakota. In October, we will be technically September, October, September 30th and October 1st. We are going to head out to the West Coast to Newark, California. A couple weeks later, October, a week later, October 7th and 8th, we're going to stay in the West Coast. We'll be in Linwood, Washington. Moving into November, we'll be double, double teaming for, I guess, I don't know if that's the right phrase, but two different locations on November 4th and 5th, San Antonio, Texas and Hoover, Alabama. So moving from the West Coast down to the South. November 18th and 19th, we will be in Holmes Beach, Holmes Beach, Florida. I'm not sure where that is, but Florida. And then lastly, in December, we are going to be in Metair, Louisiana, as well as Colorado Springs on the weekend of December 9th and 10th. So there you go. If you've been looking to take a live course with the Central Foundation, or with fitness athlete courses, one, two, three, four, five, six, seven, eight opportunities for you between now and the end of the year to catch us on the road and be able to take that course and join us. And hopefully we get to meet you out there. If you are looking to do the online courses, Essential Foundations currently is going on their seventh week of this current cohort. So we're finishing up in about a week and a half. That take about a month off. And then we're going to kick off the next Essential Foundations cohort on September 11th. So if you've been looking to get started with the fitness athlete coursework, try to get an idea of what you would do when you work with fitness athletes, get more comfortable with the barbell movements, the squat, the deadlift, the press, what CrossFit is in general, some introduction to programming as well as the gymnastics movements, such as the pull-up. Would love to have you join us on September 11th as we kick off the new Essential Foundations cohort. These courses do tend to sell out online. So signing up sooner rather than later behooves you if you're interested in it and you want to get it in before the end of the year. Advanced Concepts as well. I think that only has two cohorts a year. So only twice a year that you can actually sign up and take Advanced Concepts. That second time right now is going to be on September 17th. Advanced Concepts does always sell out. It's a more high level course. You're going to learn a much deeper dive into programming, into modifications, into the high level gymnastics movements, such as handstand push-ups, muscle ups, high level Olympic weightlifting, breakdown and progressions. A lot of really deep dive stuff. A lot of brain work and physical work you'll be doing for this course. So that one starts up on September 17th. So please be sure to sign up again sooner rather than later for that one because that one does absolutely sell out early. Sometimes a couple months early. So sign up now if you're looking to complete your coursework to get your fitness athlete certification or if it's just something that's been on your bucket list you've been dying to take but you have not and you want to get it in before the end of the year. Fantastic. So that's what we have on the docket for fitness athlete. This morning the topic at hand is the rep continuum or the repetition continuum. For those who are not sure what that entirely means, what we're looking at with the rep continuum is, I just realized my camera is really blurry over here but that's okay. Is what we commonly know as the strength endurance continuum which for the majority of us or anyone who's been in like the strength and conditioning realm what that means is okay what are the optimal rep ranges and loads that you want to use when you're trying to train strength, when you're trying to train hypertrophy and when you're trying to train more like localized muscular endurance. And for the longest time we have had the accepted theory that it is one to five reps at 80 to 100 rep 100 percent run at max. Hypertrophy is going to be eight to 12 reps at 60 to 80 percent one rep max and endurance is going to be 15 or more reps at anything below 60 percent of your one rep max. That's what's been commonly known and so in 2021 Bradshon building company down at the NSCA right they decided to do a lit review look at everything they could out there and got a better understanding of is it truly that is that the only way or are those the only things we know or are there actually other ways to gain strength gain hypertrophy gain gain endurance in our muscles and is that truly the most optimal way that we can do these things or is there other ways that we can kind of build it up can we use lighter loads can we use moderate loads can we use heavy loads and play around and dive into these different realms. So again they did a very very significantly large lit review and their purpose of the paper was to critically scrutinize the research on the repetition continuum highlight gaps in literature and draw practical conclusions for exercise prescription. Based on the evidence they proposed a new paradigm whereby muscular rotation can be obtained and in some cases optimized across a wide spectrum of loading zones. So that is that kind of the basis for the paper and it's a long one it's probably like 11 pages and you have like a bunch of pages of exactly the the the protocols that they use in all these different studies that they reviewed and I'm just going to try and do my very best to summarize what they kind of found in each section and then at the end if you don't want to like listen to this whole thing you're listening later on just jump to the last maybe like minute or so and I'm going to try and kind of concisely conclude everything there. When it came to strength strength as we know it is supposed to be ideally that one to five rep range 80 to 100 percent one rep max heavy heavy loads is how we're going to build strength and what they found in this here is that trained individuals people have been doing it for a while tended to show improvement in strength even with light loads so people who have been doing it for a while people who who already lift heavy and such when they use lighter loads in different variations there actually is an increase in overall strength albeit they they mentioned in a caveat that it is to a lesser extent than the use of heavy loads. Um they also mentioned that typically what they see is as you reach that genetic ceiling like where your where your strength is kind of at its highest or going to be pretty high the greatest benefit is going to be in heavy loads with specific movements that you're trying to get stronger and again that should be something that all of us are probably saying like no duh right that's that's the set principle right you learn that in undergrad kinesiology right specific adaptations to impose demands when you get someone that's a higher level at the very highest level and you're trying to get them stronger the way to get them stronger is to apply specific stressors to elicit a specific progressive improvement in strength that's what they saw there so what we see is with heavy loads or when we want to build strength you can do it with low loads there are ways you're going to build low loads and that practical application the clinical application is that all the studies i guess the majority of studies that found that low loads improved strength their way of testing strength was using isometric dynamometry therefore the isokinetic or isotonic leg extension leg curl hip extension you name it they used single joint mechanisms to test that single joint single movement strength from a practical application that can very easily mean for us in the rehab realm if we are trying to get someone's quad stronger if you're trying to improve specifically quad strength hamstring strength whatever it may be there is a point where we can use lower loads to high intensities right all across the board effort was dependent on improvement maximal or hard efforts with low loads showed improvement when individuals cut off before maximal effort before fatigue before stress there was not the same amount of improvement whether it was strength hypertrophy or muscular endurance so low loads can be used on single joint movements however strength is most often applied in compound movements coordinated multi-joint efforts i.e. squats deadlifts presses lunges all those type of things and so we want to make sure that if we are trying to help someone improve their squat improve their deadlift strength improve their rowing strength we're trying to create these compound movements that are are functional in nature to what they're doing we have to be getting comfortable with the barbell movements we have to be comfortable loading them heavily right so if you're going to be working with athletes who are doing functional movements you better be loading them with functional movements you better be loading them heavy with functional movements if the goal is to do actual strength improvement and that actually is nice because it it shows two things right one yes the one to five rep range eighty one hundred percent max of these movements is where we want to be for strength and two if we're trying to do very specific rotator cuff bicep quad hamstring strengthening then it's okay to use lower loads maximize that intensity range and we're going to see strength improvements there if we're very specific with what we're doing there number two moving on to hypertrophy hypertrophy getting the gains bigger bigger arms shoulders back legs quads hamstrings you name it everything there well we typically see in the realm of like bodybuilding in the realm of anyone who's trying to put on mass is we're going to be doing somewhere around that eight to twelve rep range sixty to eighty percent so submaximal loads add an effort when you get to that mid-range you're creating some sort of mechanical stress that causes that muscle to basically in essence break down a little then build back up and get stronger as long as you know all the fuel and everything is there for it and in the study the meta analysis showed comparing high loads which are greater than 60 percent of one rep max versus low loads which are less than 60 percent one rep max is that there was no real difference in hypertrophy which is kind of interesting right you can again offer an example of you can use low or high loads moderate loads kind of in that range to build hypertrophy the notable effort though again that they mentioned in here is that when individuals were using low loads the effort was much higher so it was a higher level of effort because it is critical for maximizing hypertrophic adaptations so again if our goal is to have someone who has a very very atrophied quad and we are not going to try and pursue something that allows for 60 to 80 percent of that one rep max relatively heavy loads right moderately heavy loads that are challenging and fatiguing and stressful then we'd better be using low loads but eliciting a maximal effort where they are working hard for 15 18 20 reps whatever it may be that kind of ties in a little bit with with anyone who kind of plays around with blood flow restriction training where you're doing 30 15 15 and you're maximizing that effort there it's a very low load somewhere around 20 30 percent of one rep max for a lot of reps there too but that's again there's another topic there right effort is dependent on this are we are we using maximal or high level of effort to maximize hypertrophic gains strength gains etc the one thing this study did show the review did show was cool is that for from an age-related standpoint the light load training appears to be as effective as heavy training so when we're looking at our older adults where we might see more of those joint related conditions when they can't sometimes tolerate heavy loads on their knees on their hips whatever it may be using light loads at this this higher effort level might induce a similar hypertrophic change because it's going to stimulate both type one and type two muscle fibers when we're using lower loads we're in essence what they mentioned in this review is those type one fibers might be stimulated stimulated more because you're doing more of an endurance or long bout of exercise and effort which is going to stimulate those more when you're having it's more type two muscle fibers so either way we're building them both up and we're trying to build hypertrophy in that way so there we go and even in the really said that some researchers propose that you should train both like high level volume with high effort and lower volume with higher effort as well again working in those things there too so minimum threshold though if we have to like throw a number out there is where they're in there it's somewhere in the range of 30 one rep max right we should not be training anything below 30 of our one rep max or if you're using rp like a three out of ten so hopefully that makes sense right low loads are fine high loads are fine they're both good again as i mentioned with strength and now hypertrophy effort is dependent right we need to be working hard we need to be pushing individuals and lastly there's the endurance response right less than uh greater than less than 60 percent of one rep max 15 or more repetitions right lots and lots and lots of reps trying to really fatigue those things out and um in the look review right this is probably the shortest section in there that kind of looked at and it kind of just demonstrated that like there's a lack of dose response relationship right whether you were doing uh high loads or moderate loads light loads there wasn't a significant change in overall muscular endurance and i believe uh the lighter loads for endurance were more beneficial for like lower extremities which would make sense right you're running it's a lot of like impact and going doing a lot of air squats uh things like that's going to help build that muscular endurance uh versus doing like really heavy back squats and hoping that's going to translate to doing a 5k or doing like a really long hike and stuff like that it can there's aspects of it that will help but with resiliency and like injury prevention we're talking like muscular endurance so it's the ability to go longer in that way you can look at a powerlifter who just does powerlifting and know that they ain't doing like a 5k anytime sooner a long cycle right so those those are the main kind of areas we looked at right so again a lot a lot of talk there a lot of like little details about this lit review and what i want to specify again this conclusion right what is what is the grand arching scheme or grand arching topic uh or takeaway from this it is that what we're looking at trying to build strength strength related advantages of heavier load are dose dependent right so if we are going to have someone get stronger at the squat the deadlift or the press they better be doing heavy squats heavy deadlifts and heavy presses if we want someone to specifically improve quad strength we can do squats we can do step ups we can also do isometric leg extensions at lighter loads for higher volume and what matters here is the effort and also if you are trying to train for a specific thing you're trying to help someone improve their squat or increase strength with squat they better be squatting right specific adaptations to impose demand for strength is the greatest area that we see that that has to be specified there strength is going to improve strength hypertrophy we can use high loads we can use low loads we can use moderate loads if you want to build muscle we can use them all the one thing they mentioned though is you have to remember with low loads it's a lot more effort dependent there's going to be a higher amount of metabolic stress which can lead to just general discomfort in the muscle and some people don't like that so the the likelihood of them sticking around to doing for doing like three sets of 18 at maximal effort where they're feeling like an eight or nine out of 10 difficulty is not there the compliance might not be there high loads you need more volumes more more volume right so you can you only do two or three sets two or three reps i'm sorry at 80 90 percent which means you're probably doing seven eight nine sets to get the appropriate amount of volume to elicit the hypertrophy response and what we know is that's not fun if you've ever done 10 sets of three something really really heavy that is a miserable session and it's also hard on your on your joints on your tissues it's a lot of stress so if anything is off in your training continuum whether it be your sleep your recovery your nutrition right you're going to feel that much much more which is why we probably go with that middle moderate range where it's hard enough difficult enough but it's not going to elicit any type of ill feeling or pain discomfort etc and then lastly with endurance as i mentioned already the lighter loads are going to be more beneficial for the lower extremity musculature otherwise it's pretty much equivocal like whether you use heavy loads or lighter loads for endurance you're not going to see too significant of a difference as far as gains go in that area cool i will link the study in the comments for anyone who wants to check it out for themselves that's all i got for you this morning on this fitness athlete friday if you're doing some hypertrophy work today play with some heavy load play some moderate load play some light load if you're doing some strength work get after that barbell get heavy with it and hopefully everyone enjoys their weekend thank you for tuning in and we'll catch you next week on the pt on ice daily show take care again 19:04 OUTROHey, thanks for tuning in to the PT on ICE Daily show if you enjoyed this content head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the institute of clinical excellence if you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home check out our virtual ice online mentorship program at www.ptonice.com while you're there sign up for our hump day hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading head over to ptonice.com and scroll to the bottom of the page to sign up  

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Dr.  Zach Long // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Fitness Athlete faculty member Zach Long. In today's episode, Zach shares his favorite exercises for low back strengthening, including the reverse hyperextension, heavy horizontal rowing, and Jefferson curls. Take a listen to learn how to discuss cold plunging with your patients or athletes. If you're looking to learn from our Clinical Management of the Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTROWhat's up everybody? Before we get rolling, I'd love to share a bit about Jane, the practice management software that we love and use here at ICE who are also our show sponsor. Jane knows that collecting new patient info, their consent, and signatures can be a time consuming process, but with their automated forms, it does not have to be. With Jane, you can assign intake forms to specific treatments or practitioners, and Jane takes care of sending the correct form out to your patients. Save even more time by requesting a credit card on file through your intake forms with the help of Jane Payments, their integrated PCI compliant payment solution. Conveniently, Jane will actually prompt your patients to fill out their intake form 24 hours before their appointment if they have not done so already. If you're looking to streamline your intake form collection, head over to jane.app slash physical therapy, book a one-on-one demo with a member of the Jane team. They'll be able to show you the features I just mentioned and answer any other questions you may have. Don't forget, if you do sign up, use the code ICEPT1MO for a one month grace period applied to your new account. Thanks everybody, enjoy the show.  01:25 ZACH LONG Welcome to the PT on ICE Daily Show here on the Best Day of the Week on the podcast. It is Fitness Athlete Friday. I'm excited to be with you here today. I'm Zach Long. I'm one of the lead faculty members inside of our fitness athlete division. And today we're going to talk about a few of my favorite exercises for low back strength. Before we do that, two pieces to get out of the way. Number one, congratulations Joe Hanisko, one of our faculty members here inside the fitness athlete division. He and his wife Aubrey just had their first child, so congrats Joe. Second, upcoming courses we have inside the fitness athlete division. Advanced Concepts, eight weeks online, starts up September 17th. That always sells out, so if you've already taken essentials and you want to move on and take advance, you need to go sign up for that really soon because it will sell out several weeks in advance. Upcoming live courses we have September, we're in Bismarck, North Dakota, as well as Newark, California. October, just outside of Seattle. In November, we're in Hoover, so look forward to seeing you on the road. Or in Advanced Concepts. So let's jump into today's topic and that's bulletproof back exercises. So one thing that we talk about a lot in so many of our courses, but especially in Fitness Athlete Live, is that there's just this principle of rehabilitation. Like when a tissue is injured, what do we strengthen? We strengthen that tissue, right? If you're dealing with Achilles tendinopathy, we're doing Achilles tendon loading. If you're dealing with patellofemoral pain, we're getting your quads and your glutes really strong. We strengthen the tissues around what is injured. That's a principle of rehab. But all of a sudden when we start talking about low back pain, that principle like goes out of the window. And so much of our profession then says, no, we're not going to get the back strong. Instead, we're going to worry about the glutes not activating. We're going to worry about psoas tightness. We're going to worry about transversus abdominis activation. And while I'm not saying any of that is not completely irrelevant, I'm just saying that a principle of rehab is that we strengthen the area that is injured. So when somebody has back pain, we should probably make that back a little bit stronger. And so I want to share five of my favorite exercises for doing that today. And number one for back strength is going to be the reverse hyperextension. So this is a piece of equipment that you don't see a lot of physical therapy clinics. So I'm going to describe it for those of you that aren't familiar. Imagine you have a high-low table that goes up about five feet off the ground. And it's got this nice cushiony pad on top of the table. And you lay your torso on that with your legs hanging vertically off of that. And then you lift your legs up. So it's essentially just doing like a Romanian deadlift, except your upper body's horizontal to the ground and locked in place, and you're lifting your legs up. So there's reverse hyper machines, but this can also be done a number of different ways. I have patients doing it off of beds, off of incline benches, over exercise balls, over a barbell in J-cups on a rack, over a glute ham developer. A lot of different ways to do reverse hypers. But they are a phenomenal exercise for building a little bit of low back strength and endurance. And I'd say this is probably one of my most frequently prescribed low back exercises, because it works so well, even on your highly irritable patients, so frequently they can do this and get a huge pump into those muscles around their lower back, which of course is going to help tremendously out with pain and with working through a little bit of inflammation and getting fluids moving a little bit. So really make sure you check out reverse hypers. If you've never done those before, I would highly encourage you to take a look at different reverse hyper variations. You can find some videos of that on my YouTube or my Instagram if you need some ideas on how to do that, or you can just shoot me a message and I'll send you that video. But it is a great exercise to start with. Exercise number two, any form of heavy rows. I think we very frequently think of bent over rows and other movements like that as an upper back or mid back exercise, but they're so underrated in terms of what the low back has to do in terms of holding an isometric contraction. So I love really heavy rows. So bent over rows or really, really, really love pin lay rows. So if you're not familiar with pin lay rows, here's another great exercise for you to go train and explore within your own personal fitness journey. So barbells on the ground with bumper plates on it, you hinge over quite a bit to grab the bar and you're doing a row with every time the bar goes all the way back down to the ground. And what I really focus on with my pin lay rows is that my lumbar spine stays locked in place. I let my thoracic spine round and extend a little bit as I row. And that's just a phenomenal exercise to build total spine strength. So really for sure, check out pin lay rows if you've never done those before. Next movement is a series of movements actually. So that's anything off of a glute ham developer. Not very many physical therapy clinics have a glute ham developer, but a lot of gyms do. And so a glute ham developer is an exercise, a piece of exercise equipment that has a lot of different potential variations that you can do. But really I like to do tons of isometric holds off of the glute ham developer. So the glute ham developer has this little foot plate. So you lock your feet in place and then your thighs into this other pad. And then your upper body is free hanging out here. So you can hold your upper body parallel to the ground and you're now going to do a really good isometric of your low back, your glutes, your hamstrings to hold that global extension position. But you can then do different things like hold some light dumbbells and do rows to make that a little bit more challenging. You could turn it into a hinge movement by doing back or hip extensions, either loaded or unloaded, but so many different variations of exercises that can be done off a glute ham developer to load the post of your chain and the back specifically that you really want to make sure you check those things out. Up next, Jefferson curls. So Jefferson curls tend to get physical therapists a little bit fired up because everybody seems to be on one side of the equation or the other. So Jefferson curls, where we work on segmentally flexing the spine and taking the spine from an upright position, going into global flexion with light load behind it. I love Jefferson curls because so frequently in our culture, people are absolutely terrified of flexing their spine, especially with any load. And so the lightly load that and make people feel more confident that their back can get out of neutral position and not explode. Like we see Instagram infographics happen all the time by unfortunate influencers. The Jefferson curl is a great way to build confidence that the spine can be flexed. I love this to build a little bit of submaximal strength out of positioning. I love it also for my athletes that have some neural tension. We've worked through so much of that neural tension, but I know they're going back to a sport like CrossFit where they're going to be doing a ton of hinging motion. I like to use the Jefferson curl as the in range, make sure we completely clear out any of that stiffness that might be remaining. So that's exercise number four. And you all know exercise number five, last exercise. If you've been to an ice course, whether this is total spine thrust, modern management of older adult, lumbar spine management, or fitness athlete, you know what the next exercise is. And that is the freaking dead left because that is the best exercise that has ever been invented to build low back strength as well as human's confidence in their body. It is shocking and amazing how often somebody pulls a weight off the ground that they didn't know that they could do. They didn't know that they were strong enough to do it, or they didn't know that their back wasn't so fragile that they couldn't pick up that 95 pound bar, that 125 pound bar, that 225 pound bar. They pick it up and all of a sudden, their chest pops up a little bit. They walk out of the clinic a couple inches taller because they're so much more confident in their body when they learn how to pull a heavy weight off the ground. And it's something that they weren't expecting. Dead lifts can be conventional dead lifts, sumo dead lifts. They can be kettlebell dead lifts, so many different options for it, but get your people pulling heavy weights off the ground because that builds a lot of confidence in the human body. One of our favorite research articles from that comes out from Taglia Theory and colleagues in 2020. So they looked at individuals doing low load motor control exercises and manual therapy compared to a group that did heavy loading. So they're doing squats and dead lifts and a ton of other exercises that load the spine heavy. And what they actually found was that the heavy group, the group that were getting after it lifting heavy loads, had significantly reduced levels of kinesiophobia, which when it comes to low back pain, we all know that's the key. Our patients, after they've had an experience of low back pain, are terrified of their backs. And anything we can do that reduces kinesiophobia and makes them feel more confident is really important. And in that Taglia Theory and colleagues article in 2020, low load motor control exercises, your bird dogs, your clam shells, those sorts of movements, they don't make people less fearful of their back, although they do help with their pain. Heavy loading helps with pain and makes people more confident in their body. And that's what it's all about. So five different exercises there. We've got reverse hypers, we've got heavy rows, we've got glute ham developer work, Jefferson curls, and the greatest exercise of all, the dead lift to make your patients stronger in their low back, more confident in their low back, and getting back to doing the things that they love. So I hope you enjoy this episode. As always, reach out to us if you have ideas for future topics you'd love to hear of, and we look forward to seeing you on the road. Have a great weekend, everybody. 11:12 OUTROHey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review. And be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CUs from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there, sign up for our hump day hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.    

Alan Fredendall // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Fitness Athlete division leader Alan Fredendall defines cold plunging, discusses the research behind cold plunging, and how to practically approach practicing cold plunging. Take a listen to learn how to discuss cold plunging with your patients or athletes. If you're looking to learn from our Clinical Management of the Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody? Before we get rolling, I'd love to share a bit about Jane, the practice management software that we love and use here at ICE who are also our show sponsor. Jane knows that collecting new patient info, their consent, and signatures can be a time consuming process, but with their automated forms, it does not have to be. With Jane, you can assign intake forms to specific treatments or practitioners, and Jane takes care of sending the correct form out to your patients. Save even more time by requesting a credit card on file through your intake forms with the help of Jane Payments, their integrated PCI compliant payment solution. Conveniently, Jane will actually prompt your patients to fill out their intake form 24 hours before their appointment if they have not done so already. If you're looking to streamline your intake form collection, head over to jane.app slash physical therapy, book a one-on-one demo with a member of the Jane team. They'll be able to show you the features I just mentioned and answer any other questions you may have. Don't forget, if you do sign up, use the code ICEPT1MO for a one month grace period applied to your new account. Thanks everybody, enjoy the show. 01:25  ALAN FREDENDALL Alright, good morning PT on ICE Daily Show, happy Friday morning. Hope your morning is off to a great start. My name is Alan, I'm happy to be your host today. Currently, I have the pleasure of serving as a faculty member here in our fitness athlete division and the chief operating officer here at ICE. Fridays, our fitness athlete Fridays, we talk everything related to the recreational athlete, whether that's somebody in the gym doing CrossFit, powerlifting, Olympic weightlifting, bodybuilding, out on the track, the road, running, biking, swimming, whatever, that person who is getting after it. Four to six days per week is the focus here on fitness athlete Friday. We're biased, but we would argue it's the best darn day of the week. Courses coming your way from the fitness athlete division. Taking the summer off, we have some live courses coming up in September. You can catch Mitch Babcock out in Bismarck, North Dakota. That will be the weekend of September 9th and 10th, so the first September of the fall. And then you can catch Zach Long, aka the Barbell Physio out in Newark, California. That's the Bay Area. That's going to be the weekend of September 30th and October 1st. Online courses from us, our Essential Foundations, our eight week entry level online course starts back up September 11th. We're currently halfway through the current cohort. And then our Advanced Concepts course, our level two course that requires Essential Foundations, that drills down deep into things like Olympic weightlifting, gymnastics, programming, both for CrossFit and strength, injured athletes, all that sort of fun stuff. That starts September 17th. So you can find out more about our courses at ptenice.com. So today's topic, let's talk about cold plunging. You can't trip over a rock in public these days without finding somebody trying to get neck deep in some cold water somehow. Everybody's doing it. They're posting about it. There are probably a million ads you've seen on social media for this tub. This thing that looks like a bourbon barrel. This thing that looks like a fancy bathtub. All these different ways to essentially cool down your body. So I want to attack this topic from three different angles. I want to talk about defining a cold plunge and how probably most of the people cold plunging currently or certainly what we see happen on the Internet is not true cold plunging. I want to talk about the research supporting, not supporting the use of cold plunging. And I want to talk about the practical application of what we can recommend to our patients and athletes when they come into the clinic or the gym and ask us what we know about cold plunging. What's the best way to cold plunging and all that sort of thing. So let's start from the beginning. What is a cold plunge? We need to start at the top and understand that humans have a really large tolerance for heat at rest and a very poor tolerance for cold at rest. You can imagine it's much better to sit outside on a 90 degree day than a 30 degree day. So our perception of temperature is a little bit different. It's skewed based on if we're active or if we're resting. It flips entirely when we are active. You can imagine how terrible it would be to run on a 100 degree day versus running on maybe a 50 degree day. We would all probably much choose the 50 degree day because our bodies lose heat tolerance as our activity level increases, which is all that to say of we have a really poor tolerance for cold at rest, which means when we define the parameters of what's used for cold plunging in research, we'll quickly recognize that most of us, most of the people we see aren't doing it cold enough. They aren't doing it long enough and they aren't exposing as much of their body as they need to to the cold plunge. So a cold plunge is defined by the research is going to be exposure up to your neck or possibly your entire body for 10 minutes at 40 to 50 degrees Fahrenheit. That's a large portion of our body. That's a really long duration of cold exposure for a human being at rest. And that is relatively cold. Again, we have a really poor tolerance to cold at rest. Now, imagine we've we've all taken a bath. Imagine you you take a hot bath or sit in a bathtub and then you get that feeling of, oh, I'm getting really cold. Like this water has cooled down significantly. Again, our perception of temperature is really skewed. When we decide it's time to get out of the bath because the bath water has become too cold, we've probably started in bath water of maybe one hundred and five to one hundred and ten degrees. And it has only cooled down to maybe 90 to 95 to the point where we say this is cold, quote unquote, cold. I'm going to get out of the bathtub now. But really, 90 to 95 degree water is remarkably warm compared to what we define as cold plunge in the literature. So most folks are probably simply not getting their water cold enough to even define cold plunging. Again, the duration of support in the research is cold plunging of 10 minutes. So if you are doing it for 30 seconds or one minute, just know you are not anywhere close to reaping the effects or the positive or negative that we've seen in the research. If you're only dipping your toe in for a few minutes or jumping in up to your knees or your waist and hopping back out again in the research, exposure would define itself as being exposed up to the neck, at least. So many folks just putting their legs in a cold plunge, just going up to the level of maybe the knee, going up to maybe the level of the waist or maybe belly button mid chest or something. Again, if you're doing that to slowly gain tolerance, that's OK. But if that's what you're calling normal cold plunging, just know you're probably not reaping as much of the effect. Again, positive or negative that we'll talk about here in a second as you could be. So cold plunging 40 to 50 degrees up to your neck, duration of about 10 minutes. So all that to say, most people are probably not actually cold plunging when we do it ourselves or we watch others do it. Excuse me. Simply not cold enough, not enough for their body to get in effect and not enough for a long duration. I do want to give a special shout out to ICE faculty members Dustin Jones and Jeff Musgrave. They are unashamedly posting their cold plunges every day on social media and they really get after it. You can see that they have a bunch of ICE in their backyard cold plunges and they're sometimes exposing their whole body to the cold plunges. So they are doing it right. That's the way to do it. So let's switch gears and talk about what does the research say. The research in this field is becoming overwhelming of just looking at the trend and volume of research. Eight hundred and seventy articles published on what the research would call cold water immersion since 2008. So an exponential growth in the people studying, the amount of people studying and the volume of research studying this particular area of what we might call athletic recovery. I want to talk about just two journals today, two journal articles. There are literally like we talked about hundreds and hundreds and hundreds and hundreds. But I really want to talk about two. What I like about these two articles I want to share is that they are 30 years apart and they essentially say the same thing. So first, I want to go way back. 1985, I wasn't even alive yet. Journal of Applied Physiology, Peterson and colleagues talking about cold plunging exposure after exercise. These folks did three sessions a week of what the again the research calls cold water immersion or cold plunging. They did do it at 50 degrees Fahrenheit. They did it for 15 minutes instead of 10. So they went up to their neck. They did it for 15 minutes and they did it cold enough. 50 degrees Fahrenheit. They did this three times a week after resistance training. Evaluation here looked at a lot of different things. One rep max leg press, one rep max bench press and some ballistic things, counter movement, jump, squat, jump, ballistic push up. And this article really wanted to focus on what happens to muscular hypertrophy. This journal article, 1985, now 38 years ago, said you can expect to have less muscular hypertrophy if you expose yourself to a cold plunge after resistance exercise as compared to control. Control in this group was people who just sat at room temperature like you might sit on the boxes at CrossFit class or on the curb after a really long hard run. They just sat and kind of cooled down for 15 minutes compared to the cold plunge group. Fast forward 30 years, 2015, Journal of Physiology, Peking Colleagues, very similar parameters. That's why I picked these two papers. They are perfectly 30 years apart. They use almost exactly the same parameters and they found pretty much the same thing. Peking Colleagues in 2015, very similar parameters, twice a week of cold plunge exposure, 10 minutes at a time, also 50 degrees Fahrenheit. They followed folks a little bit longer. Peter Peterson in 1985 followed those athletes for seven weeks. Peak in 2015 followed them for 12 weeks. Almost same exact parameters, though. They looked at almost exactly the same stuff. They looked at leg press strength, knee extension strength, knee flexion strength, both one rep max and eight rep max. So they're looking at maximal strength and they're also beginning to look at kind of what is your ability to produce force over time. So what we call maybe endurance, which really is indicative of hypertrophy. This team also did some muscle biopsies and what they found with the group exposing themselves to the cold plunge after resistance training compared to the control group, in this case, a group doing active recovery. So not even resting, just doing active recovery for 10 minutes after the resistance training session. The control group, who continued to exercise at a low level, had a 17% improvement in hypertrophy, a 19% improvement in isokinetic strength and a 26% improvement in myonuclei per muscle fiber. So the control group blew the cold plunge group out of the water. Now, that is not to say that the cold plunge group got weaker or smaller. They did not get as strong and big as the control group. And it's led to believe because they were the cold water immersion group, that it's the cold plunge, that something about that cold exposure seems to blunt the body's natural response for healing to encourage hypertrophy gains and strength gains. The big takeaway from this study is the myonuclei per muscle fiber. We can think of myonuclei as if one myonuclei per muscle fiber is great, but more is better. It's almost like having a personal assistant for everything in your life. Your life would be a lot easier if you woke up in the morning and someone was there who had your clothes ready for you. If someone was there who had already prepped your shower for you, if someone was there who already made your breakfast for you, right? The more people you have assisting you in your life, the more efficient you will be at running your life because they're doing everything for you. That's a lot of the role of the myonuclei in our muscles. The more the better. The interesting thing about myonuclei is they stick around even during a period of training, whether it's injury, whether we get busy with life, whether we switch training modalities, maybe we start prioritizing endurance training to train for a marathon or something. Those myonuclei stay around and that's kind of what creates that strength across life of that person who comes into the gym who says, I haven't worked out in 10 years and then deadlifts 400 pounds. You're like, where did that come from? That took me years to build to that strength. This person just naturally has it. Yes, they may naturally have some genetic strength, but what they probably had in the past from training was myonuclei that are now living in their body. And so losing those myonuclei or rather not gaining them through cold plunge exposure not only affects strength and hypertrophy in the short term, but affects really long term fitness gains over time. So very interesting study from PEEK and colleagues showing that cold water immersion after resistance training seems to really have a negative effect on strength and hypertrophy. So it doesn't seem to help. It maybe seems to have a negative benefit, at least after resistance training. Most people aren't doing it correctly. What is the actual practical application? What can we recommend to patients and athletes who ask us about cold plunging? The first thing is to make sure that they understand what it actually is and that they're doing it correctly. Of, hey, if you're going to do this, you should have a way to expose yourself up to the neck, your whole body up to your neck. You should build up your tolerance to do it in sessions of 10 minutes at a time. And the water should be really uncomfortably cold, 40 to 50 degrees Fahrenheit. We don't like to see colder than that. That can be a little bit dangerous, but we also don't like to see warmer than that. Right. Remember, cold bath water is technically hot, 90 degrees Fahrenheit. So we need to see somewhere between 40 to 50 degrees Fahrenheit. We need to talk about timing of cold plunging. The research would really suggest we should never do it after training, especially if we're just training once a day. We're training for life. We're training to be strong and be training for life. And we're not training to be competitive athletes. We're not training multiple times per day. If you're somebody that just exercises once a day, you should not finish that exercise session with a cold plunge. Maybe you start your day with a cold plunge or maybe you cold plunge before you exercise to get the effects that cold plunging can have aside from apparently blunting our strength and hypertrophy gains. And then there's a little bit of a caveat there for competitive athletes, folks who are, you know, let's think of a CrossFit Games athlete. Let's think of somebody running multiple races, an Ironman, a long cycle race. Maybe between events is the time for a cold plunge. We need to recognize those events are already really destructive to the body. Nobody goes to the CrossFit Games and comes away fitter. They come away significantly beat up with probably weeks or maybe even months of repair time needed to recover from an event like that. So at that event, we're not as concerned about not gaining as much strength and hypertrophy as possible because of the short duration. It's only a couple of days or maybe even a one day competition is only a couple of hours. So maybe that is the time between events to use cold plunging. But after regular training, we should not use it. We need to recognize the point of exercise is to create a micro injury that your body will repair and heal from. Your tissues get stronger from a tensile strength perspective and your brain more effectively learns how to use those muscles so that we get stronger and bigger over time. We become more adapted to the stress. We have an increase in tensile strength. We have an increase in myonuclide per muscle fiber. And that's what really creates robust lifelong strength. I love the quote from Pique and colleagues. Remember that anything intended to mitigate and improve the body's natural ability to improve resilience to physiological stress with exercise may actually be counterproductive to muscular adaptation. Cold plunging, NSAIDs, antioxidants, anything that can slow the chemical reactions, the natural chemical reactions in our body to respond to that micro injury is going to affect our ability to recover and be more resilient to that stressor in the future. So a lot like discouraging folks from taking a bunch of maybe ibuprofen or injectable steroids, we should say, hey, if you're going to cold plunge, make sure you start your day with it. Make sure you do it before training. You should really try to avoid finishing that workout and jumping right out into that maybe that cold plunge in the in the gym parking lot, because this research is really so profound of you're leaving maybe 20% improvement in strength and hypertrophy on the table when you cold plunge after training if you don't. So cold plunging, what is it? How does it work? Does it have a negative effect? Yes, it seems to. But also, that doesn't mean that we should say just don't do it. If you enjoy it, if it helps you start your day, if it helps you feel less sore, by all means, cold plunge. But let's rearrange when you cold plunge in your day to make sure that we're not doing it after training. And let's make sure we're doing it correctly up to our neck in the water, cold water, 40 to 50 degrees Fahrenheit. And duration should be at least 10 minutes, right? If you're just up to your knees in 60 degree water for two minutes, you're not actually cold plunging. You should feel good. You're probably not going to get a negative effect from that because you're not doing it correctly. But you're also leaving a lot on the table by not doing it correctly. So cold plunging. Hope this was helpful. We just revamped week five of our Central Foundations course to include a whole bunch of different training modalities like cold plunging. We talk about hot tubs now. We talk about saunas, both infrared and traditional saunas. We talk about compression therapy, massage, pneumatic boots, massage guns, everything folks have a question about. So if you've already taken the Central Foundations, head on over, check out week five for that update. If you haven't taken it yet, remember, September 11th is your next chance. So have a fantastic weekend. I hope you all have a lovely long four day weekend for 4th of July. We'll see everybody next time. Bye everybody. 18:00 OUTROHey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CU's from home, check out our virtual ice online mentorship program at PT on ice dot com. While you're there, sign up for our hump day hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to PT on ice dot com and scroll to the bottom of the page to sign up.

Adam Levitan, Mike Leone, and Justin Herzig discuss best ball strategy to help you separate from the rest of the field. They share some different strategies and ideas to help differentiate your teams. This is the final podcast of a six-part series to prepare you for #BestBallSummer. In this episode, we discuss: Everything you need to know to help differentiate your best ball teams Links mentioned in the episode: Leone's Best Ball Mania Manifesto 2023 Best Ball Playoff Schedules ETR's 2023 Late-Round RB Targets Timestamps: (2:18) - 4-TE builds (10:37) - What to do after you get an elite TE or QB (14:46) - Handcuffs (19:15) - Stacking without the QB (22:27) - Two QBs from a Week 17 game (25:18) - Bye weeks (29:35) - What times to draft WE CAN HELP: Tired of attention-seeking hot takes? Get the highest-quality analysis in fantasy football in your inbox, FREE. Join our email list today and we'll send you a FREE copy of our Best Ball Guide covering the 5 Biggest Mistakes To Avoid While Drafting: https://bit.ly/establishtherun Want ETR on your team this season?  Our 2023 DRAFT KIT has you covered with: Silva's Top 150 and Tiers for Drafting Continuously Updated Rankings for Every Format Sleepers and Busts Best Ball, Dynasty, and Season-Long Props (Draft Kit Pro) And tons more! All in one place. Subscribe now at https://establishtherun.com/subscribe/ $100 BONUS: Looking to play Best Ball on Underdog? If you don't have an Underdog account yet, use promo code “ETR” for a first deposit match up to $100. SIGN-UP LINK: https://play.underdogfantasy.com/p-establish-the-run DFS OPTIMIZER: We have launched a new tools company called THE SOLVER.​​ THE SOLVER will not have any content - just the software we think fantasy players need to win.​ ​Check it out: https://thesolver.com/?ref=etr FOLLOW US: Check out our social media channels for FREE fantasy football & DFS videos, analysis, and more: https://linktr.ee/establishtherun

Student challenges provide insight into the design and test processes used by NASA.

David Brin is a scientist, speaker, technical consultant and world-known author. His novels have been New York Times Bestsellers, winning multiple Hugo, Nebula and other awards. At least a dozen have been translated into more than twenty languages.His 1989 ecological thriller, Earth, foreshadowed global warming, cyberwarfare and near-future trends such as the World Wide Web. His 2012 novel Existence extends this type of daring, near future extrapolation by exploring bio-engineering, intelligence and how to maintain an open-creative civilization. A 1998 movie, directed by Kevin Costner, was loosely based on The Postman.Brin serves on advisory committees dealing with subjects as diverse as national defense and homeland security, astronomy and space exploration, SETI and nanotechnology, future/prediction and philanthropy. He has served since 2010 on the council of external advisers for NASA's Innovative and Advanced Concepts group (NIAC), which supports the most inventive and potentially ground-breaking new endeavors.His non-fiction book — The Transparent Society: Will Technology Force Us to Choose Between Freedom and Privacy? — deals with secrecy in the modern world. It won the Freedom of Speech Prize from the American Library Association.

NASA's Innovative Advanced Concepts program gives $600k grants to six. DARC's space situational awareness needed stat! Future of Roscosmos at Baikonur in question. Interview with NSA Deputy Director of Compliance Dr. Diane Janosek on her research on nanosatellites and what they mean for the proliferation of Internet of Things devices. And more. Remember to leave us a 5-star rating and review in your favorite podcast app. T-Minus Guest Our first guest ever on T-Minus is… friend of the show Dr. Diane Janosek, Deputy Director of Compliance at the National Security Agency.  She joins us to discuss nano-satellites, IoT, and cybersecurity for space systems. Follow Diane on LinkedIn. Selected Reading Free Event: From Surviving in Space to Thriving In Space: Closing the Human Factors “Technology Gap” New photo reveals extent of Centaur V anomaly explosion | Ars Technica Virgin Orbit's would-be white knight and a $200 million rescue that fell flat | Reuters Pulverizing dangerous asteroids, building an observatory on the moon and more: 6 wild ideas catch NASA's eye | Space.com 'Absolutely critical' to get DARC space situational system to Australia: Space Forces Indo-Pacific head | Breaking Defense  To Deter Attacks in Space, US Needs Resilience—and an 'Offensive Threat,' Experts Say | A&SF Magazine More context: ‘Lower the Rhetoric' on China, Says Milley | Defense One  More more context: SDA's Tournear ‘Just Not' Afraid of Satellite Shootdowns. Supply Chain Is the Greater Worry | A&SF Magazine Sunset For Baikonur? A Contract Dispute With Kazakhstan Flashes Warnings For Russia's Legendary Spaceport | RadioFreeEurope  Port Canaveral seeks solutions to broker smooth cruise and space relationship | Orlando Sentinel https://vote.webbyawards.com/PublicVoting#/2023/social/social-campaigns/education-discovery Audience Survey We want to hear from you! Please complete our wicked fast 4 question survey. It'll help us get better and deliver you the most mission-critical space intel every day. Want to hear your company in the show? You too can reach the most influential leaders in the industry. Here's a link to our media kit. Contact us at space@n2k.com to request more info about sponsoring T-Minus. Want to join us for an interview? Please send your interview pitch to space-editor@n2k.com and include your name, affiliation, and topic proposal, and our editor will get back to you for scheduling. T-Minus is a production of N2K Networks, the news to knowledge network for professionals. © 2023 N2K Networks, Inc. Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, Ed Frawley shares a question from the Ask Cindy database.  Today's question focuses on some feedback this person got from different trainers and was looking for another trusted opinion. | Links mentioned: Engagement Skills with Forrest Micke - Online Course: https://university.leerburg.com/Catalog/viewCourse/cid/6 | The Power of Training Dogs with Food with Michael Ellis - Online Course: https://university.leerburg.com/Catalog/viewCourse/cid/84 | The Power of Playing Tug with Your Dog with Michael Ellis - Online Course: https://university.leerburg.com/Catalog/viewCourse/cid/88 | Engagement with Michael Ellis - Online Course: https://university.leerburg.com/Catalog/viewCourse/cid/176 | Advanced Concepts in Motivation with Michael Ellis - Online Course: https://university.leerburg.com/Catalog/viewCourse/cid/102 | Reinforcement Schedules with Michael Ellis - Online Course: https://university.leerburg.com/Catalog/viewCourse/cid/174 | Toys: https://leerburg.com/toy.htm | About Us: https://leerburg.com/aboutus.htm

This week's product call will be hosted by Gina Hawks. She'll be covering advanced concepts for Indexed Universal Life!

In this episode of Chasing the Insights, I talk to the multi-talented Nancy Perpall. Nancy talks to us about her journey to write her book. Nancy Perpall began her professional career as a critical care nurse working in the Emergency Room and the Intensive Care Unit. While practicing nursing, she published articles in nursing journals and co-authored a textbook, Advanced Concepts in Clinical Nursing (J.B. Lippincott, 1974). She entered Villanova Law School in her early 30's, and after graduating, Nancy practiced Family Law. Nancy was appointed by the Supreme Court of Pennsylvania as Chair of the State's Domestic Relations Rules Committee and presented seminars to lawyers and judges and published widely in that field. Nancy's debut novel, Around Which All Things Bend, was just published in 2022 and is available on Amazon, in Barnes & Noble, and wherever books are sold. Her upcoming book, The Malnourished Marriage: 5 Essential Emotional Nutrients for a Healthy Relationship, will be published this year.

In this episode, Ed Frawley shares a question from the Ask Cindy database. Today's question focuses on engagement with a young, but a maturing puppy. This question asks how to improve engagement around other dogs. | Links mentioned: | Engagement Skills with Forrest Micke - Online Course: https://university.leerburg.com/Catalog/viewCourse/cid/6 | Training the Recall with Michael Ellis - Online Course: https://university.leerburg.com/Catalog/viewCourse/cid/176 | Leerburg Long Lines: https://leerburg.com/longlines.htm | Why Dog Parks are a Bad Idea - Article: https://leerburg.com/dogparks.htm | The Power of Training Dogs with Food with Michael Ellis - Online Course: https://university.leerburg.com/Catalog/viewCourse/cid/84 | The Power of Playing Tug with Your Dog with Michael Ellis - Online Course: https://university.leerburg.com/Catalog/viewCourse/cid/88 | Advanced Concepts in Motivation with Michael Ellis - Online Course: https://university.leerburg.com/Catalog/viewCourse/cid/102 | Training Treats and Bait Bags: https://leerburg.com/treats.htm 

To learn more about Jim's FREE retirement webinars coming January 2023 go to https://paytaxeslater.com/webinarsIn this third video in this Roth series, Jim Lange discusses the advanced concepts of making Roth IRA Conversions while also answering questions from the live room. If you've heard enough over the last few videos and want to know more and work with Jim, he discusses that as well! Go to https://paytaxeslater.com/contact-us to find out how to reach our offices.  00:00 - Power of a Series of Conversions/Should You Convert?00:58 - Inflation and Roth IRA Conversions03:25 - Schedule a Retire Secure Consultation Today!07:38 - Questions from the Live Room 1 - 'For the disabled beneficiary exemption to the SECURE Act 10-year stretch, what specifically needs to be done by a client to quality their disabled child ahead of time? Is receiving SSDI sufficient?'12:53 - Questions from the Live Room 2 - 'I understand this is a challenge to predict, but what future decisions by Congress could make it disadvantageous to make a Roth IRA Conversion?'16:51 - Questions from the Live Room 3 - 'Going back to the market timing thought, do you recommend waiting to do Roth Conversions until later in the year if you are awaiting a potential bearer market?'20:02 - Advanced Concepts in a Roth IRA Conversion 

Nancy Perpall is a former critical care nurse who used conflict resolution to get her patients the best care. As a practicing divorce attorney for the last 30 years, she's used conflict resolution to get her clients the best results. As a former Chair of The Supreme Court of Pennsylvania's Domestic Relations Rules Committee, she championed rules to promote conflict resolution through mediation as an alternative to litigation.Nancy's upcoming how-to book, The Malnourished Marriage – 5 Essential Emotional Nutrients for a Healthy Relationship, is a conflict resolution buffet of food for thought to help couples bilge a diet of discontent and feed their hunger for love. Nancy's novel, Around Which All Things Bend, is a story about relationships and how far we're willing to bend for love.Nancy began her professional career as a critical care nurse working in the Emergency Room and the Intensive Care Unit. While practicing nursing, she published articles in nursing journals and co-authored a textbook, Advanced Concepts in Clinical Nursing (J.B. Lippincott, 1974).She entered Villanova Law School in her early 30's, and after graduating, Nancy practiced Family Law. Nancy was appointed by the Supreme Court of Pennsylvania as Chair of the State's Domestic Relations Rules Committee and presented seminars to lawyers and judges and published widely in that field.www.nancyperpall.com

The Enceladus Vent Explorer, or EVE, would dive deep into a steep crevass where water-ice jets burst from the ocean below.

Dogs that bark, growl, lunge, snarl, and snap when on-leash. Also known as leash reactivity, this is one of the most common issues a dog trainer may be asked to help with. In this episode of The Bitey End of the Dog, I have the pleasure of chatting with Jessica Wheatcraft, who I consider one of the best out there on understanding and working with this issue. Jessica and I take a deep dive into the topic of leash reactivity and explore advanced concepts that we can incorporate in even the most difficult of cases. And don't forget to check out The Aggression in Dogs Conference where Jessica will be presenting on this very topic of Advanced Concepts in Leash Reactivity – What, When, and How to Change Criteria. For additional resources on helping dogs with aggression, visit:https://aggressivedog.comHere is the special link to The Aggression in Dogs Master Course and Expert Webinar Bundle. Offer expires on 11/1/22.https://aggressivedog.thinkific.com/bundles/the-aggression-in-dogs-master-course-and-expert-webinar-bundleDon't miss out on the third annual Aggression in Dogs Conference  9/30-10/2/22:https://aggressivedog.com/conference/About Jessica:Jessica Wheatcraft, CDBC, CPDT-KA is the Owner and Director of Behavior and Training at Instinct Dog Training San Diego. She and her team help San Diego dogs and humans live better lives through practical, positive, and effective training & behavior programs. Jessica has over 15 years of training and behavior consulting experience, working with thousands of pet dogs and their families. She has specialized in behavior issues for the past 10 years, specifically leash reactivity and aggression cases. She takes a comprehensive approach in understanding each individual dog, and tailoring her training plan accordingly. https://www.instinctdogtraining.com/personnel/jessica-wheatcraft/Support the showSupport the show

Calling all Star Trek fans! Chester L. Richards, the co-writer of "The Tholian Web" episode of Star Trek, joins in the conversation, and it's fascinating!! Some of his stories are almost unbelievable like the story about almost being killed by the great potato, the Colorado River, a crocodile, a crazed gunman...In this episode:What it was like when a rocket engine blew upWorking with the royalty of the industryMeeting astronautsMaking something that's actually space-qualifiedWhat hooked him on scienceHis UFO encounterSR71 planesUFOs or swarms of insects?How he came up with the Tholian WebWhat he thinks of William ShatnerWhat he thinks about the newer Star TrekThe closest to death he's comeHow his wife's eulogy affected himLosing his wifeAbout Chester:Prior to retirement, Chester L. Richards was an Engineering Fellow at Raytheon Space and Airborne Systems Division. At Raytheon he was Chief Architect for Advanced Concepts and Architectures. Before joining Raytheon Mr. Richards had an engineering consulting business. His diverse technology career spans half a century. At the beginning of his professional life as a scientist, Mr. Richards invented and patented the first successful automatic focus sensor using real-time image analysis. It was used in aerial reconnaissance cameras. Subsequently, while at the Ford Aerospace Corporation, Mr. Richards was Chief Engineer for Strategic Systems. At Ford he developed the flight instrumentation for the AGNT space flight and re-entry experiment. Mr. Richards invented and patented the Holographic Optical Element which is widely used in large aperture adaptive optics telescopes. Mr. Richards also invented, and successfully field tested, sub-resolution tracking techniques which improved tracking accuracy by two orders of magnitude.During part of his career Chester L. Richards served as a System Engineering Technical Assistant (SETA) consultant to the U.S. Government. In this role Mr. Richards developed the modern Space Based Laser architecture for the Strategic Defense Initiative Organization. He was a member of SDIO's Mission Analysis Working Group and its Innovative Science and Technology group. As SETA he helped define the functional architecture of Schriever Space Force Base and wrote the Statement of Work establishing the requirements for the base. For the Air Force, Chester L. Richards created the definitive high fidelity sensor model for the DSP satellite series. In addition, he developed high precision target tracking techniques for the Hover Test Facility at Edwards Air Force Base. At Raytheon one of his most important discoveries was the complete quantitative theory of bistatic radar, which previously had been only partially understood. This led to multiple fielded applications. The technical interests of Mr. Richards include system architecture, space systems, physical optics, high energy lasers, image processing, radar, ergonomics, and jet and rocket propulsion. Other activities include: Co-author of “The Tholian Web” script for the third season of the original Star Trek series.  Chester L. Richards has a Bachelor's Degree in Physics from UC Berkeley and a Masters in Physics from UC Irvine. He completed all course work for PhDs in both Physics and Engineering at UC Irvine. Mr. Richards has 19 patents. His latest patent is for a centrifugal gas generator for gas turbine engines. https://www.chesterlrichards.com