Podcasts about amrap

Ever catch yourself staring at the barbell like it's about to attack? Or walking to your next station like it's a coffee run?This episode cuts straight into transition time: the space between movements where most athletes unconsciously lose intensity, waste time, and leave gains on the table. We'll break down why this silent killer is ruining your training density, how fake pacing is holding you back, and exactly what to do to fix it.If your effort doesn't match your rest, your results won't match your goals.What You'll Learn:• Why transition time is the most overlooked part of your workout• The 3 biggest transition mistakes (and how to fix them)• The difference between real pacing and fake effort• How to program and train faster transitions for better results• A simple AMRAP challenge to expose your gapsChallenge: Try a 7-minute AMRAP with sub-5-second transitions. Let's see what happens when urgency meets effort.

HYROX Training OverviewHYROX training is a hybrid approach blending endurance, strength, and functional fitness to prepare for the race's unique demands. It differs from regular workouts by emphasizing speed, intensity, and the ability to perform under fatigue, as the 1km runs are interspersed with exercises that tax different muscle groups. Training focuses on building aerobic capacity, muscular endurance, and efficient transitions between running and stations.Key Components of HYROX TrainingRunning (Endurance):Running makes up 50% of the race (8km total), so it's critical to build aerobic capacity and get comfortable running in a fatigued state ("compromised running").Training Tips:Incorporate interval training (e.g., 6 x 200m sprints with 1-minute rest) to improve speed and lactic threshold.Include long, steady-state runs (Zone 2, conversational pace, 40–60 minutes) to build aerobic base.Practice running after strength exercises (e.g., 1km run post-sled push) to simulate race conditions.Use low-impact cardio like rowing or SkiErg to reduce injury risk while building endurance.Functional Strength Training:HYROX stations require strength and muscular endurance for movements like sled pushes, farmers carries, and wall balls. Exercises are simple but performed at high intensity.Key Exercises:SkiErg: Focus on arm, shoulder, and core endurance. Practice 1000m efforts with proper form.Sled Push/Pull: Train with single-leg step-ups, deadlifts, or squats to build leg and core strength. Sled weights vary (e.g., 152kg for Men's Open, 102kg for Women's Open).Farmers Carry: Use heavy kettlebells or dumbbells to enhance grip strength and core stability.Wall Balls: Practice thrusters or squats to prepare for 100 reps.Lunges and Burpees: Incorporate weighted lunges and burpee broad jumps for leg endurance and power.Training Tips:Perform compound movements (squats, deadlifts, overhead presses) 1–2 times weekly with higher weights and lower reps for strength.Use high-rep circuits (e.g., AMRAP or EMOM) to mimic race intensity.Train grip strength for farmers carry and sled pull with exercises like dumbbell holds or pull-ups.Compromised Workouts:Simulate race-day fatigue by combining running with functional exercises (e.g., 1km run + 25m sled pull x 3 rounds).HIIT finishers after runs (e.g., 10 burpees every 1km) build resilience under fatigue.Transition Training:Practice moving quickly between exercises to minimize downtime, as smooth transitions can shave seconds off your time.Recovery and Nutrition:Recovery: Include active recovery (e.g., light cycling, yoga) and prioritize sleep to prevent burnout.Nutrition: Focus on balanced meals with carbs for energy, protein (1.6–2g/kg body weight) for recovery, and healthy fats to support overall health. Meal prep with variety helps maintain consistency.HYROX training can aid weight loss if paired with a calorie-controlled diet, but overeating can negate benefits.Website www.luxelifediscovered.com Youtube Roku Amazon Fire TV

Delilah Rose is Brisbane-based self-described “neuro-divergent songwriter, doodler, mama of two small humans, and bold performer”. A musician since her twenties, she’s played shows across Australia; was nominated for Best Country Act (at the Western Australia Music Awards) and her single Thin Black Line reached #1 on the AMRAP charts. When not making her own music (including new single Sophia) Delilah's other pursuits include running “The Song Café”: a monthly event showcasing Women, First Nations and Non-Binary songwriters. When you hear here and love her (which you will) you’re understand the music she makes is not your Nanna’s type of country - so much to unpack!.See omnystudio.com/listener for privacy information.

"Simple & Repeatable"AMRAP 9:00-1...2...3... Squat Snatch 155/105lb*40 Double Unders after each set» View the Video Version: https://youtu.be/PlJZrisSt-U» Hire a Coach: https://zoarfitness.com/coach/» Shop Programs: https://www.zoarfitness.com/product-category/downloads/» Follow ZOAR Fitness on Instagram: https://www.instagram.com/zoarfitness/Support the show

Join Cheryl Lee - That Radio Chick on STILL ROCKIN' IT for news, reviews, music and interviews with some of our favourite Australian musicians.Kevin Borich's musical odyssey began with an olive oil can and a rusty trumpet on the back steps of his childhood home in New Zealand. Sixty years and over twenty albums later, the 78-year-old guitar virtuoso shows no signs of slowing down. "The R word is nowhere near," he laughs, describing a recent performance where fans went "nuts" down front, singing along to every lyric.This legendary Australian musician is preparing for a historic one-night-only performance in Adelaide alongside fellow rock icons John Swan and Dave Gleeson. The collaboration stems from Borich and Swan's time together in the Party Boys and their recent work on Borich's acclaimed "Duets" album, which also featured collaborations with Joe Walsh, Ian Moss, Tim Rogers, and other music luminaries.Throughout our conversation, Kevin shares extraordinary stories from a career that's intersected with rock royalty. Carlos Santana calling him onstage before 60,000 fans. Richie Blackmore of Deep Purple showing up at his gig after hearing him play. Jamming with Bo Diddley, an early influence who shaped his rhythmic sensibilities. These moments paint the picture of an artist whose talent has earned the respect of the very musicians who inspired him.From his beginnings with the La-De-Da's to performing at landmark Australian events like the 1972 Sunbury Festival and New Year's Eve celebrations at the Sydney Opera House, Kevin has consistently delivered authentic, passionate rock music. His recent successes—including his "Legacy" album topping AMRAP charts for three months—demonstrate an artist still exploring his creative potential.What comes through most clearly is his unwavering love for performance and connection with audiences. Even as he acknowledges challenges like the rising cost of living affecting live music attendance, his enthusiasm for the upcoming Adelaide show is palpable. He's "getting oiled up" for rehearsals, ready to deliver another unforgettable night of Australian rock history in the making.Don't miss this rare opportunity to witness Kevin Borich, John Swan, and Dave Gleeson sharing the stage for one extraordinary performance that promises to showcase the enduring power of Australian rock music at its finest.What has Kevin Borich been up to lately?  Let's find out!!Get out when you can, support local music and I'll see you down the front!!Visit: ThatRadioChick.com.au

Dr. Guillermo Contreras // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Fitness Athlete Division faculty member Guillermo Contreras explores the concept of AMRAP sets (As Many Reps As Possible) and their significance in strength training and rehabilitation. Guillermo begins with the importance of strength improvement for clients in various settings, including athletes and post-operative patients. He emphasizes that nearly 90% of patients aim to enhance their strength as part of their recovery or fitness goals. Guillermo delves into the science behind muscle hypertrophy, highlighting that effective muscle growth can occur even at lower percentages of one-rep max, starting at around 30%. Guillermo lays the groundwork for understanding how AMRAP sets can be utilized to achieve strength and hypertrophy goals effectively. Tune in to learn more about integrating these techniques into your training regimen! Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn from our 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.

The 4 Questions We're Answering: 1. How can we effectively incorporate mobility and maintenance work into our daily routines to enhance performance and prevent injury? 2. What mental strategies should we use to approach AMRAP workouts versus for-time workouts to optimize performance in each format? 3. How do we handle situations where children resist participating in physical activities, while ensuring they develop healthy lifestyle habits? 4. What's the most effective way to incorporate swimming into an existing strength and conditioning program for balanced fitness development? 

"Big Fish, Little Pond"AMRAP 15:00-3...6...9... Back Squat 225/155lb*after each set: 30/25 Calorie Row» View the Video Version: https://youtu.be/YaInr9ElaVM» Hire a Coach: https://zoarfitness.com/coach/» Shop Programs: https://www.zoarfitness.com/product-category/downloads/» Follow ZOAR Fitness on Instagram: https://www.instagram.com/zoarfitness/Support the show

Time-Efficient Workouts for People with Full-Time JobsLife's busy — between work, family, and other responsibilities, finding time for fitness can feel impossible. But here's the good news: you don't need endless hours at the gym to stay fit. Efficient workouts tailored to your schedule can help you stay strong, lose weight, and feel energized.Go for AMRAP or EMOM WorkoutsAMRAP (As Many Rounds as Possible) and EMOM (Every Minute on the Minute) routines are perfect for maximizing time. Grab a kettlebell and try a 15-minute AMRAP with exercises like swings, squats, and presses. Strength and Cardio ComboCombine strength moves with cardio bursts to save time. Think squats followed by jumping jacks or kettlebell deadlifts followed by mountain climbers.Morning QuickiesSet your alarm 20 minutes earlier and crush a short workout before the chaos begins. You'll boost your metabolism and start your day strong.Lunchtime Power MovesIf mornings aren't your thing, use part of your lunch break for a brisk walk or a 15-minute circuit. Active Family TimeGet the family involved! Go for evening walks, do a quick circuit in the living room, or challenge your kids to a plank contest.

"Popcorn"AMRAP 12:009...12...15...-Shoulder-to-Overhead 95/65lb5...10...15...-Box Jump Overs 24/20"» View the Video Version: https://youtu.be/38BK9xKd0w8» Hire a Coach: https://zoarfitness.com/coach/» Shop Programs: https://www.zoarfitness.com/product-category/downloads/» Follow ZOAR Fitness on Instagram: https://www.instagram.com/zoarfitness/Support the show

Workout 1: 10x40 yd hill sprints Workout 2: 10 Rounds for Time: 10 Split Jumps 10 Burpees Workout 3: Cindy 20 min AMRAP: 5 pull-ups/ 10 pish-ups/15 air squats Workout 4: Barbara 5 Rounds for Time: 20 pull-ups/ 30 push-ups/ 40 sit-ups/ 50 squats *3 minute rest after each round Workout 5: Bradley 10 Rounds for Time: 100m sprint/ 10 pull-ups/ 100m sprints/ 10 burpees *30 sec rest after each round Workout 6: Prison Triceps 3 Rounds: 20 Dips/ 20 Diamond Push-Ups/ 20 Overhead Tri Ext *push final round for extra reps Workout 7: 10 minute AMRAP: 10 pike push-ups/ 15 v-ups/ 20 walking lunges

Running a business when you have kids means you're always flip flopping between feeling guilty about not working on your business or not being present with your kids. It's a tough line to walk, but you can find a way to make it work. Implementing an AMRAP mentality with your family and using the 3 Column Method to manage your business The Life Sequencing Problem and creating seasons for explosive growth Creating your own '75 Hard' to minimize feelings of guilt -- Please dm Jon the word "mentor" at @itscoachgoodman on Instagram to learn more and begin the process of applying for the Online Trainer Mentorship -- Jon's next book, The Obvious Choice, published by HarperCollins, is now available for preorder on Amazon in Hardcover, Kindle, and Audio. Please preorder your copy today. -- FREE GIFT - Get a free copy of the Wealthy Fit Pro's Guide to Getting Clients and Referrals (digital and audio. Sells for $22.99 on Amazon.) HOW - Rate / review this podcast, take a screenshot, and send it to obviouschoicepod@gmail.com -- Hosts: @itscoachgoodman @fitnessjonestraining @amberreynolds.me -- Join 72,000+ trailblazers, leaders, and coaches who fuel up with our low-stress, high-impact 5 REPS FRIDAY newsletter at www.5repsfriday.com. The Obvious Choice podcast is presented by QuickCoach - free, professional software for fitness and nutrition coaches that elevates the value of what you do. Join 35,000+ coaches and get your account today at www.quickcoach.fit.

Mike "C-Roc" sits down with Jason Khalipa, a renowned CrossFit Games champion and the founder and CEO of NC Fit. Jason, celebrated for his achievements in fitness and his role as a pediatric cancer advocate, shares his compelling journey of overcoming adversity and finding strength through life's trials. Jason delves into his experiences as a three-time Team USA CrossFit member, detailing his transition from competitive fitness to becoming a business leader. He also opens up about the emotional journey his family endured when his daughter was diagnosed with leukemia. Through this challenging period, Jason discovered the profound impact of the AMRAP (As Many Reps As Possible) mentality, which emphasizes mental toughness and resilience both in fitness and life. Listeners will gain insights into how CrossFit training fostered Jason's mental strength and prepared him for life's toughest challenges. He discusses the importance of maintaining family unity and strength during a crisis, the transformative power of community support, and the significance of being present and focused in every aspect of life. Jason's story is a testament to the power of the AMRAP mindset in navigating adversity and making the most of every moment. Website- jason@nc.fit Social Media Links/Handles: https://www.th.fit/ https://www.instagram.com/jasonkhalipa/?hl=en

In this episode, we're diving into the world of CrossFit jargon to help you get a grip on the lingo that's essential for your workouts. Ever puzzled over what WOD, AMRAP, or EMOM really mean? We've got you covered. Join us as we break down these CrossFit acronyms, explaining what they stand for, how they impact your training, and why knowing them can elevate your fitness game. Our coaches are here to clear up the confusion and guide you to a more confident and enjoyable CrossFit experience. Tune in and get ready to master the language of CrossFit!

In this episode, I discuss whether you should prioritize sleep or training when sleep-deprived, shoulder impingement fixes, strategies to make stubborn muscles grow, and lots more. As always, these questions come directly from my Instagram followers, who take advantage of my weekly Q&As in my stories. If you have a question you're dying to have answered, make sure you follow me on Instagram (@muscleforlifefitness) and look out for the Q&A posts. Your question might just make it into a podcast episode! If you like this type of episode, let me know. Send me an email (mike@muscleforlife.com) or direct message me on Instagram. And if you don't like it, let me know that too or how you think it could be better. Timestamps: (3:41) Should I work out on 5-to-6 hours of sleep or prioritize sleep and do fewer workouts per week? (9:28) Why is Thinner Leaner Stronger recommended for women under 40? (10:20) I've been drinking salt water during my workouts. What are the signs I'm consuming too much salt? (11:18) How can I grow stubborn muscles? (17:40) What are your thoughts on training calves unilaterally? (22:36) Can using an air fryer help control calorie intake? (24:47) What's the best way to fix shoulder impingement? (25:52) Do you do AMRAP sets for most of your main exercises? (28:15) I just had ACL surgery and will be sidelined for a bit. How do I maintain my muscle? (29:00) Do you have any book recommendations on time management? (29:35) Is it bad to do sauna after heavy lifting phases for lean gaining? (31:31) The bar isn't touching my shins during deadlifts. Is that a problem? (33:13) What's the best way to boost my immune system to avoid catching colds from my kids? (35:24) Since we shouldn't eat ultra-processed foods, how healthy are whey protein and other supplements? (40:55) Any thoughts on natural tea supplements that use ingredients like tongkat ali, boron, and magnesium? Mentioned on the Show: Buy Legion Pulse Buy Legion Phoenix Bigger Leaner Stronger Thinner Leaner Stronger Legion One-on-One Coaching

We have questions for Niki Sims (and she has answers)! Learn more about Niki, her thoughts on training and life, and her goals. Questions for Niki Sims: Training, Success, & Motivation Andrew asks Niki an assortment of questions. What is a particularly memorable success story from one of your clients? A story that stands out (and there are more, but this one jump into her head) is a daughter of a client who started to lift. Her family lifts, and so she started to lift. Niki could tell something was off, but her client was not talkative. Finally, the client told Niki her back was hurting. Niki change the training and let her know training should not hurt or be something you don't look forward to. Now, she loves training, she is into it, and you can see the different in her videos. How do you stay motivated to train consistently and what advice do you give to those struggling with motivation to train?  For Niki, this has become the favorite part of her day. She has tailored the time and space to what she wants. She has removed things she does not want. If a lift is painful, she takes it out. She has her own home gym she loves. This time is a time without work (except work against gravity). You should make this as fun and enjoyable and comfortable as you can - this includes the exercises you are doing but also the space, music, and more. Questions for Niki Sims: Goals, Mentors, & the Future Niki and Andrew continue. What are your personal fitness goals and how are you working toward them?  Niki is working on her chin-ups, both 1RM and AMRAP. Besides this, she wants to consistently train four days a week with fun training sessions to get more meat on her body. Additionally, she learning how to eat to support this. Who are some of your mentors in the fitness industry?  Matt Reynolds has helped, but especially when it comes to learning about the business side of the industry. Niki las learned much from Andrew Jackson on how to organize work to be more effective and efficient. Gillian Ward, Niki's coach, has been a huge mentor, from whom Niki has learned a ton. Lastly, Niki loved to see how Dan Campbell of the Detroit Lions infused passion into the everyday work of the team. Where do you see the industry heading in the next 5-10 years? Gyms will get better and better, especially in terms of equipment. AI programming will mean less manual input but more data. You will be able to go into a gym with your program and not have to enter anything manually. You will know exactly what is available in the gym in your App. These are questions for Niki Sims. Check out the Barbell Logic podcast landing page. Get Matched with a Professional Strength Coach today for FREE! No contract with us, just commitment to yourself: Start experiencing strength now: https://store.barbell-logic.com/match/ Connect with the hosts Matt on Instagram Niki on Instagram Andrew on Instagram Connect with the show Barbell Logic on Instagram Podcast Webpage Barbell Logic on Facebook Or email podcast@barbell-logic.com

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 principle of Specific Adaptations to Imposed Demands (SAID), the principle of Somewhat Humdrum Adaptations to Rehab Treatment (SHART), and how to help patients & athletes reach & meet specific goals. Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn from our 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 everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PT on ICE Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at signup to receive a one-month free grace period on your new Jane account. ALAN FREDENDALL Good morning, PT on ICE Daily Show. Happy Friday morning. I hope your day is off to a great start. Welcome to the PT on ICE Daily Show. It is Fitness Athlete Friday. I'm your host, Alan. I currently have the pleasure of serving as our Chief Operating Officer here at Ice and the Division Leader in our Fitness Athlete Division. We're here on Friday, Fitness Athlete Fridays. We talk all things CrossFit, Functional Fitness, Endurance Athletes. If you have a patient or client who is active on a regular basis, Fridays are for you. We have an exciting announcement next week you'll see on our social media. An entire week, thanks to dry needling faculty member Paul Killoren, an entire week dedicated to the deltoid. So you'll see the podcast next week, all the episodes will be about the deltoid, and you'll see all of our social media posts next week focused on educating you, everything related to the deltoid muscle. If you've taken our upper body dry needling course with Paul, you know that he has quite the obsession with the deltoid muscle. So we're really excited to see just how much shoulder content we can give you all next week. So tune in beginning June 3rd for an entire week of deltoid themed content. Today, the topic for Fitness Athlete Friday, what are we talking about? The SAID principle, specific adaptations to impose demands. You may have heard of this principle at some point in your life. You probably heard a very generalized definition of this term that maybe did not really help you understand what it is or how it could possibly apply. to exercise or to clinical practice. WHAT IS THE SAID PRINCIPLE? So the SAID principle, really, again, very basic definition that training a particular movement pattern, training a particular skill, training a particular time domain or energy system will result in the most efficient adaptation to that imposed stimulus that imposed demand on the body. And when we uncover, when we unpack the definition of the said principle a little bit more, we talk about actually the two ways that we see changes from this. The first being structural, that we see muscle size and shape takes place, and the other being neuro or neuromuscular, that we get a more efficient recruitment of muscle fibers, that we're able to recruit more fibers, larger fibers, recruit them in a more efficient sequence, so on and so forth. So that's the said principle in a nutshell. Today we're gonna talk about why it matters, give you a practical example from the gym, give you a practical example from the clinic and kind of wrap up why maybe we need to reconsider this. Maybe if we did learn this back in high school or undergrad or grad school or maybe all of them, maybe why we need to consider this more often in our practice, whether we're working with patients in the clinic or athletes out in the gym or a more active setting. So when we interact with folks in the clinic, whether they're patients for physical therapy, whether they're athletes coming to us maybe even for performance help, they don't necessarily need help with a physical therapy related issue. They come in and they may complain about a plateau about not making progress with their physical therapy about not making progress with their performance in the gym in their running plan or whatever. And if we take the time to unpack, and if we take the time to assess a couple things, what we usually find with these folks is they seem to be at a plateau, but it's really because they're not doing things specific enough to create the adaptation that they're wanting from the stimulus that they're giving themselves. Their rehab exercises, their exercises in the gym, their strength training, their endurance training, whatever that might be. WHY DOES THE SAID PRINCIPLE MATTER? And so why does the said principle matter? Training similar things may result in some carryover, but people I think fail to understand that it won't result in the most efficient, time-wise, in the most efficient carryover to develop a specific skill, a specific movement pattern, a specific progress towards a goal. So we often say, hey, well, doing a bunch of strict pull-ups make you better at strict pull-ups. Yes, of course. Will doing a bunch of strict pull-ups make you better at free climbing El Capitan? Well, there's gonna be some carryover, right? But probably the best thing to do to get really better at free climbing is to do free climbing. And arguably, we would say and not or. The best thing to do would be to practice the thing you want to get better at and then do accessory stuff like strength training to further enhance your way onto goals. We see this a lot. In the gym and CrossFit, folks always complain about not being great at running. We do run in CrossFit, but often lower volume, shorter distances than someone who would consider themselves a runner would consider running. And so when folks want to improve their 5k time, or they want to run a 10k or a half marathon, or maybe even become a marathon runner, They often say, I'm not getting better at running. And when we ask, okay, how often are you running? And they say, oh, well, I hate running. Running bothers my shins. So every time there's running, I just row or bike. Again, is there going to be carryover from rowing or biking or doing some other cardiovascular modality to running? Yes, of course, but not as specific, not as great as if you did running training to improve your goal of getting better at running. There are certain things that happen when you run more, You get an improved running economy. You get more efficient in that movement pattern because you're spending time in that movement pattern. And yes. We can get cardiovascular adaptations from rowing or biking, but it's just not gonna translate 100% to that specific thing. So that is why the said principle matters. PRACTICAL EXAMPLE: "GRACE" When we look at our practical example in the gym, we just had a benchmark workout last week at our gym called Grace. You may have heard of this CrossFit benchmark workout. 30 clean and jerks for time at a standard barbell weight of 135.95. And talking to members that day, people asking, hey, like, what is the world record on this? Do you know? I do know it's it's 59 seconds, right? With some people completing it, CrossFit Games athletes under 90 seconds. And so the conversation began, okay, If this takes me eight minutes, and it takes them 90 seconds, what is the difference between them and me? And I think a really lazy answer when people want to improve their performance when they want to break through a plateau, whether that's in the clinic, whether that's in the gym is well, they're just in better shape than you, right? That's a very lazy answer. When we break down why is that person better at doing that workout than you, we can start to unpack some characteristics, some specific characteristics of why their performance is higher than yours. We look at somebody like Matt Frazier, five time CrossFit Games champion, a minute 18 clean and jerk, grace time 30 clean and jerks for time, which is faster than a clean and jerk every two seconds. So moving fast, moving unbroken for 30 clean and jerks, what do we know about that athlete? Again, the lazy answer would be, well, he's been doing CrossFit a long time and he's just in better shape than you. Yes, but why? And the why matters, the specifics matter because that can turn into a training program for a person who wants to maybe cut 15 or 30 seconds off their grace time. or cut time off their 5K, or get better at strict pull-ups, or rock climbing, or whatever, right? When we look at Matt Frazier, why is he better at that workout? A long history of Olympic weightlifting, very familiar with a movement like the clean and jerk, very efficient in the clean and jerk, very strong, not only in the clean and jerk, but the movements that support the clean and jerk, the front squat and the strict press, an athlete who can strict press above his body weight, an athlete who front squats several times his body weight, and an athlete who has a 425 pound clean and jerk, right? So when we look at 135 pound barbell compared to a 425 pound clean and jerk, a 500 pound front squat, a 250 pound strict press, we say, okay, this is a very strong individual and specifically related to things like the SAID principle, he is very well trained in this specific movement pattern. It makes sense that because this is an incredibly light barbell for him, but he can hang on to it for 30 reps, move it touch and go unbroken, and get that workout done in 90 seconds that might take you five minutes. Why? You don't have as strong of a clean and jerk. You don't have as strong of a strict press. You don't have as strong of a front squat. You aren't as efficient at cycling that barbell because you have not been doing CrossFit as well. And in specific, we also look at time domain, right? He is getting a workout done while he is still in the anaerobic glycolysis time domain. He still has a lot of high power output. versus when you transition, when it starts to take you more to two to three minutes, we know your power output goes down. We know you're transitioning into your aerobic energy system. He's getting it done because he's more efficient at it before he runs out of gas. And so, how do we take that and translate that to a training program for that athlete? Well, of course, we need to work on your front squat. We need to work on your strict press so that your clean and jerk gets stronger. We also need to train your clean and jerk so you get more efficient at clean and jerks. We need to train your clean and jerk where you do touch and go reps at a light to moderate weight so you get efficient in the endurance of the clean and jerk, not just the strength. And we need to train a very fast, explosive time domain for you, right? That is a great athlete where we might say, hey, every minute on the minute, I want you to do five clean and jerks, seven clean and jerks, 10 clean and jerks, progress it and make them work in the time domain in the movement they want to get better at, right? This is what endurance athletes do all day long. They progress their volume, they progress their time domain, and they get very specific in what they're doing, right running, biking, swimming, maybe all three of those, maybe just one of those, but spending a lot of time in the movement pattern you want to get better at spending a lot of time in the time domain you want to get better at. THE SAID PRINCIPLE IN THE CLINIC Switching gears, we see this happen in the clinic as well. Just like somebody is plateaued maybe on a workout like Grace, we have patients who are maybe plateaued in their plan of care. And if we're not careful, if we're not specific, if we're not assessing in the clinic, if we're not using our clinical reasoning, we can develop a very high quality loading program, a very high quality accessory program for the wrong area, for the wrong athlete, for the wrong time domain. I call this the specific humdrum adaptation to rehab treatment or the sharp principle, right? A very boring adaptation that serves no purpose, because that person in rehab was forced to do what we told them to do. And maybe we weren't giving them specific enough of a treatment. So without proper assessment, we may not know what people need to work on. And so we're often surprised and curious and maybe upset when Gladys comes in and she hasn't improved her 30 seconds sit to stand. She is still only getting four reps done in 30 seconds. She's been here for six weeks and we look back at her treatment plan and most of her treatments consist of coming into PT and riding the new step at zone one heart rate for 30 minutes or most of her session. We should not be surprised when we reflect back on the said principle that Gladys is making no meaningful improvement, right? She is struggling with a high power, short time domain demand, a 30 second sit to stand, and her treatment almost entirely consists of relatively low intensity, long duration endurance activity. Again, specifics matter. What we have our patients do, they will adapt to. If we give them the wrong stuff, or maybe just not as effective stuff to do, we should not be surprised when we do not see them make a lot of meaningful progress. We can see the same thing with patients who are symptomatic. Why are we surprised when Mark comes to the clinic, he's made no progress on his lateral elbow pain, and all we're giving him in PT is high volume, low load, banded, or lightly resisted exercises. We know that's a tendinopathy, we know it needs load, specifically it needs time under tension, and it needs progressive loading. Giving that person a high volume, low load dose is likely what caused that condition in the first place, so we should not be surprised that that person is not making any meaningful progress. So getting specific, adopting the said principle matters. Avoid the sharp principle. We can make people pretty averagely better at stuff they don't need to get better at or don't want to get better at if we're not careful with our rehab treatment. I truly believe we have a lot to offer patients and clients from both a rehab and performance perspective, but only if we take time to assess where is this person weak in their game? What is the most important thing or the maybe most important two or three things they need to work on? That's what our rehab plan, maybe that's what our accessory program for the training they're already doing should look like. Keep it specific, especially if that person needs or wants a specific result. We can be very good at giving a lot of general treatment that gives a lot of general improvements, but if it's not helping that person meet their specific goals, then it's not as effective as it could be. SUMMARY So remember, what is the said principle? Specific adaptations to impose demands, train in the time domain, exercise in the time domain they want to get better at, you want them to get better at, train the movement patterns they need to get better at, and you'll be surprised at how quickly somebody makes progress. Avoid the sharp principle. Avoid just giving a general exercise prescription. We see this a lot in students who are so happy to walk in and write down a 30-minute AMRAP on the board or 24-minute REMOM and sometimes we have to stop them. We appreciate the enthusiasm, but we have to let them know, hey, you're just giving that person a bunch of general stuff that may not translate to them getting specifically better at the stuff they need or want to get better at to meet their goals. We have a lot to offer, but we have to make sure that we're assessing, reassessing, and we're being specific. So I hope this was helpful. If you want to learn more from us in the fitness athlete division, we'd love to have you. A couple chances coming up in the month of June. Zach Long will be down in Raleigh, North Carolina, the weekend of June 8th and 9th. And then we have our Fitness Athlete Live Summit here in Fenton, Michigan. That's the weekend of June 22nd and 23rd. We'll have all of our lead faculty, all of our teaching assistants here. That's gonna be a really fun weekend. Online, our next cohort of fitness athlete level one online starts July 29th. That course always sells out. And then our next cohort of fitness athlete level two online begins September 2nd. So, I hope this was helpful. Remember, keep it specific. Assess, reassess, keep it specific. Have a great Friday, have a great weekend. 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.

On episode 262 of ABR, we are joined by Spencer Nix, the owner and chief researcher of Behavior & Performance Research. Spencer talks about his journey in the fitness industry that spans over two decades. He shares his experience of being a CrossFit Affiliate owner for more than ten years and his transition to creating BPR, which combines behavior and identity coaching with fitness and performance. Due to many similarities in their approach, a connection was bound to happen between Spencer and the team at BPR. Spencer's wealth of knowledge, heart, passion and authenticity impressed and inspired the Airey Bros. This episode is packed with valuable insights, and the conversation was so engaging that the hardest part was finishing it.Stay Connected Spencer NixBPR Instutite BPR Field ManualBPR Instagram

Alan Fredendall // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Fitness Athlete Division Leader Alan Fredendall discusses incidence of knee injury in functional fitness, common types of knee injuries seen in this space, and how to begin to treat knee pain for the fitness athlete. Take a listen to the episode or check out the show notes at www.ptonice.com/blog 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 everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PTI Nice Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at signup to receive a one-month free grace period on your new Jane account.   ALAN FREDENDALL All right. Good morning, everybody. Good morning, Instagram. Good morning, YouTube. Good morning to those of you on the podcast. Welcome to the PT on ICE Daily Show. I hope your Friday morning is off to a great start. My name is Alan. Happy to be your host today. Currently have the pleasure of serving as the Chief Operating Officer here at ICE and our division leader in the fitness athlete division and practice management divisions. It is Fitness Athlete Friday. We would say that means it's the best darn day of the week. And here on Fitness Athlete Friday, we talk all things for folks who are recreationally active. So those patients and athletes active in CrossFit, functional fitness, running, endurance sports, whatever, that person who is getting up every day and getting in their daily movement, we're here to help you help them. So today we're going to be talking about knee pain in the fitness athlete. And in the context of today, we're going to be talking about specifically those folks who are probably squatting on a regular basis. So CrossFit and functional fitness athletes, folks who are maybe squatting, squatting heavier, higher volume on a more frequent basis than maybe some of our endurance athletes. INCIDENCE & TYPES OF KNEE INJURIES IN FUNCTIONAL FITNESS So I want to talk about what types of injuries do we see in the knee in this space, describe a little bit about those injuries, and then discuss the beginning stage of how to begin to treat some of those conditions. So first things first, What do we see with knee pain in the fitness athlete population in general? The great news is over the past decade or so, we have got a lot of great high-quality research out of the CrossFit and functional fitness space about what regions of the body are injured most frequently, and then kind of what conditions follow those injury diagnoses. So we should know that in the fitness athlete, we primarily see shoulder as the most injured region. About 45% of injuries are from the shoulder. Really close behind that is the low back about 35% and then really musculoskeletal injury kind of falls off after shoulder and low back. Specifically today talking about the knee we see about 15% of injuries are related to the knee. Beyond that we have elbow, wrist and hand, ankle and foot, that sort of thing. So primarily shoulder and low back and then a real sprinkle of the knee. With those knee injuries, we're not seeing really major traumatic injuries. It's very rare, probably never in your gym, anecdotally, have you seen somebody fracture their leg, fracture their patella, tear their ACL, get hit by a vehicle, fall off a thing. That usually doesn't happen in the space of the gym. Primarily what we see in the fitness athlete population, folks who are doing a lot of impact, a lot of squatting, is that we see a lot of patellar tendinopathy and we see a lot of what we maybe would describe as a meniscus issue but really something that we could just generalize as medial knee pain. So now breaking down those two major conditions patellar tendinopathy and meniscus or medial knee pain first things first I would tell you if you haven't yet taken our extremity management course with Lindsay Huey, Mark Gallant or Cody Gingrich I would recommend you get to that course as soon as possible. That course is a really great complement to our fitness athlete courses as far as being able to recognize and diagnose and stage a tendinopathy, diagnose an extremity condition, but also treat it and learn a lot of progressions and regressions to treat those injuries. Specifically, they spend a lot of time the entire afternoon on Saturday addressing the knee in a lot of detail. So make sure you're really comfortable with these conditions. if you hear words like patellar tendinopathy or meniscal care and you think, quad sets? I don't know. PATELLAR TENDINOPATHY & MENISCAL CONDITIONS So talking about patellar tendinopathy, what do we know in overuse condition? who is that person in the gym that we maybe need to be aware of, or questions in our subjective exam with that person that would let us know this person may be in that bucket. Somebody brand new to squatting, think of somebody in their 40s or 50s, sedentary, maybe their entire life, that's not out of the realm of possibility these days, who is now jumping into CrossFit, jumping into Orange Theory, jumping into F45, being expected to squat at higher volume and higher loads than obviously they ever have in their life. Folks who maybe are not new to this space but are maybe incurring and encountering a higher level of squatting volume than normal may also fall into this bucket. There are also movement patterns that tend to show up in these folks. I like to stage these as two different movement patterns. The first is what I'll call the close enough squat depth pattern, right? That person who is getting to maybe just above or just at parallel. what do we know about that range of motion in the squat we actually know that's when force on the knee is at its highest that above that point at about 45 to 60 degrees or less of knee flexion and then below 90 degrees of knee flexion we know we have a deloading effect at the knee so those folks who are trying to squat to full depth but are in just that close enough bucket are putting a lot of mechanical force on their knee that they could get rid of if they either squatted more shallow, which is not ideal, or ideally squatted a little bit deeper. The second group of movement pattern folks who fall into overloading their knee is that back and down squat pattern person. So that person who does not break at the hips and knees at the same time. So as we instruct the squat, we like to tell people, imagine there's a rope around your hips and your knees and they're pulling in opposite directions at the same time. That means your hips should flex and your knees should flex. And ideally with a relatively vertical torso, you sit down, sit straight down into that squat pattern. The down and back folks tend to initiate their squat with a hinge, and then to get to depth at the last moment, bottom out that squat and drive all of that force into the anterior knee to hit depth. This is kind of how powerlifters tend to squat, especially with a low bar back squat. But folks who just have not grooved out the motor pattern of the squat yet, when they hinge back and then sit down to finish the depth, the knee again is taking up a lot of force that really we could clean up with some coaching and cueing, right? Maybe we could elevate that person's heels, give them a corrective to hold a plate in front of them, but otherwise encourage a more vertical torso and a more sit straight down squat pattern that distributes force equally between the hips, knees and ankles in their squat pattern instead of at the moment of truth, putting all the force in the knee as they try to hit depth. So that's the patellar tendinopathy bucket. What about the meniscus, the medial knee pain bucket? These are folks who are encountering a lot of impact in rotation. So we do see this a lot in the functional fitness space, right? We do running. We might not go run marathons, but we do a lot of workouts with 200, 400, 800 meter runs. We do a lot of box jumping to train triple extension. We do a lot of double unders for model structural cardio work. And we have begun to introduce shuttle runs, at least in the CrossFit space, to be able to run indoors during the winter in a competition environment where maybe we don't have access to run outside or we don't have the treadmills to be able to run inside on a machine. With shuttle runs comes not only the impact of running, but now a turning rotation moment. not too dissimilar from catching a box jump in the bottom of your squat with your double unders or with running in general. Also in this group are folks who might be new to squatting full depth or otherwise increasing their squat volume, right? No different than the patellar tendinopathy bucket that they are now encountering extra volume. So understanding who that person is is really important and that's where knowing that this person is a functional fitness athlete knowing if they are new to this or not, if they're returning after a break, if they've never done something like this in their life. Uncovering all of that in the subjective history is really important because it's going to give you a better idea of where your treatment might take you. TREATING KNEE PAIN IN THE FITNESS ATHLETE So let's talk about that treatment. What should be our priorities in treatment? With our functional fitness athletes, we're demanding full range of motion at every joint whenever possible. That means one of our primary goals should be if we find an asymmetry, a lack of range of motion, particularly in knee extension and knee flexion, we need to restore that as soon as possible. Again, I'll point you towards our extremity management course. I'll point you towards our fitness athlete live course to learn techniques to self-mobilize to load to restore that full range of motion. But as we're restoring that full range of motion, respecting the irritability of the patient, we need to begin to strengthen in whatever available range of motion we have. These folks do not need more volume, right? They're coming to you with an overuse, a repetitive use injury already. Giving them a 20-minute AMRAP or a 30-minute AMRAP and having them do hundreds of squats or lunges in the scope of their PT session is just adding insult to injury, especially if we are thinking that this is a patellar tendinopathy case, for example. These folks need strength, they need capacity and resilience in those structures, so that they can continue to not only stay in the gym, but perform in the gym, ideally, beyond the point at which they got injured, right? We don't wanna just return somebody to the exact moment at which they got injured. Ideally, once we clear them fully, hey, you don't need to do your PT exercises anymore, they are a stronger person than when they first began rehab with us. So we need to strengthen that full range of motion of the whole knee. Now PT school has closely associated in our brains that the knee means quadriceps and that's it, right? It's all over the research. It's all over knee extension machines and really, really focused on making sure that we have really, really strong quads, which is not a bad place to start, especially if that person is missing some knee extension, right? Some, some traction banded straight leg raises can do a lot to both begin to restrengthen quadriceps, but also restore knee extension. but we can't just stop at the quadriceps. We need to strengthen the whole knee, right? All four muscle groups of the leg that attach to the knee. So we also need to make sure we're targeting our hip abductors, our hip AD ductors. We need to target, yes, the quadriceps, but we also, especially if we're thinking this is a rotational-based injury, if we are thinking this is medial knee pain, call it meniscus, call it whatever, we really need to focus on the hamstrings because why hamstrings flexed and rotate the knee. They are pulling the knee into medial or lateral rotation in a movement like running. Ideally, hopefully, they're firing pretty much in sync so that we don't have a lot of rotation in our knee. We're primarily going through flexion extension, but our knee does have the capacity to rotate, obviously, and it's primarily driven by our hamstrings pulling the knee into flexion and in rotation. What is the problem with hamstring strengthening? The problem with hamstring strengthening is that in most functional fitness environments, we don't primarily isolate and train the hamstring. We certainly do a lot of deadlifts, we do a lot of kettlebell swings, that sort of thing, but if you think about the range of motion from the knee and the hip in motions like deadlift, kettlebell swing, it is not full range of motion of the hip and or knee, which means we're not strengthening the hamstring through its full range of motion. Yes, you'll feel a little maybe glute, high hamstring burn on high volume deadlifts or kettlebell swings, but you are not getting that deep behind the knee stimulus that you are with things like Nordic curls or even just isolated knee flexion on a knee flexion machine or banded knee flexion or anything like that. So understanding that the hamstrings flex and rotate the knee is really important to kind of finishing the drill on a really comprehensive knee strengthening program. Understanding that biceps femoris is responsible for knee flexion, but also yes, lateral knee rotation, and that semimembranosus and tendinosis are responsible for flexion and medial knee rotation. So particularly with those medial knee pain bucket folks, we wanna get into semimembranosus, semitendinosus, maybe with our hands, with needles, with cups, whatever, try to restore both that flexion and rotary component of the knee, and then get out in the gym and really strengthen those hamstrings on top of, yes, the quadriceps, the hip abductors, and the hip adductors. TIME UNDER TENSION IS KEY The key with strengthening the knee, again, is time under tension. The folks you're working with are already doing higher volume, higher repetition, relatively moderate to higher load training for the knee in a Metcon style workout. So adding in more air squats at high volume or light wall balls or thrusters or goblet squats is really just doing the same thing that they're already doing in the gym, which led them to be sitting on your table in the first place. So just giving them more of that isn't necessarily a prescription. When we have students at Health HQ, they're so excited to have people out in the gym moving, folks who are interested in taking care of their health and fitness, and they love to jump up to that whiteboard and write out, Remom 24, Amrap 30. We have to go, wait, stop, stop. That's not appropriate for this patient, right? This patient is already dealing with the consequences of too much volume. We need to back their volume down, especially in physical therapy, and focus on time and attention. So be careful that we're not actually exacerbating or at least prolonging the healing time of that patient's condition because our volume in PT, our volume for our home program is too high. Slow it down, less reps, less sets, more time under tension. Depending on the patient's irritability will let you determine how much tension you can apply both in the clinic, in the gym, and for homework. When someone's really irritable, I'm thinking maybe isometrics, and I'm thinking something like a reverse Tabata. 8 rounds, 10 seconds of work, 20 seconds of rest. There are apps out there. I personally like GymNext. It is a timer. It has a Tabata built in, EMOM, AMRAP for time built in. It can connect to a Bluetooth clock that the company sells, but you can also just use it as a standalone app and play it through a Bluetooth speaker or just through your phone speaker for your patient to hear. So reverse Tabata, eight rounds, 10 seconds of work, 20 seconds of rest, that gets us 80 seconds time under tension. That's a pretty good start, especially if we're doing it isometrically and the patient is really, really, really irritable. Now, as symptoms calm down, as function begins to improve, as tolerance to loading begins to improve, we want to increase that time under tension dose, especially if we're convinced that this is a tendinopathy based condition. So I like to move next to 10 sets of 10 seconds of work. I'll usually do 10 seconds on, 20 to 30 seconds off for 10 sets. That bumps the needle about 20%. That gets me 100 seconds time under tension. Then, when that patient appears ready, we'll probably progress to a Tabata. That's 160 seconds, right? It's the opposite of a reverse Tabata, a full Tabata. 8 rounds, 20 seconds of work. 10 seconds of rest. So the inverse of a reverse that gives us 160 seconds. So now we're close to pushing three minutes time under tension through that structure. At this point, you're probably away from isometric exercise, but if you're not great, keep rocking the isometric exercise for more attention. And then really for me, kind of the hallmark that someone is getting close to the end of their plan of care is when we can do isotonic movement, we can do five sets of five, and we can do some really gnarly tempo right think about a slant board goblet squat right so he was really elevated a lot of focus on tension through that anterior knee and that medial knee structure three seconds down hold the bottom and as deep of a squat as you can show me three seconds and then three seconds standing concentrically out of that squat. That's nine seconds per rep, five reps per set, five sets. That gives us 45 seconds time under tension per set. That gives us 225 seconds across the five sets. That is what the tendinopathy research tells us we need to be hitting as a benchmark for our time under tension. So understanding, depending on that patient's irritability, depending on how long this condition has been going on, that person may not be able to walk into the clinic and do a slant board, heels elevated, goblet squat, five sets of five at 3-3-3-1 tempo. That might be a lot, right? Certainly probably going to make them sore, but it might aggravate their condition. So understand how we can regress and progress, time and retention is needed. And then make sure as well that we're doing that for every structure of the knee. Again, that we're hitting the medial knee, the lateral knee, the anterior knee and the posterior knee, particularly doing things for the hamstrings like Nordic curls, curls on the rower, furniture slide curls, anything to really target the hamstrings as they insert at the knee as they flex and rotate the knee. and not just strengthening mid-range of the hamstrings and mid-range of the quadriceps. SUMMARY So knee pain in the fitness athlete. How frequent? About 15% of all injuries, so relatively low compared to all the other injuries that this population encounters. Primarily, folks, patellar tendinopathy, meniscus, medial knee. Why? Overuse, either a sudden spike in volume from a more competitive athlete or a new athlete, or someone who is maybe doing extra stuff outside of the gym, extra running, extra squatting, whatever. Folks to watch squat when they're with you, are they the close enough depth person? Do maybe they need some help in their ankles or hips to hit better depth and take load off the knee? Are they the back and down squat person? Do they primarily squat with a hinge and then bottom out through the knee to hit depth? That is a person that can benefit from sequencing their squat pattern a little bit better, especially if they do have a goal to be a functional fitness athlete. They need to be able to show a relatively vertical torso squat, a high bar back squat, a front squat, a thruster, a clean, that sort of thing. With our treatment, make sure that we're working as soon as possible to restore full range of motion of both extension and flexion. We need full knee flexion to squat. We want full knee extension for impact. We want to strengthen the whole knee, not just the quadriceps. Hit the hip abductors, hit the AD ductors, and particularly full range of motion hamstring work, not just things like deadlifts and kettlebell swings. They're already doing partial range of motion hamstring strengthening in the gym. And then remember, it's not about volume. It's not about coming into PT and doing 500 air squats. They can definitely do that. It's probably going to exacerbate their symptoms. What we're focused on with our strengthening with their home program is time under tension. Start with the reverse Tabata. 10 seconds on, 20 seconds off, eight rounds. 80 seconds time under tension. Move to 10 sets of 10 on, 20 to 30 off. That's 100 seconds. Move through a full Tabata. Now 160 seconds, 8 rounds, 20 on, 10 off. And then the gold standard is can we do 5 sets of 5 of a movement at 3 seconds eccentric, 3 seconds isometric, 3 seconds concentric. Can we get to that 225 second time under tension benchmark? So I hope this was helpful. I'd love to hear questions you all have, throw them here on Instagram, shoot us an email, shoot us a message over on the ice physio app. Some courses coming your way from the fitness athlete real quick before I let you go. Our next cohort of fitness athlete level one online starts April 29th. That course is already almost sold out and it does not start for three more weeks. So if you've been looking to get into that class, that class has sold out every cohort since 2017. This next class will not be the exception, I promise you. So if you've been on the fence, get off the fence. If you've already taken that course, your chance at level two online to work towards your certification in the clinical management fitness athlete begins September 2nd. And then some live courses coming your way. Mitch Babcock will be down in Oklahoma City this weekend, April 13th and 14th, if you want to join him. He'll be back on the road again, May 18th and 19th out in Bozeman, Montana. And in that same weekend, Joe Hanesko will be up in Proctor, Minnesota, which is in the Duluth, Minnesota area. That will also be the weekend of May 18th and 19th. So hope this was helpful. Hope you all have a wonderful Friday. Have a fantastic weekend. 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. Julie Brauer // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Julie Brauer takes listeners through a case study, showcasing how therapists dig deeper into patient goals in order to create meaningful treatment sessions that improve patient function. 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 INTRODUCTIONHey everybody, Alan here, Chief Operating Officer at ICE. Thanks for listening to the PT on ICE Daily Show. Before we jump into today's episode, let's give a big shout out to our show sponsor, Jane. in online clinic management software and EMR. The Jane team understands that getting started with new software can be overwhelming, but they want you to know that you're not alone. To ensure the onboarding process goes smoothly, Jane offers free data imports, personalized calls to set up your account, and unlimited phone, email, and chat support. With a transparent monthly subscription, you'll never be locked into a contract with Jane. If you're interested in learning more about Jane or you want to book a personalized demo, head on over to jane.app.switch. And if you do decide to make the switch, don't forget to use our code ICEPT1MO at sign up to receive a one month free grace period on your new Jane account. JULIE BRAUERGood morning crew. Welcome to the PT on Ice daily show. My name is Julie. I am a member of the older adult division and I'm going to be talking to you all this morning about make it meaningful, load it, dose it. So what is that? Make it meaningful, load it, dose it is the exercise prescription formula that the older division uses. So those of you who have taken our online course or our live course, you have heard this, you have learned about it. So what we're going to do this morning is I'm going to take you through how to apply this formula specifically for the goal of a patient who wants to return to gardening. So we're going to go through a little bit of a case study here. So to dive a little deeper into exactly what's coming up, I'm going to take you through how to dig deeper into the goal of when someone tells you I want to be able to garden on my own. We're going to dig deeper there and talk about why it's important And then I'm going to show you how you can take that goal and break it down into its functional movement parts, because that is going to give you all the exercises that you will be using throughout your plan of care. Using this formula is going to be able to give you all a way to create meaningful, effective, and efficient exercise programs for your patients. So we'll dig into the goal, we'll break it down into its movement parts. Then when I see you all again in a couple weeks, I will have my wireless mic by then and I'm going to go out into my garage and I'm going to show you what some of these exercises look like and give you some scaling options and how we would load it and dose it for intensity. DIG DEEP INTO GOALS TO FIND THE "WHY" Okay, so let's start from the beginning. We have to dig deep with every single patient when they give us a goal. We got to dig deep for the details. Why? Two main things. First, we want to know, in particular for this case study, when this patient says, I want to be able to garden, we want to know why. We want to know why gardening is important. What about gardening is this individual most excited about? We want to know the emotional why, because that's going to get us our buy-in. Next, we want to know details down to the nitty-gritty, exactly what this activity looks like. I want to know what this gardening task looks like from start to finish, because once you visualize it, you're going to recreate it. That is going to give you all of the exercises that you're going to ever have to do with this patient throughout your plan of care. It's the easy button. So when I say dig deeper to get to the emotional why, this is what I mean. It sounds something like this. So patient, let's call her Dolores. All right, we'll call her Dolores. Dolores tells you, I want a garden on my own and you're going to say, Dolores, tell me more about that. What about gardening is so important to you? I would love to hear more. When you are asking Dolores about her goal, you are giving her eye contact. This is not the time to open up your laptop and do any typing. You give her your undivided attention for these first few minutes while you are asking her about gardening and why it's important. Dolores, what about gardening brings you joy? What are you most excited about with gardening? This is where you can say, I love gardening. I grew up with a garden. My mom would, we would plant catnip and we would make our cats go crazy. I mean, literally this is true for me. This is what I've told my patients when they've told me they want to get back to a gardening task. Relate to your patient, right? Make that connection. When you do that, you're allowing the patient to give you more of a story behind why it's important. So Dolores is going to tell you something like this is true for a patient I recently had. My granddaughter is getting to an age where she likes to garden with her mom and I want to be able to garden with her as well and I want to be able to go outside and garden with my granddaughter and feel confident doing that. Boom, there's your emotional why. You have to dig deep enough to get to that point. Why? Because superficial goals, if you were to just leave it at, I wanna be able to garden, I wanna get stronger to be able to go outside. If you leave it at that superficial goal point, you lack the emotional connection. And Jeff Moore did a podcast, I cannot remember what it's called, but he says, and it stuck with me, this is probably a year ago, Superficial goals lack emotional connection, and emotional connection is what motivates your patient. Emotional connection is what's going to motivate your patient. So you find that emotional why, now your patient's connected to you, they believe you give a damn, you feel connected to them, you've got that therapeutic alliance, you both are invested and locked in. Okay, Moving on, the next details that you want are the nitty gritty details of what that gardening task looks like. So this is what it sounds like. I will say, Dolores, I want to visualize what this gardening looks like. Can you tell me exactly what it looks like from start to finish, from the very beginning to the end and everything in between? I want to be able to visualize it. as Dolores is walking you through all of the functional demands that she has to be able to do in order to fulfill this goal. I am using my whiteboard and I am writing this down. Now I know this was reversed for you all. I'm going to take a picture of this and put it in the comment on this post, but I am writing down every single thing she says. All right. So I have a whiteboard at the top. I'm going to put her name. Maybe I'll say this is, uh, Dolores, Dolores gets a garden strong, something like that. Those little details can make it much more meaningful to your patient. Little special things that you can add in. CREATE TREATMENTS THAT PROGRESS PATIENT GOALS So I have her name at the top and then as she is telling me what she has to do, I write it down. So she will say something like, I need to be able to push the door open on my own to get from inside to outside. So I'm writing that down. And then in parentheses, I'm putting what type of exercise exactly mimics that activity. So if she says, I need to be able to push the door open to go from inside to outside, To me, my fitness forward brain is what does that look like? Oh, a sled push. Awesome. So I write down push door open and then in parentheses I put sled push. Then she tells me, all right, and then I got to walk over grass and I have some stepping stones and I have some gravel. So she told me she has to walk over variable terrain. So then in parentheses, what am I putting down? Okay. So that's stepping on and over obstacles. Then she tells me, then I'm going to have to pick up some stuff and carry it around. So I got to pick up some tools. I got to pick up my mulch. My fitness forward brain goes, okay, what looks exactly like that? Pick up and carry. Well, I know that that's going to be a deadlift and that's going to be a loaded carry. Then Dolores says, then I'm going to have to get down on my knees and do some things on the ground. I'm going to have to get up and off the ground quite a few times. My fitness for brain says, what is that? Well, that's going to be a lot of floor transfer, part practice and full practice. Then she says, I got to pull weeds as well. It's, you know, usually like, Oh, well it's, it's not the best part of the job, but it has to be done. I want my garden to look really nice. I need to be able to pull weeds. So I'm thinking, what does pull weeds look like? My fitness for my fitness for brain says that's going to be quadruped position and I'm going to do some quadruped rowing. Okay. I'm trying to make it look exactly like that functional activity. You're catching on here, right? You're understanding what I'm doing. I am taking everything she's saying and I'm turning it into what the exercise is going to be. That looks exactly like that activity. And then the last thing she says is, and I need to do all of that and I don't want to fall over. So when I hear that, I know that I have to add in some perturbations. So I'm going to be giving her some external perturbations that are going to force her to take that reactive step. So I can train that. So I can train her dynamic balance. So now that I have that entire list, I am going to teach it back to her. I am going to say, Dolores, I was writing down everything you were telling me, all the pieces and parts that are important in order for you to accomplish this goal. Is this correct? And I'm going to go through and I'm going to say, Dolores, what I heard, what you told me is you need to push the door open. You need to walk over grass and gravel. You need to pick up and carry some stuff. You got to get down on your knees. You got to pull some weeds and you want to be able to do all of that without tipping over. Dolores is going to sit back and be like, wow, this person was actually listening to me. You have just improved that therapeutic alliance even more because you have heard her well. So now you have this entire bank of exercises. This is what you're going to pull from. Now that, I mean that was sit one, two, three, four, five, six. Those are six different movements there. That list could be less than six. It could be way more than six. So then you're going to think, okay, well, what's the next step here? I have all of these movements. What do I do with them? ASSESS,DON'T GUESS THE PATIENT'S ABILITY TO PERFORM FUNCTIONAL TASKS Next, you want to assess Dolores, how she goes through the motions of these functional movements. So when you are in an outpatient clinic, you got to recreate it in your clinic. If you're in a home health setting, this is easy peasy. You say to Dolores, all right, we're going to go through and I'm going to have you show me exactly what this looks like. All right. Something that I like to do when I, before I do this assessment to watch what this looks like is I will ask Dolores, I will ask my patients, What about all of those movements? Which of those do you feel like you can do really well? What are you really strong at when it comes to all those different pieces and parts that make up gardening? And then I will ask her, which of those movements are you fearful of? Which of those do you feel like that you don't really have the strength to do yet? I want to know her perception of her own abilities. And because as I'm assessing her, I'm looking at a lot, this is going to help me dial in exactly what I should pay attention to. I want to know the things that she's really strong at and see if she is actually strong at those. And I want to know the things that she's fearful of and see if she actually struggles with those pieces and parts. So after I asked her that, I kind of put a little asterisk sign into which of those movements are her strong movements and her weaker movements based on her perception. And then it's assessment time. So again, in the home setting, I am having her do the thing. I am not helping her. It's very similar. If you work in inpatient rehab, you just do the assessment, a FIM care tool. You're not helping them. You're simply watching how they do it. This is not the time. to assist and teach and coach, you are simply watching. In the clinic, this is where you want to set this environment up. You want to mimic and recreate this activity. BUY FUNCTIONAL EQUIPMENT, NOT BARBELLS So this may ruffle a few feathers, but as opposed to say you have budget and you have some money to spend at your clinic to buy equipment, I'm going to give you a potentially not popular opinion. Maybe instead of buying that barbell first for your clinic, if you're working with older adults, what if you bought functional activities that older adults actually use and that are not intimidating to them and directly relate to the goals they're trying to achieve? So what if you bought a laundry basket? What if you bought a bag of mulch? What if you bought some gardening tools? What if you brought in a, um, some laundry detergent, some pots, some pans, dog food, things that older adults are lifting and carrying and using at home pretty consistently. I would rather have those things at my disposal to use right away when I introduce loading to an older adult versus rely on jumping straight to the barbell where someone can be incredibly intimidated by that. This is not a or situation. This is an and. However, I have learned over time that I'm going to get more people to buy in if I have those functional activities those functional objects that people use at home that's going to get me more buy-in than saying all right you have to pick up uh and carry tools from um when you go out and garden well let's go do it with this barbell That's a lot harder of a sell. So here's your call to action. Spend that extra clinic money or just take stuff from your home that you don't use. You know, don't throw it away or go to a garage sale or a thrift store, whatever it is, and get this stuff and bring it into your clinic. All right, so you're going to set this all up in the clinic. You're going to assess, you're watching to see her quality. You're watching to see how long it takes her. I mean, this really is becoming an outcome measure for me. this is going to become like a benchmark workout. Okay. So think about it that way. This is, this is much more than an assessment. I'm going to use and recreate this, uh, call it a meaningful obstacle course that looks exactly like her gardening task. And I'm going to run it again and again and again. So I can track her progress and how well she's able to do this activity. So from them, I have recreated, the functional activity. I am assessing how well she does. I'm taking notes. I'm looking at the things she's strong at, the things she's weak at. After we're done, we're sitting down and we're recapping. Are the things that she thought she was strong at and weak at, did that match with how she actually performed? And we have a discussion there. From there, again, I'm looking at this list and now I'm talking to Dolores and I'm saying, Dolores, Based on what we just saw and what you just felt, these are the few activities, and you're looking for three to four here, three to four. These are the three to four activities that we are gonna focus on next session. And what are you gonna do? You are going to create an EMOM or an AMRAP with those few functional activities that you together have determined are the most important and you're going to find a way to load it up, whether that's adding physical load or cognitive load, and you're going to find a way to appropriately dose it so that you know you are at an appropriate intensity to drive adaptation. SUMMARY Okay, so that is how we go from taking a goal, digging deep to get to the emotional why, going through breaking down that meaningful goal into its functional movement parts. All right, that is the hardest part. It's the most important part. When I see you on a couple weeks, I will use this same exact case study and I'm going to take all of these exercises and I am going to show you ways to scale this up, scale it down, dose it, add some load, whether that's physical load or cognitive load. The idea here is we want to make our sessions and our AMRAPs, our EMOMs and the workouts harder than what the demand is that she actually has to do to reach that goal. Because if she is able to do her gardening tasks with load on her, with cognitive load on her, adding in intensity, then gardening with her granddaughter is going to feel easy. And that is the goal. All right, guys, that's all I got for you. I will post a screenshot of this list. So if you all have a patient whose goal is to garden at any point the rest of the week, you have a nice list of exercises that would probably be very relatable and meaningful for them. To end things out, I will let you guys know what we have coming up in the Older Adult Division in terms of courses. For the rest of the month, we will be on the road in Washington, Tennessee, and Pennsylvania. And then both of our online courses, Level 1 and Level 2, are starting in the month of May. We would love to see you on the road or online. PTI Nice is where all that lives. If you have any questions, any comments about anything we talked about today, hit me up. Would love to jam on anything with you all. Have a wonderful rest of your Wednesday. 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.

Welcome to The Tara Talk, your go-to podcast for all things mindset + movement! Today Tara breaks down common & not-so-common fitness terms and acronyms that you may hear / see in programming, workout classes, or in general fitness education.Episode Highlights: The 1 Rep Max Fitness acronyms broken down (AMRAP, EMOM)The one exercise Tara never does Hypertrophy training for muscle growth The different kind of "sets"?What is metcon? Compound, isolation, and accessory movementsThe purpose of HIIT style workouts Different zones of exercise + HRV  Are you ready to uplevel your health & fitness with Legion?  Use code TaraTalk for 20% off your first order and double loyalty cash back any order after that when you shop at LegionAthletics.comIf this episode resonated please leave a rate & review and share with friends! Your support means so much! Watch the episode on YouTube HERE. Follow along on @taralaferrara for no BS fitness + life advice. Follow along on @thetaratalk for episode updates and extra content. Sign up for the newsletter HERE and never miss an update!Work with Tara:1:1 coaching (apply to see if this is a fit for you)TL Method (get a FREE week of workouts!)

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 of kipping in 2024. After 128 years of kipping movements in Olympic gymnastics, we still have high levels of contention over the use of kipping in recreational fitness despite poor evidence to support or refute the safety or efficacy of these movements. What evidence do we have, and what can we do in the gym and the clinic regarding kipping? Take a listen to the episode or check out the show notes at www.ptonice.com/blog 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 FREDENDALLGood morning, PT on ICE Daily Show. Happy Friday morning. Hope your day is off to a great start. Welcome to the PT on ICE Daily Show. My name is Alan. Happy to be your host here today on Fitness Athlete Friday. Currently have the pleasure of serving as our Chief Operating Officer here at ICE and a faculty member here in our Fitness Athlete Division. It is Friday. It is Fitness Athlete Friday. We would argue it's the best darn day of the week. We talk all things Friday related to that person who is recreationally active. The CrossFitter, the Boot Camper, the Olympic Weightlifter, the Powerlifter, the endurance athlete, running, rowing, biking, swimming, whatever, that person that's getting after it on a daily basis, how to address that person's needs and concerns and be up to date on the research in this space. THE STATE OF KIPPING IN 2024 So today we're going to talk about kipping, a sometimes usually, it's fair to say, usually contentious topic. related specifically to the CrossFit space, but now as more and more functional fitness gyms open that are doing CrossFit style exercise, we see that even folks who would not say or know that they're even doing CrossFit style exercise are doing kipping movements. So I want to have a discussion. on where we're at in both the public facing, the clinician facing aspects of kipping, what kipping is, and really, what is our goal, especially when we have our clinician hat on? What is our goal when we're looking at kipping and considering Is Kipping safe? Is Kipping dangerous? Is Kipping right for this athlete? So let's start and talk about Kipping. So if you don't know what it is, or if maybe you have athletes or patients who don't know what it is, the public facing side of searching for things related to Kipping can be really gnarly, right? If you just type Kipping into Google, you get a real bunch of crazy stuff. What do you get? You get endless videos on kipping pull-ups specifically, but also a bunch of articles on why kipping is dangerous, why it's cheating. My favorite Google search is the top two results are in direct contention with each other, right? The top result for kipping is an article from Men's Health. Why swinging around at CrossFit isn't for everyone right so a little bit a little bit of a mean article a little bit condescending of an article But then the next article is from our very own Zach long the barbell physio the truth about kipping pull-ups right a lot of research on kipping a lot of practical information on kipping and a lot of the stuff that we're going to talk about today that is public facing, but in a very educational manner. So you see a lot of stuff. It can be very confusing for our patients and athletes because they're being given this message of, Hey, if I'm already doing this, here is really an endless wealth of human knowledge on how to get better at these, how to improve my performance. But also I'm seeing articles from people who tell me that this is dangerous. that this is cheating. This is actually reducing the effect of exercise on my body. It could be making me weaker. All of these different essentially thought viruses are going around simultaneously. RESEARCH ON KIPPING IS NON-EXISTENT So stepping back away from what's public facing, the social media content, the blog articles, what else is available on Kipping? Not a lot. If we're being really honest and we go way back in history to the start of modern gymnastics, we know that it started in 1896, so 128 years ago. Across that 128 years, we have watched the sport of gymnastics develop We see gymnasts use kipping on their hands, on the mat, up on the bars and rings, doing things like muscle ups and handstands, and using a lot of kipping to do so. But across that 128 years, we really still only have one research article that is relatively recent in that big span of time. that even discusses anything related to kipping. It's an article that we share in our Fitness Athlete Level 1 course by DiNuzio and colleagues. It's a randomized controlled trial back from 2019 in the Journal of Sports and Biomechanics. and it's titled The Kinematic Differences Between Strict and Kipping Pull-Ups. So a very basic article looking at subjects who performed a set of five strict and then five kipping pull-ups and just looking at what are the differences in the muscular activation patterns between folks performing the five strict pull-ups and between folks performing the five kipping pull-ups. And what we already know to be true was found in the research that we see a little bit less activation of shoulder muscles and bicep muscles and a little bit more activation of quads and of core muscles when we look at the difference between when somebody begins to kip their pull-ups or when somebody does strict pull-ups. And that's it. That's it. That's all the research we have, right? When you kip, you offload your shoulders and your arms a little bit, and the force is taken up a little bit more by your lower extremities and your core. And that's all the research we have on kipping. We have no research that it's dangerous. We also have no research that it's safe. We really have almost no research in this space, and we need to be cognizant of that. We have absolutely no research related to injury. of how many strict pull-ups can we do before we should kip. What level of strict pull-ups makes our shoulders safer from kipping pull-ups? What is the limit of kipping pull-ups volume-wise that we'd want to see somebody perform? Some sort of structured progression towards performing kipping pull-ups. We have absolutely no research on that. We need to be aware of that. And we also need to realize that's probably unlikely to ever happen. If you think about the recruitment for a study that would evaluate some of those concepts, it would look totally insane and be unethical, right? Let's take different groups of people, let's randomize them, and let's see, based on strict pull-up capacity, who does a certain amount or a progressive amount of kipping pull-ups, and then let's see how long it takes for someone to develop an injury, if ever, and then crunch that data and come up with some sort of Conclusion that we'd all love to hear, or at least be interested in seeing, of how many strict pull-ups is enough, how many strict handstand push-ups is enough, before we begin to create and allow, quote-unquote allow, kipping in our athletes. So we need to know the public facing space is out of control with this, can be very confusing to our patients and athletes, but the clinician facing, the research side, there is almost no information and there's probably not likely going to ever be something change here in a really substantial manner. WHAT IS KIPPING? So what do we do in the absence of research? Step back and better understand what kipping is. Kipping is just momentum creation and transfer. If you have taken fitness athlete level one in the past couple years, you know that we talk about this in week four when we talk about metabolic conditioning. We talk about why are we doing kipping? Why are we doing things the way we're doing them in the functional fitness gym, in the CrossFit gym? Well, we're primarily doing them to get our heart rate up, right? We're primarily exercising for power output. to create a cardiovascular response. That's why we're primarily going to CrossFit. Yes, we lift some heavy weights every now and again. And yes, we do some lower intensity, maybe zone two, zone three, steady state cardio from time to time. But primarily, we take a couple exercises, we smash them together in an AMRAP or rounds for time or an EMOM. and we're doing them in a manner that facilitates our heart rate getting up ideally into zone four and maybe if we're not careful, maybe sometimes a little bit of zone five. So when we talk about kipping, we're just doing it for momentum transfer. It's allowing us to do more work in the same or less amount of time. so that we can keep that heart rate elevated. You all can imagine that it would take a very long time to do a workout with 100 pull-ups if you did them all as strict pull-ups. We just had a great workout last weekend at Extremity Management up in Victor, New York. We had some pull-ups, or should I say pool-ups, as Lindsey Huey would pronounce it, programmed in the workout, and the folks that kip their pull-ups or butterfly their pull-ups got a lot more work done in that workout than the folks who just did strict pull-ups. So kipping is just momentum creation and transfer. I think it's important to understand we so intensely and closely begin to associate kipping just with gymnastics, specifically vertical pulling gymnastics, pull ups, and toes to bar and muscle ups and that sort of thing, that we forget that as humans, we kip almost everything in our life, right? I am standing still right now, if I begin to walk, I'm going to begin to use global flexion to global extension patterns, to propel myself forward. If I want to transition from a walk into a run, that is going to become even more intense. I'm going to begin to use more of my core, more of my shoulders, more of my glutes to produce a flexion to extension, back to flexion moment that generates momentum. If you don't think humans should kip, I want you to jump into a pool and not use your shoulders, core, or hips to swim. What you'll find is that kipping is very functional to daily life. If we begin to disassociate kipping from being up on the pull-up bar, on the pull-up bar, we recognize that we kip almost everything, right? It's a very functional thing. We kip to go from walking, from standing to walking and from walking to running. We kip when we stand up from a couch. We kip when we're swimming in the pool, or the pool, I should say. And we need to understand as well, some part of this, of why we don't just do strict gymnastics, why we don't just do strict weightlifting, is that it really limits our top end performance, right? Imagine if you watch the Olympics, and gymnastics was strict work only, right? Only the very strongest people would be able to do that stuff, and they wouldn't be able to do a lot of it, right? We would watch somebody come out on the floor, we would cheer for them, This is this is Steve from Belarus. Hey, Steve. And he does like maybe three strict muscle ups, right? He's not swinging around on the bars anymore. We don't really care about his landing, because he can't generate momentum to swing around to land. Imagine if Olympic weightlifting did not allow momentum and people just performed a deadlift to a strict high pull to a strict press, it would limit top end performance, we would not see people clean and jerking 500 pounds, we would not see people snatching 300, 400 pounds. So that momentum generation is a very functional part of being a human being and of performing these functional movements. And we can't take that away from people. Because even if for nothing else, it would become really boring, right? So not only is it functional, at some level, it's kind of fun to do. And it's fun to move along that progression from Okay, I can do some strict pull ups. Okay, I can do some kipping pull ups. Cool. Now I'm working on muscle ups, so on and so forth. WHAT IS THE GOAL WITH KIPPING? So what is the goal? If we put our clinician hat back on and we think, what is the goal with our athletes? Really the kind of the question we're answering in our mind, and when we ask questions like, how many strict pull-ups is enough? What we're really asking is, what level of strength in the shoulder begins to be protective of injury? And the answer we don't wanna hear is that it depends. And what does it depend on? It depends on that athlete's history, right? Somebody who has been performing a lot of strength training for a very long time that comes into a CrossFit gym or a gym where they might be doing kipping movements, that person has a lot less concern for the momentum on the shoulder or the momentum on any other joint in the body, right? We could say the same thing about runners, right? That person comes in with a higher what we call training age and therefore less worry about the capacity of that person's body as we begin to produce and create momentum with it. So the answer is, it depends. We can't say one strict pull up is enough. Five is the minimum. 13. Is five safer than one? Is 13 safer than five? It depends on that athlete. It depends on their training age. If they have never done any sort of vertical pulling, exercise, then we're just a little bit more concerned, right? We want to see that person begin to develop that strength. We'd love to see that person get one strict pull-up. We'd like to see them continue working on it. The answer, at least in our gym and the way that we coach, is that you should always be working on your strict gymnastics. You should always be doing strict pull-ups. You should always be doing strict handstand push-ups. We had a workout just last week with a bunch of strict pull-ups, and I coached it, and I was very, very adamant. Do not kip these. Do not use a band to kip these. I want a strict pulling stimulus today. If you can't do strict pull-ups, here are the scales that are going to help you get a strict pull-up. We're not going to bypass the strict training stimulus just to be able to go faster. If you can't go faster with strict work, we need to scale and work on that strict work. The other thing is, anecdotally, if you work with these athletes in a gym or you work with them on the patient side as a clinician, having a super high strict pull-up capacity does not guarantee high quality kipping pull-ups. That person who comes in who's been doing lat pull-downs and strict pull-ups for 30 years They can do a ton of pull-ups, but their kip probably needs a lot of work. What we see is opponents of kipping don't kip, and so they don't interact with individuals who do kip. And so we begin to develop this false belief that being able to do 10-strick pull-ups guarantees large, high-quality sets of kipping or butterfly pull-ups, which is completely unfounded. We all know that athlete who can jump up on the bar and do 10 or 15 or 20 strict pull-ups in a set, and then we ask them to, hey, try kipping those, and you're like, oh, God, what's happening, right? You are just swinging around on the bar. So just having the strength doesn't necessarily guarantee the technique that's going to lead to efficiency in that movement. So the truest answer is we always have to be working on both. When it's time to do strict work, strict pull-ups, strict handstands, whatever, we need to be doing those strict or finding a scale that allows us to progress to strict, and when it's time to allow momentum, kipping pull-ups, kipping, handstand push-ups, toes-to-bar, whatever, we need to find maybe also scales there, even if the person has the strength to do them in an ugly fashion, that allows the development of the technique, so the person that can do 10-strip pull-ups is somebody that goes on to be able to perform very large sets of high-quality kipping or butterfly pull-ups or toes-to-bar or muscle-ups or whatever. So once someone has demonstrated that they really have that functional shoulder strength, we need to recognize that they're naturally going to increase the volume of vertical pulling, and it's slowly going to ideally increase over time. And at that point, we're really dealing with an issue of volume management, we're no longer dealing with an issue of foundational shoulder strength, that person has the capacity to do strict work. Now we just need to carefully watch that person's volume, making sure that when they begin to develop kipping pull ups, they can do sets of five, they don't decide to help themselves to a workout where maybe they're doing 150 pull ups in a workout or 200 pull ups in a way that Volume is now the concern for the shoulder and not necessarily the foundational strength. SUMMARY So where's kipping at in 2024? The same place that has been for 128 years. There is a lot of public facing information out there that is confusing to our athletes and patients of how to get better. how to work on these for performance, how these can improve your performance in the gym, but also an equal amount of information on why these are dangerous or deadly or detrimental to your fitness progress. So understand the concerns that your athletes and patients are going to have when it comes to the KIP. Know that on the clinician facing side there is almost no research for or against kipping. We have just one article that looks at muscular activation patterns between strict pull-ups and kipping pull-ups and shows that when we kip we reduce the demand on the shoulder a little bit and increase the demand on the lower extremities in the core. Understand really fundamentally what we're looking at with kipping. We're just looking at momentum transfer and that we do this in a wide variety of movement patterns away from the gymnastics bar in the gym. Yes, we can kip pull-ups and toes to bar muscle-ups and handstand push-ups, but we also kip when we stand up. We kip when we transition from walking to running and jumping in the pool and swimming and so on and so forth. What is our goal? Our goal is always the pursuit of as much vertical pulling strength as we can get. So when things like strict pull-ups show up, things like strict handstand push-ups show up for vertical pressing, we need to make sure that we're working on strict work and not bypassing the foundational strict work with kipping just because we can't do the strict work. What's the answer to how many strict pull-ups is enough? Two answers. Strict work does not guarantee performance, efficiency, safety with kipping, but also you can never be strong enough. So always continue to work on strict pull-ups, even once you develop kipping pull-ups. And even once you believe that your kipping pull-ups or butterfly pull-ups or toes-to-bar or whatever are in high capacity and high quality, you're still working on that fundamental strengthening of the shoulder because we know Strengthening is protective of injury. And understand that once someone develops the strength work and begins to kip, we're not really dealing with a volume management issue. We're dealing with maybe the future potential development of a tendinopathy, not necessarily a lack of functional shoulder strength once that person can do a couple of strict pull-ups. So I hope this was helpful. I know it's a very contentious area across the functional fitness space. Happy to take any questions, comments or concerns you all have thrown here on Instagram courses coming your way from the fitness athlete division. Our next level one online course starts April 29. Our level two online course starts September 2. and then we have a couple of live courses coming your way before summer kicks off. Mitch will be down in Oklahoma City on April 13th and 14th. Joe will be up in Proctor, Minnesota on May 18th and 19th. That same weekend, Mitch will be out in Bozeman, Montana. The weekend of June 8th and 9th, Zach Long will be down in Raleigh, North Carolina. And then the weekend of June 21st through the 23rd is a really special weekend. It's our Fitness Athlete Live Summit here in Fenton, Michigan. We'll have all of our lead instructors and teaching assistants here. So Zach will be here, Mitch, myself, Joe, we'll have Kelly, we'll have Guillermo. We'll have all the fitness athlete crew here for a special offering of Fitness Athlete Live at CrossFit Fenton. So I hope this episode was helpful for you all. I hope you have a fantastic Friday. Have a wonderful Easter weekend if you're celebrating Easter. We'll see you all 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.

CrossFit Games and Torian Pro commentator Jeremy Austin joins host Chase Ingraham on the podcast to recap Week 2 of the 2024 CrossFit Open. Open Workout 24.2 was announced by WWE Superstar and World Heavyweight Champion Seth Rollins. Following the live announcement, we saw Justin Medeiros and Colten Mertens go head-to-head in a 20-minute AMRAP of rowing, deadlifts, and double-unders. Rewatch the live announcement of Open Workout 24.2 →    • CrossFit Open Workout 24.2 Live Annou...   On today's show, Austin and Ingraham revisit all of the action from the live matchup, review leaderboards after two weeks of workouts, and announce this week's Golden Barbell Award winner, highlighting a local service member in the CrossFit community. The two also take a peek at the men's and women's competitive landscape in Oceania for the 2024 CrossFit Games Season. — The CrossFit Games are the ultimate proving grounds for the Fittest Man and Fittest Woman on Earth™ and are world-renowned as the definitive test of fitness. Join host Chase Ingraham and various guests in the CrossFit space as they break down the latest news, happenings, and information from the CrossFit Games season. Subscribe to the CrossFit Games podcast and share it with a friend. Like and drop a comment on your favorite episodes. Listen on Apple Podcasts and Spotify → Apple Podcasts → https://podcasts.apple.com/us/podcast... Spotify → https://open.spotify.com/show/6sQXfti... Google Podcasts → https://podcasts.google.com/feed/aHR0... Learn more about the CrossFit Games → https://cf.games/learn Learn more about CrossFit → https://www.crossfit.com/what-is-cros... Find a CrossFit gym near you → https://www.crossfit.com/map?utm_sour...

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 strategy behind helping athletes & patients consider adding extra training volume on top of their normal exercise routine. Why should we add it, when should we add it, how should we integrate it into our normal training, and who is appropriate for extra volume? Take a listen to the episode or check out the show notes at www.ptonice.com/blog 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 FREDENDALLWelcome in, folks. Good morning. Welcome to the P-Town Ice Daily Show. Happy Friday morning. I hope your day is off to a great start. My name is Alan. I have the pleasure of serving as our Chief Operating Officer here at Ice and the Division Leader here in our Fitness Athlete Division. It is Fitness Athlete Friday. It's the best darn day of the week, we would argue here, from the Fitness Athlete Division. Those of you working with crossfitters, Olympic weightlifters, powerlifters, endurance athletes, anybody who is recreationally active, part of that 10% minority of the human race that exercises on a regular basis enough to produce a meaningful health and fitness effect. We're here to help you help those folks. INCREASING TRAINING VOLUME So here on Fitness Athlete Friday, today we're gonna be talking about increasing training volume. A hot topic, especially this time of the year, the CrossFit Open has begun as of yesterday. This is often the time of year as people go through the Open, maybe they did not perform as they thought they would, and they begin to ask questions about how can I make my performance look more like someone else's, right? So 24.1 was released, a couplet of dumbbell snatches and burpees over the dumbbell. I just finished it this morning, just finished judging a few hours as well. First workout, usually very approachable. People maybe have questions of how can I get faster as we get into the later weeks of the Open. Heavy barbell comes out, high skill gymnastics comes out, people begin to have more questions. What else could I be doing besides coming to CrossFit class? This relates to other athletes as well. Endurance athletes who maybe want to get faster in their mile time, faster in their race times, stronger to have less injuries. All of those questions tend to come up of what else could I be doing? So today we want to focus on asking in the concept, in answering the question of increasing our training volume. Why should we do that? When should we do it? Who is the person that's appropriate for it? And then how should we actually begin to introduce increasing training volume? WHY SHOULD WE INCREASE VOLUME? So let's start from the top. Why should we increase training volume? I think this is really important and that's why I have it as the first point today. often folks are maybe disappointed with their performance in the open or a recent road race or competition or something like that and they want to do more training and just adding in more training without understanding why we're doing that training or having a goal for that training can be a very rocky foundation to build upon and can really ultimately maybe set us up for an unsuccessful addition of volume that doesn't meaningfully improve our performance and maybe leads to an increased risk of injury for no reason. because we don't really know why we're training for more volume, right? Just doing more CrossFit metabolic conditioning workouts or just doing more accessory weightlifting or just running or biking more miles without a goal is really just adding meaningless volume to the equation. We need to understand why should we do this. So when folks come to you with that question of What should I be doing extra outside of my running or outside of CrossFit class? We should be asking back, why do you feel the need to add more training volume in? What specific deficit are you understanding or do you feel has been recently exposed that we need to add more training volume in? To just improve general fitness, with those folks we would say, Be patient, right? Continue going to CrossFit class. Continue if you've only been running for a year or two, continue your normal running training, right? Understand that high level performance often comes with most folks. When you look at them, they have a large training age, which means they have been doing whatever they're doing for a long period of time. And so expecting to close that fitness gap in just a couple of years by just adding in more volume is not really an intelligent way to approach that. But if we have identified some specific deficits, then that can be an argument to maybe add in some extra volume. So, folks who are maybe long endurance athletes who are noticing the longer my runs, the slower I become. I perceive that I maybe need to add in some speed work. Folks may be doing CrossFit that say, you know what, I'm great when the weight is body weight or when it's a low to moderate weight, dumbbell, kettlebell, barbell, whatever, I'm okay. But as we get heavier, I perceive that my strength, my upper limits of strength is limiting me from moving the weights around. In CrossFit class, where I'm perceiving that if I added in some more resistance training to whatever I'm doing, Maybe my tissues would be healthier or I don't have some of the skills and I would like to begin to practice them, right? I would like to practice double unders outside of class. I would like to practice pull-ups or muscle-ups or handstand push-ups outside of class or maybe add in an extra day of running if I'm a CrossFit athlete. So understanding why we're adding volume in is very, very, very, very important and it should be to address a specific perceived deficit and all the better if we can actually objectively test that so that we know if we're starting to make up ground on that deficit or not with the extra volume that we're being asked to add into our programming. So starting with why is very important. WHEN SHOULD WE INCREASE VOLUME? The next question is, when should we do this? I would argue that we should really only add in extra training on top of what we're already doing when we feel like our current training has plateaued. Of that person who says, I have been going to CrossFit six days a week for 10 years, and I feel like my ring muscle ups are not getting any better. I feel like I have literally not added a pound to my max, clean and jerk, whatever. When a perceived plateau is there, That can be a good argument to begin to add in some extra volume, especially those folks, uh, endurance athletes as well. Like, Hey man, I have been running for a decade and my marathon pace got faster, faster, faster the first couple of years, but it's been pretty much the same pace for the past two or three years of races. I feel like something needs to change. Or, again, those folks who do not have a skill. So that's when we begin to action that extra volume. For me, over the past year, my extra volume looked like adding in some more running. Doing pretty well, pretty happy with my CrossFit performance, but when runs showed up, especially in workouts where the runs were longer, 800s, miles, workouts like Murph Hero workouts with a lot of running, really, really, really impacted my performance despite doing pretty well on the other stuff that wasn't running. So beginning to add in extra running outside of CrossFit class. HOW DO WE INCREASE TRAINING VOLUME? Now, how do we do this? This is as important as why. How do we add in volume in a very intelligent manner? The key is with anything else, just like when somebody first began an exercise program, we need to start low. We need to go slow. We need to stair step this volume. A lot of folks perceive a deficit or otherwise feel like they want to add in more volume and they just do more of what they're already doing. And sometimes they do it every day, right? The person who leaves CrossFit and goes to Planet Fitness and does an hour on the stair stepper. or does an hour of machine weights, whatever. Adding in a big chunk of volume, again, if we don't have the foundation of why and when we should be doing this, can be a really unintelligent decision. So we should do this carefully. For me, this looked like one extra day of running for a couple of weeks, two extra days of running for a couple of weeks, so on and so forth. Using a running coach to very carefully and controlled add running volume in on top of working with a nutrition coach to make sure that I was fueling appropriately. So making sure that if we do come to the decision that we could benefit from extra training aside from what we're already doing, that we do it very, very, very, very carefully. What we're trying to do adding in extra exercise pieces is we are trying to push ourselves maybe into a short period of what we would call overreaching, functional overreaching. We're pushing the margins just a little bit, but we also need to be mindful of all the other training that we're doing, and we have to be careful that this functional overreach does not become overtraining, right? We need to make sure that if we're adding an extra stuff, we respect this new volume. We do it carefully. This extra volume should come with a progression in a deload. So for example, my running coach always had me on four week cycles. where every fourth week was a deload, added a little bit of miles every week for three weeks, and then a deload, add, deload. That deload week is a chance to give my body a break, go back to essentially my pre-running amount of volume, but it's also a great week to assess how did my body respond to the previous three weeks of training. Should we continue with the next block of extra volume? Or should we stay where I was at? Or should we maybe even regress a little bit because it was a little bit too much of an overtraining feeling rather than that functional overreach? And again, being objective with why are we doing this can really help us know did that little burst of extra volume create a change? Did mile split times go down? Did a race time go down? Did strength go up maybe two pounds or five pounds or whatever? Can I do two muscle-ups now instead of one muscle-up? So on and so forth. Having those objective indicators lets us know, okay, we're making the progress we want to see, and as long as everything is feeling good, we're good to continue going to that next step on the staircase of increasing volume. And when we think about how we add in this training, most importantly, we have to ensure that this extra training does not impact the normal training, right? The worst thing you can do is have your extra volume, make it so that when you show up to your normal training, so in my example, I never wanted to get to a point where my running made it so that I could not come to CrossFit, right? That's a dangerous spiral to get into, where now my normal baseline strength and conditioning program can't be performed, and now I'm adding extra volume even though I can't handle the current level of volume I was already doing before I added in my extra training. So being sure that whatever we're training at baseline, CrossFit, weightlifting, running, whatever, that does not become impacted by whatever extra stuff we're doing. Now that being said, if we're feeling good, we feel like we're making progress, we are objectively making progress, and our normal training is not impacted Okay, continue to either maintain that extra thing, whatever you're doing, or maybe even progress it a little bit. WHO IS APPROPRIATE FOR EXTRA VOLUME? Now the final part of the equation is who should do this? I would argue the answer is very few people should do this. Who is the type of person that is appropriate for extra volume? that person should be incredibly consistent with whatever they're already doing, right? Which by default erases most of the people who want to do extra volume. A lot of people perceive a gap in fitness between maybe themselves and their friends in CrossFit class or themselves and their friends and their run club or whatever. They want to close that gap even though What they don't want to hear is that maybe the gap there is because they're already not consistent with what they're doing, right? They hit the snooze alarm a couple days a week on CrossFit class or going for their run, right? I want that individual who is already incredibly consistent with their normal training. They are training four to six days a week, every week. They understand the importance of active recovery and rest days. They are prioritizing their sleep and their nutrition. The volume means nothing if we can't match that volume with an appropriate dedication to recovery. Again, we're trying to create bouts of small windows of functional overreaching. We're trying not to throw somebody into a downward spiral, a death loop of overtraining where they're going to be at increased risk for injury, where their fatigue, their soreness, whatever is going to impact all of their training, not just the extra volume that they're now doing. Most people are not consistent enough with what they're already doing to consider taking on extra volume. And I think that's tough to hear, but it's the right decision. for you as the coach, the clinician, whatever your role is, to have in a conversation with that athlete. If you are only coming to CrossFit on Monday, Wednesday, Thursday, you sleep in on Tuesday because Monday wrecked you, you sleep in on Friday because you're sore, you don't come to the gym on the weekend, let's see what your fitness looks like when you're consistent with your current fitness routine, and then maybe later on we can revisit talking about extra volume. I have found in my coaching career that the folks who come up to me and tell me, hey coach, I'm ready for butterfly pull-ups, happen to also be, coincidentally, the people who maybe can't even do strict pull-ups, right? The folks who are able to tolerate extra volume, extra skill progression, are the folks who are already very consistent and it's very clear that they, because they are consistent with their normal level of training, recovery, attention to their sleep and diet, They are aware, and I am also aware, that they can probably handle extra stuff, and that the people who want it really, really, really, really bad are almost always likely the people that should probably not do it because they are so inconsistent already. CASE EXAMPLE: RYAN A really good example I have is our friend here at the gym. His name is Ryan Battishill. You may know him. He develops a lot of your websites. He's a website developer by trade. He's a member here at our gym. I love how calculated and intelligent he is with just a little bit of extra training every day after class. So I want to tell you a little bit about him and then tell you the volume that he's added in in the results. So Ryan's been doing CrossFit for five or six years now. He has a history of running as well. He has a good morning fault squat. So a very kind of hingy squat. It tells us there's maybe a deficit in the quads, wants to get better at gymnastics, and wants to train for a half marathon as well. So, a lot of different goals, but it's good. Again, why are you adding extra volume? Are you just doing it meaninglessly, or do you actually have a goal? Okay, we have a couple of goals here. We want to improve our foundational lifts, we want to improve our back squat, our deadlift, We want to improve running. We want to improve our gymnastics. Okay, good. We have concrete objective ways to know that volume is working. What does that extra volume look like? And I think you would be surprised to hear that his extra volume is about 10 to 15 minutes a day after class. It's nothing crazy. One day he does an EMOM, usually a 10 minute EMOM of strict pull-ups and push-ups to help his gymnastics foundations. One day he focuses on front rack barbell step ups to focus on quad strength. Another day he does hip thrusts to work on his posterior chain and low back strength. And a fourth day of the week he adds in a couple extra miles of running. Nothing he does conflicts with his ability to come to CrossFit five days a week. He's a Monday through Friday regular, very consistent with five days a week of CrossFit training, very consistent with his nutrition, very consistent with his recovery, right? Somebody that's getting on most nights, eight plus hours of sleep, getting plenty of fuel as well. What are the results? A lot of people might look at the work he does and say, there's no way that 10 to 15 minutes of extra work could translate into anything meaningful, right? A lot of us look at extra volume, we think, if I want to be better, I need to run five miles extra a day, I need to do an extra hour of CrossFit a day, right? I need to do more and more and more volume instead of really intelligently planned extra accessory work. Over the past year of adding in that extra volume, he has broken through plateaus on his back squat, his deadlift, and his bench press from all of the strict gymnastics, the front rack step ups, and the hip thrusts. He has improved his running, even though he's already a great runner, in accordance with his goals to be able to run and complete a half marathon. and his gymnastics are certainly becoming on another level. His kipping pull-ups, his toes-to-bar, his muscle-ups, his handstand push-ups are all also improving accordingly because of his focus on strict gymnastics work. So I hope from that you glean that when we're talking about adding extra volume, it doesn't need to be this grueling stuff. It doesn't need to be very high-intensity stuff. It just needs to be intelligently designed in a way that does not affect our current training, And that puts us in a short state of functional overreaching, but does not become this long-term overtraining issue. Understanding that as we increase that volume, our nutrition, our calorie intake should increase as well. And we definitely need to make sure that our recovery is on point because we're now taking on extra physical volume that our body will need to recover from. SUMMARY So extra volume, why should we do this? We should do this only to address a specific perceived deficit that we can objectively measure the impact of extra volume on. When should we do this? When we have perceived a plateau, right? If every time we're testing a lift or testing a mile pace or a 5k pace and we are still getting faster, getting stronger, whatever, we have not yet reached that plateau. And so I'd argue it's not yet a time to consider taking on extra volume. If we do decide extra volume, extra work, extra accessory work is appropriate, how should we do that? We should do that very carefully. We should do that as a stair-step approach. We should do that in a manner that we can reassess the impact of our extra training. Is it actually working? And we should do it in a way that our normal training is also not impacted. We should never be skipping our normal run because of our strength training or our speed work. We should never be skipping CrossFit class because of our extra running or our extra accessory work that we maybe do before or after class should not impact our normal training. And then who should do this? Again, I would argue a very small amount of people should actually do this. Folks who are already incredibly consistent with their normal training routine, who are training four to six days per week, understand and are consistent with recovery, right? The stuff that happens outside of training, diet, sleep, nutrition, recovery. and folks who are aware of the nutritional goals are meeting them and are also aware that adding extra volume is going to increase the demand on how much and the dedication we have to our recovery. And then finally understanding it doesn't have to be crazy high volume, crazy high intensity to have an impact. 10 to 15 to 20 to maybe 30 minutes of extra work just a couple of days a week can go a really long way if the extra volume is done in a meaningful manner to address those extra deficits. finishing a metcon and doing another metcon is usually just going to result in that metcon being of even lower intensity that you may have to scale the weights and the ranges of motion more rather than coming over and doing some front rack step-ups or doing some strict pull-ups or doing some sort of skill practice or really judicious strength piece or run piece, cardio piece, something like that, right? Extra metcons, a 60-minute AMRAP, at the end of a 40-minute AMRAP is really not going to push the needle. Again, we're looking for that functional overreach and making sure we don't push that into overtraining. So, extra training, who, when, why, and how, those are our thoughts. So, hope you have a wonderful weekend. If you're going to do 24.1, I hope you have fun. My advice, go fast at the start, go fast in the middle, go fast at the end. It's designed as that kind of workout. Low skill, high work. one of my specialties. So hope you have a great Friday. Have a fantastic weekend. If you're going to be on a live course this weekend, we hope you enjoy yourselves. Have a great Friday. Have a great weekend. 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. Julie Brauer // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Julie Brauer discusses how to introduce a fitness forward philosophy with your clinic/co-workers. Julie describes four main points to use when trying to change practice philosophy: put fitness forward on display, host in-services, let patients be your voice, and be a mentor to other clinicians. 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 JULIE BRAUER All right, good morning crew. Welcome to the PT on Ice daily show brought to you by the Institute of Clinical Excellence. My name is Julie and I am a faculty member of the older adult division. This morning, I am going to be answering one of the most commonly asked questions that we get in our online courses and our live courses. That question is, how do I get others on board to a fitness forward philosophy? How do I create consistency when my coworkers don't understand this philosophy or potentially they don't care? The answer to that question is that we are going to pull and not push. We want to pull, not push to attract a fitness forward culture. So let's unpack it and I will give you guys a few actionables that you can start implementing right away. PULLING VS. PUSHING TOWARDS BEHAVIOR CHANGE So what do I mean by pull, don't push? You want to be attractive. You want to be magnetic. You want to pull people towards you and towards a fitness forward culture. You want people to be drawn to you versus pushing your agenda on others aggressively versus sending a message that could potentially be received as my way is better and I am better than you. All right. So I want to relate to so many of you in that I know so many of you are incredibly fired up and passionate about underdosing older adults. You get, I mean, your blood boils when you see that out in the clinic and I understand this. I've been there. And I know that it makes you want to call people out left and right. been there, done that, and I'm telling you that's not the way to get people to change the way that they do things. Now, I do think it's incredibly important to call our profession out as a whole. If you've been to any of our live courses or taken our online courses, you know that we call our profession out. and we ask our students to self-reflect on their clinical practice. However, I do think there's a way where you can be aggressive in that messaging and aggressive towards this mission of ending the professional pandemic of underdosage, but there's a way to do it and be kind about it. APPROACH WITH GRACE What I want to emphasize is that we have to approach this with grace. And believe me, I have made a ton of mistakes in my messaging and been way too aggressive. And that's not going to change culture. That's not the way to do it. But we need to realize that behind a lot of underdosed exercise that we see, there's still humans behind that underdosed exercise. Many of these humans are burnt out clinicians who are just trying to do their very best. And many times in a system that does not set them up for success. I know this to be true. I have hurt feelings of my own friends who are colleagues who are really good clinicians because of my aggressive messaging and because I wasn't realizing that people are out there and they have, they are in different seasons of life. They could be going through a lot of crap. And they're just treading water and they're doing the best that they can. It's not that always someone just doesn't care and wants to phone it in with older adults. We don't know what people are going through. So many people are in tough seasons of life that last a short amount of time or a long time. And we have to have some grace there. So instead, we want to invite people in towards this fitness forward culture. We want to be attractive. We want to be magnetic. So how do we do that? Here are a couple ways. PUT FITNESS FORWARD ON DISPLAY Number one, do your sessions out in the open. Put that fitness forward philosophy on display as much as you possibly can. Why? Because it's the most powerful way to share this message. And instead of, again, pushing a message or telling people what the right way is, you get to show them. So imagine this. You work in inpatient rehab. And instead of kind of flying under the radar, this is what I did a lot for a long time, and you bring your equipment in your own bag and you do that session in the room because you don't want people to ask questions and you just want to do your thing and move on. Instead, go do it out in the open gym. When you know all the people around you, you're going to look around and see we have yellow TheraBands, we're playing balloon toss over there, people are on the new step and chatting it up for 10 or 15 minutes, but you are in the middle of the room. You are loading your patient up with a kettlebell, they're doing a deadlift, you are blasting like really pump up music and drowning out the really like low slow music that doesn't make anyone want to work out so you're pumping the jams your patient is working really hard they're having fun you're having fun everyone around you gets to look over and see like damn i have that patient later in the afternoon and i saw them yesterday i had no idea they could do that Huh? They look like they're having a really good time. That is how you start to get people curious. Like, Whoa, how are they doing that with that patient? That's awesome. I want to learn more. You are pulling people in towards you without saying a word, without telling people, Hey, I want you to do things my way. So that's number one. Do your sessions out in the open as much as you possibly can. Put that fitness forward philosophy on display. Okay. HOST IN-SERVICES Number two, put on an in-service. Be a wave of influence here. This is one of the easiest ways to spread this message to as many people as possible. Okay. Now, a lot of you are like, I don't have time to put together a workshop or an in-service. I don't like to speak in front of a group. I totally get it. That is why the MMOA division has created workshops for you. They are done. They are skeleton slides. You can put your branding on them. You can add to them. You can do whatever you want with them. They're all done for you. They are on topics such as One rep max living, osteoporosis, arthritis, build better balance, learn how to fall. They're done for you. Even better, if you're thinking, okay, I love that the information is there for me, but I'm really nervous presenting in front of a group. We have a solution for you too. The workshops also come along with a recording. of one of our faculty members presenting this information to their communities and to other individuals. So all you have to do is watch the recording and you can say the phrases and do exactly what they do. So it completely mitigates this fear of public speaking because you have a perfect example of how to display this information. I will put the link to all of the workshops. They're on our website on mmoa.online under free resources. I will link it there for you. But that's one of the easiest ways to spread this message to a lot of different people. You get everybody in the same room, hopefully not only clinicians, so your peers, but managers and supervisors. If you were able to get some of the rehab doctors in on that workshop, that would also be amazing. So a wonderful opportunity there to spread this message wide, be a wave of influence. GUIDE YOUR PATIENT'S VOICE All right, number three, guide your patient's voice. Guide your patient's voice. If you want your colleagues to get on board with a fitness-forward culture, empower your patient to help you guys out. Think about what's going to be more effective here? You going to your colleague and saying, hey, I want you to do this with my patient or your patient when they are with one of your colleagues for their session that day or that week saying, hey, I did this thing called a deadlift with a kettlebell last week with Julie, and it was really awesome. I loved it because it really helped me realize how strong I can get so that I'm able to lift my granddaughter up from the ground. If a patient comes to you and says it like that, and they're so excited, you sure as hell bet that therapist is going to be like, okay, this is exactly what my patient wants to do. I'm going to figure out how to replicate what that other therapist did because clearly my patient is all about it. That is really powerful if your patient can also use their voice to help drive this change. So that could be a conversation you have with your patient. Hey, do you think what we're doing during this session has been really helpful? Your patient's going to say, yeah, I mean, it's hard and it's strenuous and I sweat, but I know this is going to help me. Then you guide them, all right, so next week, because I'm not gonna see you for another two weeks, let's figure out a way where you can advocate for yourself and so your next therapist continues to do this work so you continue to get better. So you and your patient come together and figure out what that conversation looks like and then your patient goes to your colleague and has that conversation. it's going to be a lot more powerful than you directly just saying to your colleague, do this, don't do this. Guide your patient's voice. All right. BE A MENTOR And then lastly, be a mentor, be a mentor. So we have a lot of people who at our courses will say, you know, let's say it's a, let's say it's a CODA. Okay. and who's at our course and they're like, well, what's going to happen? I mean, I will be doing this stuff, but my OT isn't going to be doing this stuff. Or it's a, it's a PTA saying like, I love this stuff, but my PT is definitely not going to do this stuff. What do I do? You want to be a mentor. Look at it Not like me versus you, right? Not what I'm doing is right, what you're doing is wrong. Look at it as this is a really great opportunity to teach my colleagues. how to do these things and and think about in a way not just because you know it's going to benefit your patient but because it's going to benefit your colleague. We all want each other to be elevated and we want each other to be inspired to do one percent better the next day with older adults. So why wouldn't we want to invite them in to share how to do this stuff? There could be a lot of reasons why your colleague isn't following your plan of care. They may not understand what an EMOM is or an AMRAP. They're like, what are those letters? I have no idea. Like we're spell check. I don't even understand this. They could never have seen a deadlift before in their life. And they're just very confused about what these movements are. Again, there could be a lot behind it. Don't assume someone is not reading your documentation or likes what you're doing. It could just be that they lack the confidence and they don't have the knowledge. So be a mentor. This is where you can go to your colleague and say, hey, Betty is loving what we've been working on. We're doing some really cool loaded carries and squats and deadlifts. I would love to show you what we're working on so that we can maintain consistency, because I know that Betty's going to get better faster if we do that. You can use your time. Donate your time as a mentor to pull them over, show them some of these movements, show them how you document them, and even better, If they have some time, be like, hey, I've got Betty at this time, right? Maybe you can have some overlap if you're in home health, or you can have some overlap if you're in acute rehab and be like, hey, could you come over and watch a little bit of my session with Betty so you can see what we're doing? and you really make it that individualized mentoring experience. And I guarantee you guys, if you approach this with kindness and try and pull people in and get them to be curious and present yourself as someone that an individual, your colleague can come to you and say, I'm a little nervous, I don't know how to do this. If you're able to do that over and over again, you're gonna start to have a lot of colleagues asking you questions and getting curious because they know that you're an approachable individual that they can seek mentorship from. And I promise that's going to make you feel really, really good about not only the work that you're doing with your patient, but being able to give back to your colleagues. All right. So those are the few ideas of how you can pull people in towards that fitness forward culture versus pushing that agenda on them. SUMMARY So to recap, number one, do those sessions out in the open. Put that fitness forward philosophy on display. Make it as visible as possible. Two, do an in-service. Be a wave of influence. I'm going to link that website for you guys in the comments of this post. Three, guide your patient's voice. Realize it's going to be so much more effective if your patient is advocating to do these fitness forward things versus you just telling your colleague to do them. And then lastly, be a mentor. Donate your time and energy to showing and educating your colleagues how to do this. realize that you're going to be helping them enjoy doing their jobs more, not just benefiting your patients. So it's a win-win. All right, guys. Lastly, I will let you know about what courses the older adult division has coming up. So in March, we're pretty darn busy. Well, first, well, yeah, March is this weekend. It's crazy. So we are in Maryland as well as Georgia this coming weekend. There are spots open for those two courses if you want to snag one. Then we will be in Madison, Wisconsin and Kansas the rest of the month, and we have our next L1 eight week online course starting March 13th. So March is super busy. Go ahead and jump into one of our courses. We would love to see you on the road. We would love to see you online. Have a wonderful rest of your Wednesday. Let me know if some of these techniques worked for you all the rest of this week. 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.

Dr. Jeff Moore // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Chief Executive Officer Jeff Moore discusses the differences in how regret can present from overworking an unrewarding job, but also from underworking in a career with a lot of potential for both personal & professional impact. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog. 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 JEFF MOOREAlright team, what's up? Welcome back to the PT on Ice Daily Show. Thrilled to be here on Leadership Thursday. I am Dr. Jeff Moore, currently serving as the CEO of ICE and always pumped to be here on Leadership Thursday, which always pairs as a Gut Check Thursday. Let's get right into it and talk about the workout. So what we've got is the CSM workout. Both Alan Fredendahl and Paul Kalorin of Ice and iDryNeedle, the combo, are going to be there to lead you all through a workout Saturday morning. Anybody at CSM who wants to get some movement in, please join us. 5 a.m. CrossFit Southie. You've got to sign up on the form. So go to the Ice Students page. The form is on there. It's here on Instagram. It's on the pinned post for the CSM WOD. I think we have like 20 signups and I want to say they're taking in 30 or 40 so as we get very near to Saturday morning make sure you jump on there if you indeed want to work out. It's going to look like this should you choose to attend. It is going to be an AMRAP 25 minutes. Now mind you, anybody not at CSM should still do this. Teams of 2. We've got a 100 calorie row. We've got 80 alternating hang dumbbell snatches at the usual 50-35. You've got 60 box jump overs at 24-20. You've got 40 toes to bar, and then finishing off with 20 burpees over a dumbbell, and then going back up to the top, should you have more time in your 25 minutes. Should be a really nice chipper running through that. Gonna get kind of a one-to-one work-rest ratio. Should be able to keep moving. Should be an awesome workout. If you go to the CSM workout, please make sure to tag us. I won't be there, so I'd love to see photos and videos of all of you getting after it. Let's jump into Leadership Thursday. DEATHBED REGRETS The topic is deathbed regret. Will you have them? I think perhaps not. Let me explain. So the usual story goes something like this, and I think we've got to respectfully counter it. The usual story goes something like this. Your grandfather or your grandparents in their twilight years are regretting spending too much time at the office. right, saying, you know, oh, I wish I would have pursued more of my hobbies, done more things that I really cared about, et cetera, et cetera, et cetera. And the cautionary tale here that we're supposed to pull away from this constantly heard story is that you shouldn't overwork, okay? This is the concern, this is the moral of the story, if you will. REGRET FROM OVERWORKING Okay, I don't know about you all, but my grandfather worked in paint factories in downtown Detroit, Michigan. Tough gig, tough city, right? But he did what he had to do. I have no doubt, given the option, he would look back and say, I never asked him, but I'm sure he would have looked back and said, I wish I could have done a bit more of that. Or I wish I would have chose to, if there were sufficient resources, do a little bit less of that and spend less time there. I have no doubt about that. That's fair. If your job feels like that, like it's tough, it's grindy, it's not necessarily one that you're super passionate about it. You're kind of doing it because you have to, but you can't change that because you're doing what you have to do. That's the job that's available to you and you're getting it done because that's your responsibility. Not only is that noble, but it's totally understandable to do what you need to do, but I would agree, maybe don't do a ton extra. And I can totally appreciate how regret at end of life could come should you choose to do a ton extra of something you don't necessarily love. I will cough that up. I will agree with that. I can appreciate why that's been the narrative for a lot of years. That being said, It is much more likely that you are doing something that you chose and that you are passionate about and that you love. Particularly if you're sitting here on Thursday morning, taking in leadership Thursday, the odds are really good that you chose your career amongst a variety of options and you chose one that you believe in, right? You probably didn't choose the paint factory in downtown Detroit. It's a tough gig, right? That probably isn't one you were drawn to. And again, if you're in this ethos, where you're taking in this kind of content, you're probably in a position where you chose something you loved. Now, if you started a company, or you joined a company that you really believe in, regret is unlikely going to be the byproduct of your hard work in that space. So what I'm saying is that we need to advocate, or I wanna advocate, for a shift from people on their deathbed say to or towards people on their deathbed used to say. Because I don't foresee myself or any of you saying in your twilight years, I really wish I wouldn't have fought so hard for something I believed so much in. I just don't see that coming. I totally see it from the paint factory, right? I don't see it when you chose your passion that you feel most aligned with, where you want to be of some use. I don't see that statement on the horizon. For me, the thing that I believe I'm fighting for is freedom for everybody from dependence on the medical industrialized complex. From the pharmacy, from the surgery, right? Instead, a belief in a utilization of one's own physical resilience, right? The belief that changing the narrative and educating the public that if they train and fuel well, and they don't have a bad accident, that you can maximize and enjoy an incredible health span. And unfortunately, the narrative in this country is solely the opposite. The amount of people who are unbelievably dependent on a ridiculous amount of prescriptions, that are so quick to surgery, that leave anything healthy once they're injured, that we have so much to fight against. But I believe in this fight. And I don't believe that when I'm 80, I'm gonna say I wish I would have fought it less. I don't believe that. The principle runs too deep. REGRET CAN ALSO COME FROM UNDERWORKING Instead, and to close off the episode, a bit of real talk perhaps, I think that our regret risk in this generation, now that that shift where choice is kind of the driver of career has been made, the risk more lies in the following items. I feel like I never made a difference. I feel like I didn't fulfill my potential. I didn't go hard enough. I never found my limits. I don't know what I was capable of doing in the good fight. I never generated sufficient resources to be able to support myself and others. I think this is probably the list of regrets that is more common and they come from underworking, not overworking when you've chosen something that you believe in. And many of us get to make that choice. So my message to you on this Leadership Thursday is first of all, make sure you're doing that if you're able to. I do not mean to put anybody in a bad mental spot if they're like, dude, I'd love to, but my cards don't allow it. My situation, maybe right now and future, totally respect that. Do what you have to do. There's so much honor in that. If you get to choose, if those are your cards, choose something that you believe in and go all in. If you are a part of a team that achieves something that you believe to be deeply meaningful, you are not going to look back and wish you spent more time on yourself on vacation. That isn't how it's gonna shake out. You're gonna look back and say, I'm so glad that I was of some use. I'm so glad that I figured out the maximum that I was able to contribute in an area that I believe needed my efforts. That isn't something you regret. That is something you celebrate. It's time to push back against the narrative. Things have changed. Let's acknowledge it and let's stop scaring people into not working enough to find their potential because of things being different 30, 40, 50, 60 years ago. Give it some thought. Thanks for being here on leadership Thursday. We've got a million courses coming up. It's our busiest time of year. I think this weekend alone, we have 12 to 15 live courses. Make sure you jump on ptonice.com and check out that schedule. Get those skills, get out there and help some people y'all. Cheers. 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, join Modern Management of the Older Adult division leader Christina Prevett discusses how it can feel very overwhelming when your practice looks very different then what you are exposed to in a course like Modern Management of the Older Adult. You don't need to change drastically overnight (though you can!) but we encourage you to take the first step. In today's episode, Christina takes you through 4 steps you can take TODAY, to level up 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. CHRISTINA PREVETT Hello everybody and welcome to the PT on ICE daily show. My name is Christina Prevett. I am one of the lead faculty within our geriatric division. And today I wanted to talk to you about something that we see a lot as we talk to clinicians across the country, across North America, sometimes internationally, about some of the barriers to implementing some of these exercise interventions that we know are so, so relevant and helpful to get our older adults as strong as possible, to give them as much reserve as possible. So when we go into different live courses, we have our two-day online, or we have our eight-week online course, we have our two-day live course. We talk to clinicians in the geriatric space who are in a lot of different practice settings, right? It's really great and really unique that one, we oftentimes have a multidisciplinary group. So we're seeing OTs, PTs, CODAs, PTAs. But then we also have a lot of people in the room who are in different practice settings. So in any course, we can have some people who are in acute care, in home health, in skilled nursing facilities, long-term care facilities, outpatient clinics, fitness. We kind of see this spectrum, right? And we know that with our older adults, that there is a spectrum. And in our courses, we try to speak to that spectrum. So we try to speak to the clinician who is working with really sick folks in the hospital, to the, person who's in fitness and is keeping older adults who are doing fairly well as active as they can into hopefully their 90s and 100s. But sometimes there can be these barriers that are maybe not to do with the client that you're seeing, but the clinician and the space at which the clinician is at in order for it to feel like an overwhelming barrier to get individuals to or to see some of the changes we know are going to lead to better outcomes. And this is not to cast any blame on the clinician, but to acknowledge that it is not just you working with the client, it's you working with the client within the system that is medicine and the system that is your employer. And it's something that we want to acknowledge. So I was at a course recently and I had a person come up to me and I just, I loved the vulnerability, but she said to me, you know, I am a worse clinician than I was five years ago. And she was, she's about five, six years out. And you know, I'm going to talk about what you can do today, but I want to acknowledge this first. And she said, I'm just so tired. And she wasn't saying it for, you know, sympathy. She was just wanting an acknowledgement that she knew that all of the things that we were talking about in this course were exactly what she needed to be doing. And yet all of the other stuff around the system that she was experiencing was making it so that she was exhausted and it made it hard to do the better thing, right? Because Seated Therax is not as cognitively demanding on us as clinicians. The safety profile is oftentimes a lot lower, is a lot lower, even if the returns are not as good. And I first, before we start talking about ways that we can start leveling up our therapy practice, like what is the next step that we can take? If this story is resonating with you, what I want you to do is know that we see you. We see how hard clinicians are working. We see how hard it can be to push back against a narrative that has been, you know, kind of placed into our system that makes it so that there are barriers that are systems and administrative barriers that make, you know, leveling up in geriatrics be difficult to do. It is especially difficult if you are the one trying to push against this and everybody else in your practice is not. And so I first want to just acknowledge you and say, you know, I'm going to start trying to give some practical tips around ways that you can take that next step. But if your biggest barrier is where you are at from a headspace perspective or where you are at from a cultural perspective, just know that I acknowledge that where you are. and maybe some of that reflection will help work towards, you know, I don't know what that next step is for you to try and help get you out of that burnout or out of that exhaustion state, but it may be your biggest hurdle when it comes to leveling up in the geriatric space. So I wanted to acknowledge that first. "WHERE DO I START?" Okay, so the next step is I have no idea where to start. and I have no idea what to do. And so where I want all of you to start, and this is gonna be my challenge for you for the rest of the week, is do one thing different. level up in one thing. So when people come and take our course, they think, okay, now everything that I do has to be different. And that would be like taking you and you eat fast food six times a day or six times a week and you don't exercise at all and you're not sleeping and you're over caffeinated and you don't know what water is. And then you say, okay, I'm going to go and I'm going to eat super clean. I'm never going to have any fast food ever again. I'm just going to drink water. I'm going to kick out caffeine and I'm going to exercise 150 minutes. of aerobic and two times a week of strength training. I love that goal for you, but we wanna make it so that it makes what seems impossible possible. And we're gonna start taking these little steps, right? So we talk a lot in MMA about graded exposure and acknowledging that process when it comes to our patients, but we acknowledge that that practice change also takes time. And if this is not an area where you are focusing with respect to intensity, and this is particularly true in the resistance training space, just know that we don't need to drastically change. LAYER IN STANDING EXERCISES We need to take the next step. And so what can that be? Let's go through three examples of what that can look like. So you have a patient who is coming in and you have been doing predominantly seated exercise. and this is no shame at all. This is where you are at with this person. They are tired, their joints are irritable, and you know that you're gonna have to do a lot of pressing to get that session to be mostly in standing. Great. I want you to get them standing for one. If that's one exercise, that's one set. If you are doing long arc quad, change that to a standing terminal knee extension with a band around the rig or around a doorknob or around the high-low table that allows them to do that exercise in standing. So the one next step can be is to choose one person on your caseload where the easier choice was to do the seated option, but you're going to get them to do the standing option. So that's taking the step Here, that was number one. START USING AMRAP SETS Number two, if you are a person who has had trouble finding a quantifiable baseline assessment of strength. And this is so many people in our profession, like we ask all the time, like how many people take a kind of estimated strength measurement before they prescribe strength exercise? And most people are saying, well, shoot, I don't really do that. And it was a big growth area for me too. So the first opportunity for leveling up, today in your geriatric practice is to get a person who you would have chose a seated option, but you're going to try and get them into standing for at least one set. The second one is going to be to pick one exercise for one person and do an AMRAP set. So we talk about using estimated 100 maxes. So an AMRAP set is as many repetitions as possible. We can use it for a quantifiable baseline amount of strength, You're going to choose a weight that you think individuals can do for 10 repetitions or less because there's a cardiovascular component if we're over 10, if you've ever lifted heavy weights for more than 10 reps, you know what I'm talking about. And I want you to put an AMRAP set in today. So that's number two. Number three is you take one person's session and you get an objective measure for every set. So this is my number three. So one is get a person in standing if we want to have them sitting even though we know they can stand. Number two is getting an AMRAP set to try and find a quantifiable baseline amount of strength. BEGIN TO OBJECTIVELY QUANTITY EFFORT WITH RPE And three is to find a rate using a rating of perceived exertion, an RPE, for each exercise. and try and get individuals in that moderate sweet spot between five and seven. Hey, if you want to push them up to 10, I'm here for it. But if we are trying to take the first step to level up, what we want to make sure is that we are asking our patients, how hard do you think this is? And some people are going to say it's hard because they're tired. Some people are going to say it's hard because of pain. or some people are going to say it's hard because it's effortful, and effort is the name of the game, right? Effort when we're bumping up against pain can be that we're kind of toggling in this wiggle room between this increase in pain and how long it takes for their pain to come down to baseline. It can be exertional effort, but effort is the currency that we are looking at when it comes to all of our rehab interventions. And so the step that I want you all to take is to take a rate of perceived exertion for every exercise. So if they are doing clams, if they are doing bed mobility, I wanna say how hard do you think that was on a scale of one to 10? Or was it easy, medium, or hard? And you want them at least in the medium. There are so many times where I think that I am hitting the right mark when it comes to intensity for my older adults, and then I ask them, and they're like, oh, it's like a three. And I was like, well, dang. Linda, I'm going to switch this weight for you." And we end up taking the weight and putting it higher. Of course, your clients learn that and they'll look at you and you'll ask and they'll say, eight. And I was like, I don't believe you. That's not an eight. And you switch that exercise out. But giving you a rating of perceived exertion, one, that's something that you can document to make sure that you're getting that intensity, is a great way for you to be able to level up your Jerry game today. Okay, I know I said three, but I'm gonna give you four. BEGIN TO MEASURE REST INTERVALS The fourth one that you can do, and then I'll kind of go through all of them again, is to record your rest. Oftentimes we do our sets and then we kind of wait and we wave a little bit and we think, oh, well, I'm getting bored or they're getting bored or they're finished with the story. Okay, we'll start the next set. And we have no idea what that intensity looks like if they are resting for 30 seconds versus 90. If you are working with an individual with a high enough amount of load, they should need that full minute to recover. And so if we don't Check how much rest they're getting it can be really difficult for us to know if we're hitting the mark again with intensity So I gave you a bonus one So I'll do three plus bonus that I didn't lie to you at the beginning of this session About or this podcast about what our ways for us to level up our Jerry game So let's bring this around full circle the first thing is I want to acknowledge you if the hardest part about leveling up your Jerry game is because of the mental state that you are in right now if that is because of your job if that is because of family stress if that has become because of work culture expectations that make it difficult. I want to first acknowledge that and where you are. And know that sometimes if you are sitting at a 40% baseline, your cognitive reserve, and you're giving 40%, then you're giving 100% of the effort that you have available right now. And I want that acknowledged. And I know that it's not just simple as like, let's just change these one things for individuals who are kind of in the throes of some of those difficulties. If you are able to get through and try one thing different today, I gave four options, right? So doing that AMRAP set, getting a person doing an exercise in standing that we probably would have biased towards sitting, taking a rating of perceived exertion for every exercise in a session, or measuring rest, putting a clock on in the background and having it roll up and just kind of getting an idea of how much rest individuals are taking. You'd be surprised how much of our exercises, our interventions are gone because of us taking longer rest intervals than are probably necessary. SUMMARY All right, if you want to learn more of these level up steps, you can hit us up at MMOA Live. In two weeks on the 17th, 18th, I'm in Oklahoma City, Oklahoma with Sam. It's going to be such a fun course. On the 23rd, 24th, We are in Gales Ferry, Connecticut. We actually also have a sold out course right now in Rochester on that same weekend, which is super exciting. I love when we see these big crowds. But Alex is going to be in Gales Ferry. And then March 2nd and 3rd, we are in Rome, Georgia and Sparks Glencoe, Maryland. So if you are looking to find us on the road, if you want to figure out all these level up techniques, That is the place to do it. It is two days. It is so fun. You get to hang out with us and our crew. Maybe we can give you that little boost of motivation that you need to take that first step forward. And we would love to be that little bit of a motivation boost and a culture for you if you are struggling right now with different aspects that are outside of your control and your patient's control. within our healthcare system. So I encourage you to see us on the road if you haven't yet. Have a wonderful rest of your week, everybody, and hopefully I will see you all eyeball to eyeball at a course soon. 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.

Dr. Jeff Musgrave // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Jeff Musgrave to discuss recent research evaluating the efficacy of high-volume vs. low-volume resistance training for older adults as it relates to facilitating muscular hypertrophy. Jeff breaks down the research but also offers practical implications for the clinic. 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 to the PT on ICE Daily Show. I'm gonna be your host today, Dr. Jeff Musgrave, Doctor of Physical Therapy, currently serving in the Older Adult Division, trying to demolish things like underdosing, ending frailty, and I am super excited to bring to you a very interesting research study that just dropped January 4th of this year. So the title of this article we're gonna be digging into today is Higher resistance training volume offsets muscle hypertrophy, non-responsiveness in older adults. So, trying to dig in to figure out if someone is not responding to resistance training, what can we do about it? So, obviously if you're listening today, if you're following in the world of ICE, you know that resistance training is paramount. Getting people strong is how we're going to break the cycle for people that are coming in with pain and dysfunction, musculoskeletal disorders. There aren't any conditions where we can get people too strong. And we know specifically through the lens of working with older adults, when we've got things like frailty, adults who are pre-frail, who are very vulnerable to external stressors, or maybe one rep max living, we've got to bring them quality resistance training. We need everyone to have a path back to load. As quoted by Lindsey Huey in the extremity division, we love to say that load is our love language and all paths lead to load. HIGH VS. LOW VOLUME RESISTANCE TRAINING So let's dig into this a bit more. So higher resistance training volume offsets muscle hypertrophy, non-responsiveness in older adults. So what we've got, we've got 85 subjects. over 60 years old male and female that had 14 dropouts and everyone was required inclusion criteria included they could not be doing any formal aerobic training or resistance training prior to being included in the study. Their nutrition was actually analyzed by a dietician, which I thought was really cool for this study that they were looking at that. They also acknowledged that variations in sleep patterns are going to impact people's ability to recover. They weren't able to control for sleep, but they did figure out that by and large, there weren't any huge variants in nutrition, but they did have everyone supplement protein So they did a 20 gram protein supplement in the morning and in the evenings in between meals. The purpose of this study was they were trying to figure out, can we identify strategies like what's gonna happen when we adjust volume at a set intensity for older adults? and then figuring out like what do we do with non-responders so we do have people that are going to respond to resistance training but maybe we may have some people in our caseload and you've probably seen this clinically that don't respond as quickly to resistance training and they were just isolating out the variable of volume, not intensity. So what they did is they had each participant was a study in themselves where one leg was identified for lower volume and one leg was identified for higher volume. What they did is they were looking at the quadriceps muscle They got a baseline cross-sectional area from an MRI, and then they did one rep max testing on a single limb knee extension machine. So single limb knee extension machine to get a baseline one rep max, and then they did an MRI to look at the cross-sectional area of the quad muscle. And then the right or the left leg was assigned randomly to a higher volume program and a lower volume program. METHODOLOGY: WHAT IS LOW VOLUME AND WHAT IS HIGH VOLUME? So when we dive into the methods here a little bit, what we find is for the first couple weeks of the program, they were, the low volume group was doing one set. Okay, one set, trying to hit an eight to 15 rep max. And then the higher volume set did four sets at that eight to 15 rep max. So we got one set versus four sets. So that's what they're calling low volume, and that's what they're calling high volume. And that was for each person. So they were able to like kind of control for a lot of factors by testing the low and high volume on the same person, which I thought was really cool, a really cool way to test this. So after the first two weeks, they amped up the intensity a little bit and they were asking them to hit a eight to 12 rep max, still one set on the limb that was identified for low volume, and then four sets on the side that was for higher volume. So they continue that from weeks three to 10. So 10 week duration of intervention, we've got a low volume side and a high volume side. So what they did is they analyzed the results and they were looking to figure out who are our non-responders and who are our responders. So they're looking at cross-sectional area of the quad and changes in one rep max on knee extension. So what they found between all the subjects between the right and the left limb, they found that 60% went into their non-responsive category where they did not make statistically significant changes in their one rep max and or their quad volume. So those were 60% were deemed as non-responders. And then the responders, about 40%, it didn't matter, the low and the high volume side, both improved in their quad size based on the MRI and their one rep max. So really interesting here that they found that the responders, it didn't really matter the volume as long as the dosage was there and that maximal effort. And when you look at the literature for older adults, it is all over the map. And in general, this is a wide brush stroke here, okay? So not for every study, but a lot of the studies will say the more deconditioned someone is, the less, Intense a dosage needs to be to make change. So if you've been doing absolutely nothing Something is going to be beneficial But then the dosage for true strength training, you know, there are lots of studies Landmark studies for older adults like the lift more trial that's looking at you know hitting percentages of 80% for a five by five five sets of five repetitions, but when we you know dig a little deeper into this dosage and you know, based on the rep ranges for their intervention there, because they were doing eight to 15 rep maxes, sets of that. So we're looking at a 60 to 80% rep range, not rep range, percentage of a one rep max. So, pretty decent on dosage, but typically we're going to start people at a minimum of a 60% and then we're going to amp that up to 80%, maybe 80 plus, and then be adjusting the rep scheme. But this is just looking at maximal volitional output to muscular failure in that eight to 10 rep range. And what they did is if they hit more than that number of reps, then they would add a little bit of weight in increments of one kilogram. some weight away if they were doing multiple sets like on the high volume side. CLINICAL IMPLICAITONS So really interesting to really think about the impact of volume but this isn't typically what we're going to do clinically right so if we're going to add a higher percentage of one rep max we're going to drop those sets and reps and not be doing these AMRAP sets for each set. Not a great experience, causes lots of soreness, can produce symptoms. And these were all non-symptomatic patients. These weren't people having pain like what you're going to see in the clinic. So there's one caveat there, but just keeping in mind like rep ranges and kind of these basic rules that we try to use for programming strength training. When you look at something like Perlepin's chart, for example, that's been used in the strength and conditioning and Olympic lifting world for years, you're going to see that Rep ranges are going to vary, but you know, if we're in that 70 to 80 rep range, we're going to be doing sets and reps of three to six. So add a total volume of about 18 reps total. And same thing for our 55 to 65% of a one rep max, we're gonna be doing sets of three to six, not these eight to 15 rep maxes, which I understand for the study design and to try to equalize this, that was necessary to be able to compare apples to apples. But clinically, we're gonna be doing smaller sets and reps, and we're gonna be, as we increase a one rep max, not this 8 to 15 maximal effort. So when we're looking at this through the lens of Prolepin's chart for the low volume to be doing one set of an 8 to 15 rep max, you're maybe not going to hit the minimum threshold on volume to make strength adaptations. IS LOW VOLUME TOO LOW FOR SOME PATIENTS? And I know there's some studies that say, that are leaning into one maximal effort being enough for strength gains, but I would say clinically, that's not typically what we do. If we're gonna be using that 60 to 80% rep range, we're gonna be breaking that up into smaller sets and reps, and we're gonna be adding more volume than that. So I would question that the low volume group because we did not adjust the intensity up, it's not apples to apples here. Because if we're going to increase that percentage, we're typically going to be doing smaller sets and reps, but also going to be hitting more volume. So I feel like the low volume group probably didn't really hit threshold. And I think that probably impacted, this is all opinion of course, but I think that impacted the low volume group's ability to make changes. And I think that's why we're seeing 60% non-responders. But if we were going to dose this out at that volume, we would have been doing much higher percentages. And the high volume group is probably more a normal rep range and percentage that we would use if we were just going to create a program for someone. So I think that's a weakness in this study, but I still think there's some things we can take away from this. USING RESISTANCE TRAINING DOSAGE TO OVERCOME BARRIERS So if we're thinking about training with older adults, we know that there are often lots of barriers. So our older adults come in typically with lots of fear. They may have beliefs on board that are going to limit our ability to be able to really push that intensity or push the weight because of fear, bad experience, or maybe just lack of experience with weight training, that they're scared, there could be histological barriers where maybe someone's coming in and their primary concern is they've had a fragility fracture or they've got low bone mineral density. And knowing the timeframes for healing on bone, we're gonna make muscular adaptations much faster than we're gonna make changes in the bone. So we may actually hit what's appropriate at that point we're going to be adding volume which goes in line with what this study is telling us is if someone's not responding to lower volume up the volume and we're not looking at high intensity and the other thing this study is not testing is it is not comparing low and intensity to high intensity resistance training it's moderate intensity and high volume or low volume which is not typically what we do but it was just looking at the impact of volume is all it's doing at a set intensity so for those people that we hit barriers where we can't go heavier then we're gonna have to add more volume. But keeping in mind that there are specific benefits to higher volume or higher intensity, higher load training that we will not get with moderate or low load training. But we will, if we want the strength adaptation, we are gonna have to adjust that total volume up. So our people that aren't responding or we've got barriers, then we need to up the volume. So I know all this digging in to say, If we hit barriers in hitting that higher load, then we're going to have to add more volume. But that's a reality of what we see in clinical practice, especially with older adults. And I think that's something that's valuable to keep in mind if we're working around injuries or belief systems or fear or time frames for healing. of tissue, especially like bone or cartilage that may have a longer duration of time, that we're going to have to supplement with more volume. So really from a clinical standpoint, I think that's helpful to keep in mind. But still keeping in mind that if we can hit high load, we want it because we're going to get strength adaptations, adaptations to the bone and other tissues faster and create more margin. Because with older adults, it's all about building as much strength and as much margin in the tissues, whether we're talking about strength or fitness or bone density, we want as much margin as possible. And the only way you're gonna get that is with high load. But if we can't, the next best option is to add volume. SUMMARY Team, I hope this was helpful. I found this article really interesting. I'd never seen a study put together quite like this. If you have maybe taken our online courses and you want to get into live, where we do lots of practical labs, you've got some great opportunities coming up. So we've got MMOA Live in Kearney, Missouri, January 27th and 28th. We've got Oklahoma City, Oklahoma, February 17th and 18th, that same. And then the weekend after in February, we've got course in Connecticut and Minnesota on February 24th and 25th. Team, I hope you enjoyed this talk. I would love to hear your thoughts on this article or your experience with older adults with adjusting volume and maybe what you've seen. Other than that, team, have a wonderful rest of your Wednesday and we will catch you next time. 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.

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Julie Brauer discusses workout ideas for acute care patients, including those who are confined to bed, able to move at the edge-of-bed, and those who can transfer & ambulate with assistance. 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. JULIE BRAUER Good morning crew. Welcome to the PT on ICE daily show. My name is Julie. I am a member of the older adult division. Excited to be talking to you all this morning about a few workout ideas for your hospitalized patients. All right. So what we're going to dive into this morning is first, we're going to talk about why it is so incredibly important to bring a fitness forward approach to our medically complex sick older adults in the hospital. and then we're gonna dive right into how to do it. So I am going to give you three different workouts. They're simple. They only consist of three exercises and they're going to be for three different individuals. FITNESS FORWARD ACUTE CARESo the individual who is the bed level patient, so they are not ambulating, they are not transferring. Then I'm going to give you a workout for the individual who can sit edge of bed, so who can tolerate those positional changes, but again it's not someone who is transferring or ambulating. And then lastly for the individual who is able to transfer out of bed. Okay, Let's dive in. First and foremost, team, what I think we can all agree on is that patients are being sent home sicker and sicker and sicker. Insurance is denying acute rehab left and right. And once patients do make it to acute rehab, if they're lucky enough to get there, they're only getting enough days to just barely make them functional. We have to agree that these patients need to get as strong as possible and they need to do it as quickly as possible. If we can agree on that, then we have to realize the massive opportunity we have in the acute care setting to bring a fitness-forward approach. Now, I know what a lot of you are thinking. Fitness in the hospital What the heck? No way. It doesn't belong there. I don't have the equipment. They're too sick. That's for down the road. I want you to come along with me and get a little curious. I want you to be open minded and perhaps shift that perspective. Think about it this way. You are a fitness forward clinician. You are working in the hospital setting. You have hundreds and hundreds of patients handed to you on a silver platter. All these patients are in one place, door after door after door, literally right in front of your eyes. And they are just waiting for you to walk in, inspire the hell out of them, and guide them to the land of wellness and fitness. You do not have to hope that these patients who need you walk into your clinic doors. You do not have to hope that your Facebook marketing or your Instagram post is seen by your target avatar. They're all there waiting for you. You literally have a captive audience. Literally, these patients are in their hospital rooms. They are in their hospital beds. They have alarms on. They are tied to lines and tubes, et cetera. They're all there at your disposal. Team, the patients who need you the most, the ones who are medically complex and sick, They are waiting for you. They are handed to you on a silver platter in the hospital. Do not waste this opportunity. We have to realize that ankle pumps and glute sets, walking to the door and back, doing 10,000 tenettis a day, are not going to get the job done. Those are not going to increase our patient's reserve and resiliency, so they don't end up back on your caseload in a week. Fitness forward therapy is absolutely critical for these sick folks. Okay, so we've gotten curious. We're starting to shift our perspective. The most important thing that comes next is, well, how the heck do we do it? So let's dive into three different types of workouts we could do. WORKOUTS FOR BED-LEVEL PATIENTS Workout number one, this is going to be for your bed-level patient. So this is an individual who is in the ICU, perhaps, or they are in inpatient rehab. They cannot tolerate positional changes. Maybe their vitals go totally wild when they try to sit up. The alarms are going off, the nurses are running in. Vitals go wild, you gotta lay them back down. Perhaps they're incredibly orthostatic when they do sit up. Their blood pressure absolutely tanks, and you have to lay them back down. or they may have significant fear or pain. They just refuse to get out of bed. Hell, this could be the patient who, you know, your last session should hits the fan. You went way over time and now you have barely any time with this human. You do not have the time that it's going to take to get this person up and out of bed. Okay, so think about a couple of those scenarios that you may walk in to your patient today and this perfectly fits that description. This workout is for them. Okay, so what are we going to do? This individual supine is pretty much all they got. The bed is all they got. What we're gonna do is turn that bed into a workout machine. The hospital bed turns into a home gym. What do you need? You need a Sally tube slide. So what is that? You've seen them if you've been in the hospital. They're yellow, they're plastic. Individuals and the staff will use them to transfer patients because it decreases friction. You need that and you're gonna need a wedge or a slide board. and a gait belt. So three pieces of equipment, sally tube slide, a wedge or a slide board, or and a slide board, and a gait belt. Okay, so what are the three movements that we're going to do? We are going to do a modified pull-up, we are going to do a modified leg press, and we are going to do a modified rope climb using the gatebell. Okay, so how do we set this up? You get that sally tube slide underneath them. For our modified pull-up, you're going to tilt the bed. They are going to reach to the bed rail that's above their head and they are going to pull themselves up. That sally tube slide is going to allow them to slide and we're going to add some gravity onto them so we get them to a degree of a vertical pull. For our leg press, you're going to set that on the slide board, sometimes the wedge on top of the slide board at the bottom of the bed. We're going to tilt that bed again. They are going to kick and press to do a leg press, and then they'll slide back down, and then they push again, slide back down, etc. For our rope climb, you're gonna use that gait belt. You're gonna tie it to the foot bed rail. You're gonna tie that gait belt on there, and then they are going to grab onto it. They are going to pull themselves as much as they can to get to an upright, long sitting position, and then slowly let themselves down. Okay, so that's how those three exercises with the equipment are gonna be set up. Now, how do we dose this? Remember, this is an individual who has very low tolerance. We are just trying to get that blood flowing. We are trying to do very short bouts of activity and they're going to need a lot of rest. So how I would set this up is an EMOM, maybe an EMOM for six or nine minutes. Minute one, we're going to do that pull-up. I'm going to have them work for 20 seconds, and then I'm going to give them a full 40 seconds of rest. What am I doing during that time? Taking their vitals, right? Watching to see that they are responding okay to the exercise. I'm going to want to know what their blood pressure is, their heart rate, their oxygen saturation. Minute two, they're going to do that leg press, 20 seconds, and then they get 40 seconds of rest. And then lastly, they're going to do that rope climb for 20 seconds, 40 seconds of rest. What is beautiful about a workout like this is that many times what you will find after you're able to increase the intensity with them in the bed where their vitals are staying at a reasonable level, they're not going wild, then you sit this individual up and you will find all of a sudden their blood pressure actually stabilizes here. And now they're someone that you can safely get out of bed. Okay, there's your bed level workout for that individual. WORKOUTS FOR EDGE-OF-BED Next, now you have someone who can tolerate a little bit more. We're going to do a combination of a bed level exercise and sitting edge of bed. So they can tolerate positional changes. This is for that patient who can transfer out of bed, but it totally exhausts them. One rep and they're absolutely toast. This is for the patient who you know would thrive at acute rehab, but you really need to build their tolerance. You need to be able to say to those acute rehab liaisons, hey, this patient can tolerate multiple sessions of therapy per day. So we're going after endurance here. All right, so what do we need for this one? We need a heavy TheraBand or a resistance band. And that's it. One piece of equipment. So what we're going to do is we are going to do a AMRAP here. A 15-minute AMRAP. As many rounds as possible. Three exercises. Why are we doing that? Because we want to show, hey this individual tolerated 15 minutes of non-stop work. What are our three exercises? First, we are going to do a resisted bridge. How do you set up a resisted bridge in a hospital bed? You take your TheraBand and you anchor it one side of the bed rail to the other side of the bed rail. Now, when they go to bridge up, they have some resistance there. You can do it double leg, you can do it single leg. Exercise number two, we are going to do repeated supine to sideline to sit transitions, all right? And then exercise number three, while they're sitting on the edge of the bed, they're gonna scoot laterally to the foot of the bed and then to the head of the bed, okay? So those are your three exercises. How are we gonna dose this? Again, the goal is endurance. So we want them to be doing only enough repetitions to where that RPE at the end is only like a four to five. We don't want them to be seven, eight, nine. Remember this is endurance we want them to be able to sustain for 15 minutes total because that is going to be the buzzword that helps get them to acute rehab. So for that entire 15 minutes you're going to do as many rounds of those three exercises and you're going to try and keep the rep scheme to as many that keeps that RPE about four to five. That you're going to go ahead and document about why this person is perfect for acute rehab because they can tolerate 15 minutes and then you are going to progress them from there, try and get to 18 minutes the next time you see them and then get to 22, etc. Okay, that's your second patient. WORKOUTS FOR AMBULATORY PATIENTS The third patient, this is an individual who can transfer out of bed all right so they only need a little bit of help they can transfer out of bed but when they get really fatigued their can their performance is really inconsistent so this may be where the physicians or the case managers are like hey they can transfer out of bed like they're high level, they can go home. But you know that when they get fatigued, their knee buckles, or they really lose that eccentric control, their balance starts to go out the window. You know they need acute rehab in order to improve their tolerance so that they are able to do safe transfers throughout the day. Mimicking when someone throughout their day is going to have high and low levels of fatigue, you want to know that that consistent performance is safe. So, what are we gonna do here? In this workout, what we're gonna do, three exercises, we're gonna do an overhead press, a standing march, and then a stand-step transfer, okay? So that overhead press, what do we need? You are gonna get that toiletry bucket that every patient is given, you're gonna dump all the crap out of it, you're gonna take a towel, you're gonna roll it up, you're gonna soak it in water. That makes that toiletry bucket now have some load. This is what we're going to use for the overhead press. It's going to be done sitting on the edge of the bed. Next is going to be the standing march. This can be a standing march that doesn't have any load to it. You can have your arms on the walker for upper extremity support or you can use something like a bedside commode bucket. clean that you put a bunch of weights in like ankle weights load it up and they can do a one-handed uh carry or a hold while they march okay and then with the stand step transfer you just need their assistive device and a chair set up next to the bed all right so in This type of workout, what we are wanting to do is we are wanting to really increase the intensity of those first two exercises, the overhead press and the standing march, and then have them do the transfer because we want to show Hey, this is what it looks like when this person is under fatigue and then tries to do a transfer. You want to prove to those acute rehab liaisons, balance gets really poor. I have to jump in and I have to give them some support in order for them to not lose their balance when they do that transfer. So you're showing the deficit here. So in those first two exercises, you want intensity to be really high. So comparatively to our first imam, it's going to be the same exact thing, but work and rest is going to be reversed. So you are going to have them work for 40 seconds, and then you can give them only 20 seconds of rest. and that 40 seconds, you want it to be sprint effort, okay? You want them to be working at RPE 789. You want them to really, really push it. So similarly, you can do this for 6, 9 minutes, 12 minutes, 15 minutes, and the goal here is that when they get to that stand-step transfer, they're under fatigue, you are going to see what happens. Then you can document and show acute rehab, hey, This is all the assist that they need. This is how their technique breaks down when they are under fatigue. That is going to be the buzzword that you're going to be able to use to advocate for them to get to acute rehab. You're going to also use that and progress them to just try and build that endurance. So let's say acute rehab is still like, screw you, we're not letting you in. Now you have a baseline workout. You continue to hammer in on improving their endurance so that when they get to that transfer, they have stability. SUMMARY All right, three workouts for you. That bed-level patient who cannot get out of bed, supine's all you got. You turn the bed into a workout machine. You got your second workout for that individual who can tolerate transfers, transitionals, and can get to that edge of bed. And then the third, you got a workout for someone who is able to get up and transfer out of bed. I have multiple reels that I've made about each of these individually. I'm going to put them together and post it. You will have that soon so you can get a visual of what all this looks like with my actual patients. And I cannot wait to hear how you guys use some of this stuff out there in the clinic this week. All right, to finish this off, we've got courses coming up. We want to see you guys out on the road. We would absolutely love to see you. We got tons of spots left in Missouri. That is this weekend. Alex will be out there. That course is going to be absolutely amazing. We got multiple courses coming up in February. I will be in Minnesota. It's going to be a freaking blizzard. I cannot wait. And then our online courses are going to be starting up in March. So we'd love to see you online or on the road. All right, y'all, that's all I got for you. Get out there, bring that fitness forward approach to your hospitalized patients. I cannot wait to hear about it. 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.

"Kardashian"AMRAP 10:00-90/70 Calorie AirBike -50 Sandbag Squats* 150/100lb-Max Handstand Walk***sandbag may be held however**every 5ft = 1 rep**scale to Wall Walks» View the Video Version: https://youtu.be/cJMJgodnVOg» Hire a Coach: https://zoarfitness.com/coach/» Submit Your Score: https://zoarfitness.com/tng/» Shop Programs: https://www.zoarfitness.com/product-category/downloads/» Follow ZOAR Fitness on Instagram: https://www.instagram.com/zoarfitness/Support the show

"Not Nate"AMRAP 20:00-2 Strict Ring Muscle-Up-4 Wall Facing HSPU-7 Russian KB Swings 70/53lbView the Video Version: https://youtu.be/Ri-fAAiUPBwHire a Coach: https://zoarfitness.com/coach/Submit Your Score: https://zoarfitness.com/tng/Shop Programs: https://www.zoarfitness.com/product-category/downloads/Follow ZOAR Fitness on Instagram: https://www.instagram.com/zoarfitness/Support the show

On the 2nd day of Fitmas, Do Hard Things gave to me: Deck the Halls AMRAP!   Ready for a holiday AMRAP challenge that will make your heart race faster than Santa's sleigh? Introducing the "Deck the Halls" AMRAP (As Many Rounds As Possible) workout!  

I am so excited about this episode. I am going to try something new here on my podcast. I am going to guide you through a workout right here on the episode. In last week's episode, episode #6, I talk about Fast and Effective workout and movement ideas you can do when you don't feel like you have time to fit a workout in. And today's workout is an example of a fast and effective workout you can do anytime, anywhere, no equipment necessary, when you are short on time. I will guide you through a 5-minute total-body AMRAP workout, and I add in a warmup and cool down equaling another 5 minutes, for a total workout time of only 10 minutes. So, if you are ready to get a quick workout in with me today, grab your water, tie those shoes, and let's get started. Warmup: 10 Squats 5 Inch Worms 10 Alternating Bird Dogs 10 Arm Circles Forward 10 Arm Circles Backward   5-Minute Total-Body AMRAP (Complete As Many Rounds As Possible in 5 minutes): 10 Squats 10 Mountain Climbers 10 Right Lateral (Side) Lunges 10 Left Lateral (Side) Lunges 10 Pushups 10 Glute Bridges   Cool Down: 5 Open Arms Chest Stretch Standing Hamstring Stretch Standing Quad Stretch – Right Leg Standing Quad Stretch – Left Leg   If you don't know how to do one of the exercises, CLICK HERE to see visuals of all the exercises in this workout, including the warmup and cool down. And if you have any questions, don't hesitate to contact me. Let's get moving, Corene   NEXT STEPS:    Get my FREE Fast and Effective Workout Guide: https://leavenworthhealth.com/fast-workout-guide/   Join my Simplify Fitness For Life Program: https://leavenworthhealth.com/fitnessprogram/   Join my Simplify Nutrition For Life Program:  https://leavenworthhealth.com/nutritionprogram/   Join my FREE Fitness and Food Made Simple for Busy Moms Facebook Group: https://www.facebook.com/groups/362361277680532   Fill out this form with the Fitness and Nutrition topics you want to hear more about on the podcast: https://thrivecoach.link/3T91EQF6   Visit: https://LeavenworthHealth.com Email: office@leavenworthhealth.com   Warmup/Cool Down Track: "Sugar Cookie Dreams", Johnny Moore Music provided by https://slip.stream Free Download / Stream: https://get.slip.stream/7nlBP9 Listen on Spotify: https://go-stream.link/sp-johnny-moore   Workout Track: "Totally Toning" Music provided by https://slip.stream Free Download / Stream: https://get.slip.stream/LInkxr   Intro/Exit Track: "Here We Are" Music provided by https://slip.stream Free Download / Stream: https://get.slip.stream/P4XGUJ  

Learn the best way to build to a 1RM or Rep Max whether in Olympic Weightlifting (snatch + clean & jerk) or Powerlifting (squat, bench, deadlift).Watch on YouTube: https://youtu.be/l6K5bLVoBvEView All Episodes: https://zoarfitness.com/podcast/Hire a Coach: https://www.zoarfitness.com/coach/Shop Programs: https://www.zoarfitness.com/product-category/downloads/Follow ZOAR Fitness on Instagram: https://www.instagram.com/zoarfitness/Support the show

JP Dinnell talks about the book "As Many Reps As Possible" by Jason Khalipa and answers question about how to taking action is the most important part of the OODA Loop.  Check out AMRAP: https://www.amazon.com/As-Many-Reps-Possible/dp/1684019818 More from JP Dinnell: https://www.jpdinnell.com/ Join the conversation on instagram JP Dinnell: http://instagram.com/jpdinnell/ Lucas Pinckard: https://www.instagram.com/lucaspinckard Get that BEEF: https://littlecattle.co/ JP Dinnell is a former U.S. Navy SEAL and now a Leadership Instructor, Speaker and Strategic Advisor with Echelon Front, where he serves as Director of Experiential Leadership Training Programs. J.P. is also a pro team athlete and spokesperson for Origin Maine and Jocko Fuel, an American clothing and supplement company. J.P. has a signature Energy Drink flavor “Sour Apple Sniper” with Jocko Fuel. Jeremiah spent nearly a decade in the SEAL Teams with three combat deployments. Sent to the violent terrorist stronghold of Ar Ramadi, Iraq in 2006 with SEAL Team Three's Task Unit Bruiser, J.P. served as point man, machine gunner, and lead sniper for Delta Platoon opposite the American Sniper, Chris Kyle, who was in Charlie Platoon. For his leadership and courage under fire, JP was awarded a Silver Star, 2 Bronze Stars with Valor and the Army Commendation Medal with Valor helping Task Unit Bruiser to become the most highly decorated special operations unit of the Iraq War. He worked closely with SEAL Officers Jocko Willink, his Task Unit Commander, and Leif Babin, and was the driving force on many of the daring combat operations Jocko and Leif wrote about in Extreme Ownership. Upon his return, J.P. again worked directly for Jocko as a training instructor at Naval Special Warfare Group One Training Detachment, where he orchestrated realistic and challenging training scenarios for Special Operations Urban Combat training and Close Quarters Combat training to better prepare SEAL units for the real-world battlefield. He also served as a Combatives Instructor, Marksmanship Instructor and earned his Master Trainer Specialist qualification while helping Jocko rebuild and enhance these training programs into the highly effective platforms they are today. J.P. brings exceptional experience and frontline leadership perspective from the winning mindset and culture of Task Unit Bruiser.

Michael and Kegan sit down with Nate Pack to discuss this year's annual Space Race, which occurs on New Years Eve. Previous editions include a 24-hour Assault Bike challenge in teams of three (580 miles was the final 'winning' score), 12-hour Dante's Triathlon (ski, row, bike 50-40-30-20-10 calories repeated in teams fo 3 or 4 depending on total weight of the team), and a 6-hour 40/400 AMRAP (40 calories plus 400m run) done solo. Continuing to cut total time by 50% would obviously lead to a 3-hour event and no one saw the point in that — the goal must be challenging and difficult enough to cause change or adaptation if that is what one seeks. And the power of having a date or deadline for performance, and people to do it with should not be underestimated.Once the structure of this year's event was determined they delve into the psychological (and physical) limitations of truly hard effort, the challenges of different time domains, and how most people never actually work hard but believe they do. Nate also discusses his impressions of the Capacity manual and the eight-week progression proposed therein ... and how ‘simple' is much harder to abide than we imagine. Within this context they cover the various interval structures and training styles that helped develop them into the athletes they are today.Finally, Michael declares, "You have to rewrite what your brain thinks is hard in order to do something harder ..." and drops the mic. 

We ganked this week's question from the /Powerlifting sub-Reddit: “Is there a cut off range for AMRAPS?”What does AMRAP mean, and does it have a place in powerlifting training? And as to the original question, how many reps is too many? Support for this episode was provided by Legion Athletics. Use our code “goodcompany” for 20% off at legionathletics.com.Have a question for one of our Friday “One Good Question” episodes? Hit us up on social media and use the hashtag #onegoodquestion.Join our Discord for free at goodcompanydiscord.com!Check out our gym (Third Street Barbell) at ThirdStreetBarbell.com https://www.thirdstreetbarbell.com/ and subscribe for updates about our apparel line at goodcompanyapparel.com https://3sb.co/! Local memberships and international fresh fits! Get early access to our NEXT DROP!Check out our podcast website: 50percentfacts.com https://www.50percentfacts.com/50% Facts is a Spreaker Prime podcast on OCN – the Obscure Celebrity Network.Hosted by Mike Farr (@silentmikke) https://www.instagram.com/silentmikke/ and Jim McDonald (@thejimmcd). https://www.instagram.com/thejimmcd/ Produced by Jim McDonald Production assistance by Sam McDonald and Sebastian Brambila. Theme by Aaron Moore. Branding by Joseph Manzo (@jmanzo523)This show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/5538735/advertisement

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. 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.

Music by: N.W.A. - "Express Yourself" 

I've cracked the code to getting lean. And it doesn't include MetCon, AMRAP, or any type of circuit training.  In fact, you can get lean without any cardio.  ... Although I don't recommend it for optimal health. So how should you train to lose fat, build muscle, and optimize your health?  Listen and learn: What's the minimum effective dose of cardio? [4:42] Are there benefits to ladders, AMRAP, or MetCon? [8:45] How to build better athletes or become more athletic yourself. [14:40] Why you should stop doing CrossFit (or never start). [25:53] When's the ideal time to shut off screens before bed? [30:10] What training advice would I give my younger self for better gains? [32:24] Is there a smart way to bulk and cut? [38:39] Why I no longer rage against the machines. [44:48] Sponsors AG1: A high impact blend of a multivitamin, minerals, probiotics, and more to improve your gut health, immunity, and boost your energy and recovery. Go to drinkag1.com/jay to get yours today.  Cured Nutrition: No jitters. No caffeine. No crash. Just clean and clear brain energy for lasting, unbreakable focus. Go to curednutrition.com and use code RENEGADE to try RISE today and save 20%.

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.

Jason Khalipa is a whirl wind of a guy!  If he's not moving there's a problem, or at least that's the way it seems!  He is either working on or has figured out ways to show up in almost every facet of his life.  A father, husband, businessman, athlete and more!By approaching every day with the AMRAP mentality (As Many Reps As Possible) it forces him to focus on the moment, whatever that moment may be!Listen in as we talk:Brazilian Ju Jitsu and why he has "self-defense Sunday" in his homeBecoming a CrossFit ChampionTeaching your kids how to do hard thingsOvercoming adversity, including Pediatric LeukemiaHunting, archery, scuba diving and moreHow to approach sports and life by being presentGiving the gift of exploration to your familyJason, thanks for the great conversation!  It was truly an honor to sit and learn from you today!

Dr. Christina Prevett // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic Division Leader Christina Prevett breaks down two recent studies, one that is VERY new to challenge beliefs on prolapse, the pelvic floor and strength training. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses 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. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION 00:00 INTRO Hey everyone, Alan here. Before we get into today's episode, I'd like to take a moment to introduce our show sponsor Jane. If you don't know about Jane, Jane is an all-in-one practice management software with features like online booking, scheduling, documentation, and a PCI-compliant payment solution. The time that you spend with your patients and clients is very valuable, and filling out forms during their appointment time can quickly take away from the time that you all have together. That's why the team at Jane has designed online intake forms that your patients can complete from the comfort of their own homes. And to help them remember to fill out their forms, Jane has your back, with a friendly email reminder sent 24 hours before their appointment. This means they arrive ready to start their appointment, and you can arrive ready to help. Jane's online intake forms are fully customizable to ensure you're collecting everything you need ahead of time, whether that's getting a credit card on file, insurance billing details, or a signed consent form. You can build out your intake forms from scratch or use templates from Jane's template library and customize it further to meet your practice needs. If you're interested in learning more, head on over to jane.app slash guide. Use the code ICEPT1MO at signup to receive a one-month grace period on your new account. Thanks everyone. Enjoy today's episode of the PT on ICE Daily Show. 01:22 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 pelvic health division. If you are interested in learning more about our pelvic health division, we have a online newsletter that goes out every two weeks that focuses on the research, which I'm going to talk about today, in pelvic health. One of the things that is so exciting, but maybe a little bit overwhelming about being in public health and being in this area of exercise and rehab in the pelvic health space is that it is constantly changing. The research is coming out at a very fast pace, fast being relative because research is very slow, but we try and focus in on getting that research to your inboxes every two weeks. You can go to PTonICE.com slash resources and sign up for that newsletter. I am writing it this week and it goes out on Thursday. Also all of our online content, our next online cohort, and all of our upcoming live courses, our two-day live course is in that email newsletter. I hope that you all sign up to get all that research straight to your inbox. 02:48 ACUTE EFFECTS OF RESISTANCE TRAINING Today I'm going to be talking about a new study that came out of Carrie Bowes' lab, talking about the acute effects of resistance training on the pelvic floor. And so before I do that, I kind of want to set the stage for you all around some of the thoughts in pelvic health around heavy strength training. Where we have started this journey was that one of the risk factors for pelvic organ prolapse or descent of one or more of the vaginal walls towards the vaginal opening is that occupational heavy lifting. So individuals who lift heavy weights for their job, consistently lifting heavy weights, were shown to be at risk for more objective descent of one or more of those walls compared to those that didn't. And that because we didn't have any research on resistance training was extrapolated and said, well, maybe we shouldn't do any strenuous heavy lifting as females in order to mitigate or prevent the risk of pelvic organ prolapse from occurring. That was kind of the thought. Since then, we have really pushed back against that narrative and said, well, that doesn't really make a lot of sense because it's very different to go in for eight hours a day doing lifting versus, you know, the 30 to 90 minutes that individuals are doing. In your job, you can't control if you're feeling bad or feeling weak and just take a rest day or modify the way that you're doing your exercise. So again, there isn't really that comparison. 04:24 ACUTE CHANGES TO THE PELVIC FLOOR And now we're starting to get more and more research come out that's talking about kind of this acute change to the pelvic floor that we're seeing with different amounts of strength training or different types of strength training. So Carrie Bo came out with a study and what she was doing was she was taking individuals who were resistance trained. So on average, these were individuals who had never had kids. They were Nellie Parris. And so I never had a delivery and were trained resistance trained athletes. So they had on average about two years of experience. They were then put into a crossover design. So what that means was they took half the individuals and got them to strength train first and then took half the individuals and got them to rest first and then kind of compared. So what they were trying to look at was after a high load resistance training session, what was the impact on the pelvic floor? The thoughts were one of two camps. There's two camps in this space. One is that individuals who strenuously lift are going to have bigger pelvic floor muscles, stronger pelvic floor muscles. And the other is that it may actually create damage over time that they're going to see a big change in symptoms or change in vaginal descent. So you kind of have individuals in both of these camps and we're trying to figure out which hypothesis is correct. And so they took, they did a one rep max or a perceived or rate of perceived exertion that was very high in the squat and the deadlift on one day. And then they got them to come back the next day. So after that one rep max test, they kind of flushed out, let the body recover, came back in. Half the group started with a rest window. So took pelvic floor muscle strength measures at the beginning pre, then half of them rested and did a post and then half of them did a four by four strength training session between 75 and 85% of their one rep max on the squat and the deadlift with reps in reserve between one and three and then did a post assessment and then they flipped, they flipped them. So what they saw was that there was no big differences, no statistically significant differences between the rest pre post, but then also the resistance training pre post. And I think that's really interesting because one of the things that we kind of explain around our, our thoughts around heaviness or prolapse are things like that it's a fatigue issue or so maybe it isn't fatigue or maybe it is, but doing a supine assessment, which is our traditional way of conceptualizing pelvic floor muscle strengthening, isn't sufficient to look at this type of, of fatigue, like to really evaluate this type of fatigue in individuals who are experiencing these symptoms. So that was really interesting. The other thing was that, you know, they did see some individuals who complained of urinary incontinence in this sample around 28%, I believe. And so those individuals, the study wasn't powered enough to be able to subgroup those that experienced incontinence versus those that didn't, but there, what it was not just on individuals who were symptom free. I think that's a pro to this study because we can say, well, of course there isn't any fatigue or any downstream effects of individuals who've never experienced pelvic floor dysfunction, but that's not the case in this study. There was a significant cohort of these individuals who did experience leaking with lifting and the study just wasn't powered enough to subgroup this out. So the first step was to kind of take a full circle approach and say, was there any differences? And then the next step is going to say, is there any differences for individuals who do experience pelvic floor dysfunction versus those that don't? And then the next step is those that are multiparous or multiparous, like multiparous, we kind of, tomato, tomato, those who have had vaginal deliveries before or have given birth before vaginally versus those that haven't. And so this is kind of setting up this conversation around the way that we message things. So another study was done in 2016 and I just found it because it was in the discussion section of this paper around vaginal descent. So Carrie said the Bowe study was looking at pelvic floor muscle strengthening, pelvic floor muscle strength and assessment. 09:23 VAGINAL DESCENT AND EXERCISE The next question is around vaginal descent and are you more likely to experience symptoms of prolapse or heaviness post resistance training? And so this study was done in 2016, I believe it was published out of Janet Shaw and Ingrid lab that was looking at CrossFit athletes, those who experience, sorry, those who participate in strenuous exercise. So they got CrossFitters and they got them to do pre-post on the pop cue versus those that participate in non-strenuous exercise. So let's kind of break this study down too, because I think it's important. So in this second, this, I guess it was the first study, what the group from Nygaard and Shaw's lab did was they took individuals who were CrossFitters, got to check their pelvic floor muscle strength and the pop cues. The pop cue is an objective assessment of prolapse that has good reliability that looks at the different segments of the different walls of the vagina. And then as they do a strain maneuver, they see what the range of motion or the amount of each segment of each component of the wall are, and then create a grade based on the most amount of movement in whichever section of the vaginal wall that may be. So they took individuals who were CrossFitters and then they took individuals who participated in non-strenuous, non-high impact exercise and got them to come into the lab. And then the strenuous group was, they did a pelvic floor muscle strength exam and then the pop cue and then in the non-strenuous group, they did the same thing. And then they got the CrossFit group, the strenuous group to do a 20 minute AMRAP of sit-ups, heavy deadlifts. There was an impact movement in there and kind of went for 20 minutes. And then they got the non-strenuous group to do 20 minutes of an exercise of their choice at a self-selected pace. And then they did the pop cue again. Here's something that's really interesting. So the strenuous group was participating in CrossFit for over two years. They had an extensive history of strenuous exercise versus the non-strenuous group. And they kind of conceptualized this based on looking at what they did for exercise and the amount of loading in their bones to try and get some sort of measure of impact, which I thought was kind of brilliant. And they compared them. Strenuous group had done a lot more loading of their bones and musculature and therefore loading of their pelvic floor compared to the other group. And what they saw was that before their pre-exercise, descent in pelvic floor muscle strength was not different. Was not different. So this created preliminary research that the strength, individuals who are participating in strength training for several years, so it was like on average 22 months plus or minus, and they had to have at least, I think, a year of doing CrossFit regularly, three to four times per week to be able to get into the study in the first place, that there was no difference in vaginal descent. They had, there was no differences between the two. So that kind of goes against this argument that resistance training is going to cause a prolapse, resistance training in general for individuals who haven't had a vaginal birth yet. So I think that's interesting. And then post-partum, or post-exercise rather, they did see differences in descent in both groups. So both groups saw a difference in descent immediately post-exercise, which again, I think is really interesting because this does not support that resistance training and high impact is going to lead to prolapse down the line. Now again, we have a lot of work to do within this space. This was one study. I'm not going to just start shouting from the rooftops that all of a sudden, you know, we know all of the things that we need to know. I'm not saying that, but the fear focused language that is coming into this space around resistance training and avoiding Valsalva and all these types of things isn't founded objectively. So the other interesting thing was that there was only one individual, even though there was a change in descent, right? There was some changes pre-post-exercise and they didn't re, they didn't kind of follow them further and further forward. I would have loved to see them do multiple time points to see how long it took before that changed or kind of returned to baseline. There wasn't anything that, that was looking at what, what that change of symptoms were. 12:57 RESISTANCE TRAINING & PROLAPSE And there was only one person with subjective symptoms of prolapse. So again, we're, we're seeing this disconnect between objective signs and subjective experiences, which I think again is really interesting because we are focusing a lot on the grade, like what grade do you have? What grade do you have? And the evidence isn't really supporting that we, that should be our focus. If you are thinking surgical routes, if it is coming past the level of the Hymen, absolutely, because then we're going to say, is this impacting your quality of life? Is there sufficient imaging data to see that a surgery, for example, would be warranted? For individuals in the conservative space, again, we're, we're, we're questioning, does the objective signs matter? And, you know, we can't answer that question, but it is an interesting thought experiment and we're starting to have more evidence accumulate that, you know, there is a big disconnect. And yes, our body is going to change and show signs of fatigue with things like impact, but what's the cost benefit? What is the risk of telling people that they shouldn't be getting strong for their 60-year-old self, for their 70-year-old self, for their 85-year-old self, when we know that strength is such a huge, huge component of independence in later life? So it is so exciting, kind of going through Carrie Bowes where she didn't see any change in pelvic floor muscle strength to some of the research coming out of the Nygaard and Shaw lab that are talking about changes in pelvic organ support with heavy lifting and long-term heavy lifting. I think we're starting to get more and more data that the fear-focused messages aren't warranted, that we're going to start treating the symptoms and that we can expect changes to the pelvic floor when the pelvic floor gets a workout. Again, I don't think for anybody in the ice fitness forward community that that is necessarily a surprising finding, but it is definitely pushing some of the narratives in pelvic health and I think pushing them in a really necessary direction to try and change this narrative around the fear-focused language of resistance training in the pelvic floor. If you are interested in those studies, I'll post their DOIs below in the comment section. I am so excited to be talking about this research. Again, if you are a research nerd like me and you want to see the new studies that are coming out in this space, which these two studies are going to be in our newsletter this next week, I encourage you to go to ptonice.com slash resources to look for the pelvic newsletter. I am really excited to see some of the changes happening within our course and I just can't wait to continue connecting with you all about research in the pelvic health space. All right. Have a great day, everyone, and I will talk to you soon.  16:40 OUTRO Hey, thanks for tuning into 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.

Dad Bod Destroyer Blueprint - AMRAP - part 2 ____ Websites: http://www.saltwaterexperience.com http://www.tomrowlandpodcast.com If you have questions or suggestions for the show you can text Tom at 1 305-930-7346 or email Tom through email: Podcast@saltwaterexperience.com You can follow Tom Rowland on Instagram @tom_rowland See and buy all the gear we use on each episode of Saltwater Experience at tackledirect.tv This podcast is presented by Black Rifle Coffee. THE BEST DAMN COFFEE YOU'VE EVER HAD, PERIOD. Your favorite light roast, medium roast, and dark roast coffees are roasted here in the USA by a veteran-led team of people who are mission-focused to make sure nothing but the best hits your mug. Use this link http://bit.ly/3zDIRUa and this code BLASTOFF25 for 25% off your first month! Stay Hydrated in the HEAT! I use LMNT everyday to get my electrolytes without all the sugar and junk. Get yours and an LMNT Electrolytes Special Offer of a sample pack of every flavor when you use this code: http://DrinkLMNT.com/TomRowland This episode has also been brought to you by Waypoint TV. Waypoint is the ultimate outdoor network featuring streaming of full-length fishing and hunting television shows, short films and instructional content, a social media network, Podcast Network. Waypoint is available on Roku, Samsung Smart TV, Amazon Fire TV, Apple TV, Chromecast, Android TV, IoS devices, Android Devices and at http://www.waypointtv.com/ all for FREE! Join the Waypoint Army by following them on Instagram at the following accounts: @waypointtv @waypointfish @waypointsalt @waypointboating @waypointhunt @waypointoutdoorcollective Find 18 seasons of Saltwater Experience on Waypoint STREAM ALL OUR FULL SEASONS ON WAYPOINT TV: https://waypointtv.com/saltwater-experience ____ SPONSORS: https://waypointtv.com/saltwater-experience http://www.hawkscay.com/ http://www.yellowfinyachts.com/ http://www.tackledirect.tv/ http://www.lowrance.com/en/ http://www.yeticoolers.com/ https://www.mercurymarine.com/en/us/ http://www.fla-keys.com/ https://www.hukgear.com http://www.blackriflecoffee.com - Use Code Blastoff25 https://ameratrail.com https://stcroixrods.com http://www.power-pole.com/ https://www.nikonusa.com/en/nikon-products/sport-optics.page Learn more about your ad choices. Visit megaphone.fm/adchoices

Alan Fredendall // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE COO Alan Fredendall discusses average arrival rates in physical therapy, what the research says about how to improve arrival rates, leveraging technology to improve arrival rates, and creating policies & systems that ensure your clinic still gets paid for missed appointments. 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 ALAN FREDENDALL Good morning, everybody. Welcome to the PT on ICE daily show. Happy Thursday morning. Hope your morning is off to a great start. My name is Alan. I'm happy to be your host today. Currently have the pleasure of serving as the chief operating officer here at ICE and the faculty member on our fitness athlete division. We're here on Thursdays. We talk all things leadership Thursday, small business ownership, practice management, that sort of thing. Leadership Thursday also means it is gut check Thursday. This week we have a 17 minute AMRAP, as many rounds and reps as possible in 17 minutes of the following 21 plate ground to overhead. Our Rx weight there for guys 45 for ladies 25. So grabbing a bumper plate, hinging down, tapping one side of the plate between your feet and then up and over overhead, almost like a snatch. Moving into 15 cows on the rower for guys 12 for ladies and then finishing with a small dose nine burpees to plate. So looking for somewhere between three to five rounds of that great workout for home, the garage, the basement, the clinic. Just need a rower and a bumper plate. Great to maybe take out to the park as well and sub the row for some running or something like that. So that is gut check Thursday. Course is coming your way. We have so many about to enter a very, very busy season for ICE here as we get into the fall, get away from the summer, school starts back up, that sort of thing. We have a couple hundred courses coming your way between now and the end of the year. So if you're looking for live courses, head on over to p10ice.com, click on our courses and check out our map to see what's coming to your neck of the woods. Some online courses I want to highlight. Pretty much all of our entire catalog of eight week online courses are starting back up after Labor Day. So if you don't know about our online courses, they are eight weeks online. They are synchronous, which means that you meet with us every week. They are not completely self study, a mixture of lecture, of reading, of homework and of live meetups. They're meant to simulate the feeling of a two day live course, but stretched across eight weeks to make it a little bit more accessible, save you a little bit of money on travel. So online courses, pretty much like I said, all of them are starting after Labor Day. We have ICE Pelvic Online. That's our entry level online pregnancy and postpartum course. That's going to start September 4th. We have Fitness Athlete Essential Foundations taught by yours truly Mitch Babcock, Kelly Benfee and Guillermo Contreras. That's going to start September 11th. The very next day, September 12th, Brick by Brick is going to start very relevant course to this day of the week to Thursdays. We talk all things practice, startup and ownership and management in that course. Injured Runner Online also starts September 12th and then Virtual ICE will open back up September 26th for our next quarter of enrollment. So let's get into today's topic. Let's talk about how do we handle, how do we get better at when a patient reschedules, cancels or no shows. I want to talk today about three main topics. I'm going to talk about what are the average no show cancellation rates, what we would call an arrival rate across the country, across physical therapy, what's normal, what's abnormal. I want to talk about how to improve those arrival rates. And then I want to talk about how to get paid when somebody does not show up for those appointments. 05:46 ARRIVAL RATES IN PHYSICAL THERAPY So let's start at the beginning and let's talk about what is a normal rate. If you have been practicing physical therapy for a while, if you have been practicing in a traditional clinic, you may have heard that the common recommendation for the maximum arrival rate is about 93%. That is to say that 93% of your appointments show up for their appointment that day. That there's some margin of error. We recognize that 100% of people probably won't make it, but pretty typical. 93% is the standard that's set and sometimes enforced by the clinic that you work for. Maybe if you fall below that, maybe you get a warning, maybe you get a talking to, or maybe they actually dock your pay for visits underneath that 93%. What's awesome about this topic is that we actually have a lot of research, surprisingly, supporting the numbers that I'm about to tell you. So we have a great survey back from 2015 of about 7,000 outpatient physical therapists. This is from Bo Kinski and colleagues, sorry if I mispronounced this, of 7,000 outpatient PT's looking at a couple of different things. Looking at finding the average cancellation no-show rate, but also finding what things seem to help fix that. So across the country, we see an average no-show cancellation rate of actually about 10 to 14%. So thinking you may have been told 93% is the gold standard, in reality, somewhere between 85 to 90% is actually probably more realistic. If you had 10 patients scheduled for the day, you could expect maybe eight of them to show up for the appointment. You could expect maybe one to two appointments to be unfilled. I like this survey because it goes a couple levels deeper. It asks why. Now knowing that rate, knowing that 10 to 14% rate, why do people not show up for the appointment? What is the number one cause? The number one reason why patients do not attend their appointment is not that they can't afford it, not that they don't like you, it's that they forgot and that the clinic that they went to physical therapy to had no reminder system. So that's a huge error, that's a very easy fix. When we delineate outpatient physical therapy from hospital-based outpatient physical therapy, so private practice versus hospital-based, we see that hospital-based clinics actually the no-show cancellation rate of a private practice clinic. Why is that? I would imagine it's probably due to having a modern reminder system, but again, that number of 93% isn't the gold standard that we think it is. In private practice, we can expect maybe 85 to 90% arrival rate, a little bit lower in hospital-based, maybe 75 to 80% arrival rate. Now this survey looked at the concept of a multi-method reminder system. What does that mean? That means that the patient received multiple reminders across multiple communication methods. That they usually received some sort of automated phone call reminding them of their appointment. They received probably a text message and then maybe also an email message. So they received two to three different reminders ahead of their appointment across different modalities, basically reminding the patient as much as possible of their upcoming appointment. Now they found that those clinics that used a multi-method reminder system had a significant reduction in no-show cancellation rates, about a 50% reduction. So they cut their no-show cancellation rate in half just by having a reminder system. And we're going to talk about how to set that up at your clinic here in a minute. The second reason that clinics did better with no-show cancellation rate was those clinics who had a 24-hour appointment change policy. That is inside of 24 hours, you will be penalized if you cancel or reschedule or no-show your appointment versus if you give more than a 24-hour notice that you need to reschedule your appointment or otherwise cancel it. So those clinics which had a 24-hour policy and enforced that policy on their patients also had a reduction in their no-show cancellation rate. So that brings us to the question of if 10 to 14% is the mean of the average of no-show cancellation rates across the country, then how realistic is 7%? The answer is not very, right? Even if you are treating one-on-one for an hour and you maybe only have eight patients on your caseload for the day, it's probably unrealistic to expect 100% of those people to show up every day. That we have to recognize at some level that the reason we see so much overbooking in traditional physical therapy clinics is it's just that leadership strategy to limit the impact of those inevitable no-show cancellation rates. That if you see eight patients in a day and 10 to 15% don't make it, you may see five to seven patients. So kind of the aggressive leadership solution here is just to make you see more patients. That if you see twice as many patients and you still have that 10 to 15% no-show cancellation rate, then you'll still see more patients than originally intended and scheduled to and the clinic won't lose as much profit. But that being said, that is an aggressive way. That is a way that puts all of the burden of the work on the therapist and none of it on the ownership, none of it on the leadership and none of it kind of on the backend logistical side of the clinic. Instead of making you see more patients, why don't we just have a 24-hour policy that we enforce? And if we're not using a reminder system, why don't we start using one? Why don't we do some more conservative approaches to reduce that no-show cancellation rate, especially now knowing that we have research that supports, does those actually improve our no-show cancellation rates? So let's talk about that. 08:48 IMPROVING ARRIVAL RATES Let's talk about aside from having a reminder system, aside from strategies to remind patients to get to the clinic and aside from having a policy, how can we approve improve those arrival rates? You know us here at ICE, if you've been listening to us for a while, Jeff Moore, our CEO says it best. The first thing you can do to make patients show up to physical therapy more is make sure that you're focused on getting good and not getting busy. That when people see results, when they begin to associate value with their physical therapy appointment, they come to their appointment more often. I think this is so overlooked, especially in a higher volume clinic where a therapist may be expected to see multiple patients per hour. By providing lower quality care, patients aren't able to get results or they're not able to get results as fast as maybe they want to. They don't really associate physical therapy as a valuable use of their time and it makes sense that they find better stuff to do and that you get that message at 4.55 p.m. that your 5 p.m. patient is not going to make it in today. So really focus on getting good, not getting busy. We also need to recognize that people are not stupid. When they show up to PT and they see that you are working with three other people at the same time and you have forgotten about them in the corner at the TheraBand station or on the recumbent bike or the pulleys, again, that really begins to lower the value proposition that patients have with physical therapy and it's not surprising again that they begin to find better stuff to do with that hour of their time. The counter argument here is that you can get so good as a physical therapist, I'm good enough that I can see multiple patients at once or patients aren't as fragile as we think. We don't need to give them one-on-one care, but we need to recognize that at some level, patients are paying for it, especially if they're paying cash for a one-on-one visit. They are expecting one-on-one treatment. Even if you are an insurance-based clinic and using a patient's insurance, that insurance is still paying you based on one-on-one care. And not only that, but the patient expectation is that you are going to give them the care that they need. And I often relate this to other professions of you would lose your mind if you had a therapy appointment with a psychologist, a mental therapy appointment, if you showed up and there were three other people getting mental health therapy at the same time as you. No one would put up with that, but for some reason, it's just expected and normalized that that's the kind of care that we give in physical therapy. So then it's no wonder that patients, again, find something better to do with their time for the hour. So really focus on getting good and not getting busy, of taking really quality care of that patient that you have on your schedule for that hour. And you'll be surprised how much they come back to physical therapy when they see their range of motion improving, when they see their balance improving, when they feel stronger, when their pain is getting better, whatever their goals are, as they can see progress towards their goals, it's much more likely that they're going to come back to physical therapy. And I think that is often overlooked. My second point with improving arrival rates is to leverage technology, implement that multi-method reminder system. It's 2023. There is no reason why your clinic does not have automated reminders, text, email, phone, whatever. It's all built in to a modern EMR. If your EMR does not do this, you need to get an EMR that does this. If your front desk person is still calling people by hand to remind them of their appointment, you're a little bit behind the curve, right? to do the work for you so that you can focus on treating your patients while the technology sends out those reminders for you. We need to recognize that people are busy and that the more we can be prominent in front of mind with reminders, the more likely people are to attend their appointments. We have research that supports this, right? We can cut these no-show cancellation rates in half with a multi-method reminder system, but also it gives the patient a chance to reschedule if they know they already can't make it, right? That text reminder, when they get that phone call, when they get that email, it gives them multiple chances to reschedule. And if they don't, it also kind of builds the case for you against them that you gave them plenty of chances to reschedule and they still did not. And that makes it a little bit easier to charge them money, which we'll talk about in a few seconds here. So remember, we can cut that rate in half, that no-show cancellation rate in half with a multi-method reminder system. So if you're still using Google Drive as your EMR, if you're still using paper documentation and scanning it into a computer, consider getting a modern EMR. They're not that expensive. EMRs, we're big fans of Jane here, obviously, at ICE, other EMRs, Prompt, PT Everywhere, pretty much all the modern web-based EMRs are going to offer reminders and more often than not, they're free for you to use. So why not use them, right? It's one more push of a button when you're building out that patient chart for them to get reminders. In addition to reminders, leverage technology to create an online booking and waitlist system so that when you do send that reminder, it should come with a link where it says, hey, if you can't keep this appointment, please click here, right? So that your appointment comes off my schedule and that you get a little link to rebook at a time that works better for you. So we still keep that visit on the schedule, but we also open up that visit to maybe somebody else who can use it so that we don't have a missed slot on our schedule. Pretty much just like reminders, modern EMRs are very good at having automation with waitlists of where when a patient reschedules and a slot opens up, usually automatically or with the push of a button, you can pull people in from your waitlist and make sure that that slot stays filled without having that patient get charged for cancellation or no-show because they were able to go in on their own and reschedule their own appointment. So make sure we're leveraging technology whenever possible to do this work for us. My last point here on improving arrival rates is probably something that we don't consider very often of making sure in that initial evaluation that the patient actually has the time and or money to come to their physical therapy appointments. I feel like a lot of time patients feel beholden to maybe a referral they had from a doctor or what you tell them of some sort of verbal contract of the doctor said I have to come here three times a week for six weeks or maybe that's what you wrote on your documentation is the physical therapist and they feel like they have to come no matter what, even if they know they do not have the time or money. I feel like this is something that should be discussed as we're wrapping up our initial evaluations that just doesn't get done. As we're building the bike for that patient, we're explaining our findings, we're demonstrating that we can help that person reach their goals by showing them some improvement in that first visit and as we begin to discuss what that plan of care might look like, also making sure that the patient is on board, right, including the patient that conversation of hey, Diane, this seems to be a pretty irritable tendinopathy. You know, I think I would like to see you here in the clinic twice a week, probably for at least the next four weeks. And instead of stopping there, take it one step further. How do you feel about that? Right? What do you think about my plan for your care? And we don't necessarily have to ask, hey, can you afford this? Or do you have the time for this? But that's what we're hinting at of how do you feel about coming here twice a week for four weeks? How do you feel about coming here once a week for the next four weeks and getting the patient's input because that's a great time for them to say, that's going to be tough with my schedule. You know, I have 17 kids or I work 30 jobs. I won't be able to do that, right? That's a great time to make sure that person does not get put on your schedule for a bunch of visits that they're not going to attend. And then making sure we're following the law, right? No surprises act that was passed last year that were very transparent with how long we think the plan of care is going to take and what that's going to cost that patient. Whether you're charging cash, whether you're billing insurance, you need to provide that information upfront to the patient. I would argue you should be doing it even if it's not the law, just so you don't have people on your schedule who are not going to show up. But being very forthright and how long you think it's going to take and what's that going to cost and get that patient's input on it before we talk about scheduling out for their visits. 19:05 GETTING PAID FOR MISSED APPOINTMENTS My last point here of talking about what average arrival rates are, what improves arrival rates is how do we get paid when somebody does not show up to the clinic? This is another area where I think physical therapists are very uncomfortable with asking people for money to come to rather not come to their appointment. And it's an area where again, when we look at the research, what improves arrival rates, multi-method reminder system and having a rescheduled cancellation policy that is enforced. If you don't enforce it, you can't get paid for these missed visits. And if you try to enforce it like halfway through the plan of care, the patient is probably going to be upset versus if you're straightforward from the start in your intake paperwork and with your expectations before they begin physical therapy, it's not as jarring to that patient when you charge them for that canceled or rescheduled appointment. So remember, combination of a reminder system and a clearly stated 24-hour rescheduling policy that's enforced are the keys to reducing your no-show cancellation rate by as much as 50%. So first things first, create a policy. What do you want your policy to be? Make sure that policy is very clear, very transparent and that patients see it before they actually come to the clinic. So for us here at Health HQ, this is the first thing that patients see when they go through their intake paperwork. They see our cancellation no-show policy. They see our rates. They know what they're going to be charged. They know the maximum they can be expected to pay out of pocket if they do have insurance and they're going to see what they can be expected to be charged if they cancel or reschedule appointment within 24 hours. So ensure you have a policy, make sure it's actually written out, make sure that it gets in front of patients before they commit to a plan of care and then decide on what you want to charge that person. Decide on what your rate will be. I would argue it should be what you would want to get paid for that hour even if the patient had come. A lot of clinics will have what I would call a dinky, kind of a really lackluster enforcement policy where maybe if you don't show up to your appointment, you're charged $10 or $15. That's really not enough for people to have skin in the game. Being charged $10 or $15, especially if you don't actually enforce it, is really not going to set the expectations for your patients the way you want it. For us, we want to be sure the patient, sorry, the therapist gets paid as if they had seen that patient even if the patient no shows or cancels. So we charge $75 and we enforce it. Right? How do we enforce it? Well, you should probably start obtaining payment methods before the plan of care begins. So again, somewhere in your intake, transparent, clear, laid out should be what you charge for cancellation, a no show, a reschedule, the amount, and that you should take a payment method and have that payment method on file even before the initial evaluation happens so that even if they don't show up to the evaluation, your therapists are able to get paid for that hour. And then actually enforce it. You have to enforce it. You have to rip the bandaid off and actually do it. If you don't do it until somebody has done this to you 19 times, it's going to be difficult to actually start enforcing it because you've let them get away with it so many times. Maybe your personal policy in your mind is that everybody gets one freebie. Whatever that is, stick to that and then start actually enforcing it. What you'll find is that when you enforce it, guess what? The first time that patient gets charged that money, guess what they never miss again? Physical therapy. Or they reschedule so that they don't leave an empty spot on your calendar book. So recognize that we have to enforce this. Yes, it's uncomfortable, but the more you do it, the sooner you do it in the plan of care, the more you'll find patients will either adhere to it or they might decide therapy with you is not for them and that's okay too because the end result is we want people on our schedule who are actually going to come to physical therapy. We need to recognize that this is not unusual. Oftentimes we said, well, this isn't something physical therapists do. They don't charge people for not coming to appointments. Literally every other industry on the planet does this. When you make an appointment to get your haircut or whatever personal beauty grooming thing you do, they have a reschedule cancel no show policy where if you don't show up to your appointment for whatever reason, you're probably going to get charged a little bit of money. Massage therapists do this. Lawyers do this a lot. You have to pay money upfront to even talk to a lawyer, right? You have to have that retainer money on file. Dentists do this. Other healthcare providers do this. This is very, very common across a wide range of industries except for physical therapy. People often ask me, why do you think that is? I think it's because we spend a lot of time with our patients and we begin to almost view some of our patients maybe as friends or at least acquaintances, which makes it that much harder to begin to charge that person for missing a physical therapy appointment. So we need to recognize that yes, it is difficult, but again, every other business does this. Every other industry does this. The sooner and more comfortable you get with enforcing this, the less awkward it's going to feel. And remember, leverage technology to fill those missed appointment slots so that ideally the therapist still gets paid for that person not showing up, but maybe they can also fit another patient into that spot still. I love when I pull up our schedule and I see that somebody has canceled, they've been charged for it, and we've been able to pull another patient from the wait list to fill that same slot. That therapist went to work, came to work here that day thinking, I'm going to see seven people and they actually got paid as if they had seen nine. That's fantastic, right? That's way better than systems where you may be expected to clock out if a patient doesn't show up and not get paid at all for your time, or you may be expected to clean the toilets or something like that in that missed time versus actually getting paid for that time and either being able to use that time for whatever you want or trying to fit another patient into that slot. So remember, it's really important here. This is all an end, not or situation that there are different components to this that we need to implement. It's not just we need to charge people for not showing up. It's not just we need to have a reminder system that we need to understand that at some level, having 100% arrival rate is unlikely. People not showing up is unavoidable, whether kids, family emergencies, that sort of thing. But there are things that can be done to reduce those rates. They're not unavoidable that we can deliver great outcomes to patients so that they do not find other reasons and other things to do instead of coming to physical therapy. We absolutely have to get with the program and begin to leverage technology, begin to send these reminders out if we're not doing it already, begin to use technology to have a waitlist system so that we can fill empty slots quickly, create and actually enforce a policy, get credit cards on file, begin to actually charge people for not coming to those appointments, hold them accountable, hold their feet to the fire, but also recognize and have that conversation early on of what is realistic for that patient. Do they actually have the time and money to come to therapy two or three times a week? Or do we need to look at maybe, hey, I can see you once every other week, but you're going to have to be really judicious at home with your homework because you're not coming here as much. So having those conversations early and often in the plan of care so they don't come back to bite us later on and then utilize technology to get paid for those visits and fill those empty slots. So reschedules, cancels, no shows, not to the end of the world, things we can do better to get better at them, I should say. Leverage technology, enforce a policy. So I hope this was helpful. I hope you all have a fantastic Thursday. Have fun with Gut Check Thursday. If you're going to be on a live course this weekend, have a wonderful weekend with our faculty on the road. We'll see you all next time. Bye everybody. 24:17 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 the need for falls prevention initiatives to shift their focus towards early identification of individuals at risk for falls. By doing so, healthcare professionals can implement targeted interventions and reduce the occurrence of falls before they happen. Christina emphasizes that outcome measures should be used to guide interventions. She mentions the Mini-BEST as a specific outcome measure that assesses various aspects of balance and mobility. By administering this measure at the beginning of a session, the clinician can immediately identify areas of deficit and tailor their intervention accordingly. For example, if the person shows deficits in dynamic gait and reactive posture control, the clinician can focus on exercises and strategies to improve these specific areas. Overall, the episode highlights the importance of outcome measures in falls prevention and emphasizes that they should not be conducted for the sake of it. Instead, outcome measures should provide meaningful and actionable information that guides clinical reasoning and informs interventions. 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 ready to get started, make sure to use the code ICEPT1MO. When you sign up, that gives you a one-month grace period that gets applied to your new account. Thanks, everybody. Enjoy today's show. 01:33 CHRISTINA PREVETT Hello, everybody, and welcome to the PT on ICE Daily show. My name is Christina Prevett. I am one of the lead faculty within our modern management of the older adult division, part of our geriatrics team. Everyone, we are flying high this week because we got everybody from our MMOA division to descend on Lexington, Kentucky at Jeff and Dustin's Stronger Life facility, which was beautiful. And we got to show the world some of what we have been working on, which is some revamped material. So we got to really focus on dialing in live to be about lab. We were moving all weekend. It was so fun and so amazing. If you were thinking about joining MMOA live, we have a couple of opportunities coming up in the remainder of this month. So this weekend, Dustin and Jeff are going to be in Bedford, Texas, and Julie and Ellen are going to be in, oh my gosh, I'm blanking on where they are. They're in Minnesota. And then there I was like, I know this. And then the next weekend, Alex is going to be in California. And so if you are looking for where MMOA is going to be, we have a ton of courses into the end of 2023. We are not adding any more locations for MMOA live in 2023. So if you're kind of waiting for one to come closer to you for the end of this year, that isn't going to happen if it's not there now because we're kind of locked in. We have lots of offerings that's going to come up for 2024. So if you're looking to see that live material, that is where to go. 03:29 A FRAMEWORK FOR BALANCE INTERVENTION OK, so today I wanted to talk a little bit about a framework for balance intervention. When it comes to balance, I think it's a bit tougher for us to put this marker of effort or intensity on, maybe more so than other styles of fitness. What I mean by that is when we think about aerobic training, it's easy for us to conceptualize effort because we're seeing that perspiration, we're seeing that heart rate response. And that's correlating to our rates of perceived exertion. When it comes to resistance training, right, the amount of effort is either going to fatigue kind of in those higher rep ranges or our personal preference is getting to fatigue and effort through higher load. And again, it corresponds to changes in rates of perceived exertion. When we're trying to conceptualize intensity and then we're really trying to dial in our balance interventions, it's a bit tougher, right? We don't really have the same magnitude or the same outcome measures with respect to gauging intensity well. And so within MMOA, we really try and create this framework for individuals to help guide them through this kind of thought process and then create a kind of stepwise framework within our mind for how we implement this in clinical practice. The way that we do this is by first looking at the mechanism at which individuals are falling or where they are having near falls. This is important, right? 05:00 FALLS PREVENTION INITIATIVES Our falls prevention initiatives are only preventative if we are identifying individuals early rather than waiting for them to get hurt and then working in secondary tertiary prevention. We want to be able to identify those who are at risk for falls before that fall has happened, which unfortunately is not as common in our health care system as it stands right now. So we want to figure out the mechanism. We want to identify risk factors that are intrinsic to the individual and extrinsic around their environment. And then in order for us to put objective data on those things, we need to take that information from our subjective and use the appropriate outcome measure in order for us to have a good data point or multiple data points in order to guide our interventions. And then we want to make sure that those outcome measures that we are selecting are giving us tangible information, right? We don't want to be doing outcome measures for the sake of doing outcome measures. We want to do our outcome measures so that they can guide our clinical reasoning. And so let's kind of go through this very briefly and speak to the different aspects of this framework. So the first thing is mechanism, right? When we are asking about our person subjective, many times they're kind of cursory with their storytelling. A lot of individuals are when they're speaking about falls. Oh, well, I stubbed my toe and I fell over. What were you doing when you stepped your toe? What was your frame of mind? Were you really rushing to get from point A to point B? Were you really tired because it was late at night? Were you holding something in your hand when you tripped and that created an other barrier or other cognitive load in your mind that created more of a predisposition to not be able to keep your center of mass over your base of support and respond to that perturbation? Was it that there is a visual issue going on and you were having trouble with depth perception? We need to kind of dig really deep into some of these stories because that's really going to triage this risk factor profile in our brain. But you're probably thinking, well, Christina, a lot of my clients just can't do that or they don't remember or they are not able to give us some of that really tangible information. And I hear you. And so when we don't have that information, the next step is for us to go to the literature and look at what are common scenarios that lead to falls in different settings. Right. And how much do those mechanisms and that group of individuals that are being conceptualized in this research study relate to the people that are in front of you? An example is if you're an outpatient orthopedic therapist looking at some of the acute care mechanisms of falls may be relevant, but probably is less relevant to you. So you're going to be wanting to know, well, what is happening for our community dwelling older adults? What is their profile look like? What age group are individuals looking at in this study? And then how does this relate to my current caseload or people that I have that I am seeing right now? And so there is a recent study that came out in 2023 that was doing a prospective. So following older adults forward in Boston that was looking, for example, at mechanisms of falls in community dwelling older adults. So what they did was every month they sent older adults in this study. So they consented to this study. They were in their 70s or older. They sent a postcard to them and asked some questions. Did you have a fall in the last month? If yes, what was the mechanism? What were you doing at the time of the fall? And what was the cause of that fall with what you were doing? And I think this is interesting because they are two different things, right? 09:26 SLIP & TRIP TRAINING So the cause of the fall in our community dwelling older adults over 70, for example, more than half was a slip or a trip. The activity when they were having that slip or trip was walking forward. That gives us a lot of information in terms of where we start with our older adults. We're not going to start standing on one leg. We're going to start with slip and trip training. We're going to look at reactive stepping, volitional step training. Maybe we'll do that in standing first to see where a person's control is, but we want to see what happens when they start having perturbations. And so if that slip or trip is happening going forward, it also tells us that that perturbation is often backwards or lateral. People aren't falling forwards, right? It's that they're slipping and coming to the side or they're slipping and coming back. And that's a really important piece of information for us. And then it's going to guide where we go. So the next thing is now we're going to look at a person's risk factors, right? So extrinsic risk factors when individuals are having slips and trips was, was this in the wintertime and they're slipping on ice? Was this a step? Was this a rug that we know we're never going to get rid of, but we may ask about trying to tape down? These are things that we may be considering when we are looking at these mechanisms or are asking these questions. And so that's extrinsic. So we're taking this mechanism. We're looking at some extrinsic factors. And then the intrinsic people are going to be telling us in their narrative that they may feel like their balance isn't really great, or they're having trouble holding on to objects and navigating around their home or navigating outside. Or they recognize that the pain in their knee is making them not feel as strong or confident in their gait. And it's going to create them to have a hesitation to react when a perturbation happens because they've had times where their leg has given out. Or they they don't feel like they're strong enough to move their feet, right? They're they're telling us these things in their subjective. And so when we take that information, now it's going to guide us into our outcome measures. So if individuals are saying that they're having falls because of a strength deficit or a weakness issue in their lower extremity, we may want to make sure that we have a general mobility or a strength focused measure in our assessment to get a good idea of where our triage list is going to be. So we may use a five times it to stand or a 30 seconds to stand test, or we may go a bit more general and go to the short physical performance battery because the mechanism of their fall is showing us that potentially that being that capacity to move their feet is coming from a weakness issue. 11:54 REACTIVE POSTURAL CONTROL We are also going to want to in this example, look at their reactive postural control. We heavily leverage the mini best because there is a subsection of the mini best that looks at reactive postural control in each direction. So we're going to look at a person's capacity to react to a forward perturbation, backward perturbation and lateral perturbation. Right. If a person is having pain in the lower extremity, they're worried about it and we do a lateral perturbation, they may not move their feet out. They may want to cross because they're worried that that painful knee on that left hand side is not going to support their weight. So their reaction may be a step out to the right and a crossover to the right because of that painful knee. So now we've learned two things, right? We know that their pain is a contributing factor to their falls mechanism. It's an intrinsic risk factor that's creating troubles with clearance. It's impacting their gait, whether it's causing deviations in their gait or it's making them not lift their foot enough and now slips and trips are more common. And we recognize that their lateral posturing, the way that they are moving to the side is impaired. So now we've really dialed in our assessment, right? We've gotten a good idea about what's going on and we've picked the outcome measures that are going to give us that information. Because if we just focused, for example, on a burg. Because that is our go to balance assessment, not only are community dwelling older adults more likely to sealing that out, but it's not really getting to the two really big issues that they spoke to in their subjective assessment, right? They are probably going to be able to stand up once and do a pivot transfer. But that five time or 30 seconds to stand that's requiring a repeated chair stand is going to hit into maybe their pain thresholds that they're going to start having some compensatory mechanisms. And they're talking about having perturbations in a forward movement pattern. So the burg is in capturing backwards and lateral perturbations. So we have to be using those mechanisms and risk factors that they're discussing with us in their subjective and then leveraging the outcome measures that have strong reliability, validity, responsiveness, interpretability in order for us to have a good idea of what the next step is. But we're not going to do outcome measures for the sake of doing outcome measures. The next step is that we need to use those and leverage them in our interventions. One of the reasons why we also love the mini best is that oftentimes the way that we implement this is not day one. It's a little bit more of a longer intervention or sorry, it's a longer outcome measure. But we use it at the beginning of a session because it drives us into our intervention immediately. So if we have, for example, there's the anticipatory sub scales, sensory orientation, dynamic gate and reactive posture control. If we think that dynamic gate and reactive posture control are the two areas that based on a person's objective, they may struggle with more. We may use those, see where they're starting to have these deficits. It may be obstacle navigation, for example, with that still going with this example of having slips and trips because of a painful knee and seeing gate deviations where they're not clearing obstacles as readily as they used to when pain was a bit more managed. And they may have issues with reactive postural control backward and laterally. And we're going to see that it's coming to the left because it's their left knee that's painful. So now we have a lot of good information. We have a lot of good data. We use those outcome measures and we're directly going into intervention, right? Like I may use a clock yourself app and block out the forward stepping and I'm going to be focusing on reacting backwards. Or I may take out the right hand side of the clock and I want them to react to the left. And that is going to do at different cadences and then see, you know, what does the threshold look like? What does the step length look like? Does pain start to increase? What is that pain threshold like? How long does that pain take to come back down? And we're also intervening. We can also take, you know, some of these obstacle courses and put them into our interventions that day. Throw all of them together and put them into a round for time or an AMRAP where they're going back and forth between reactive stepping and obstacle courses. And now you're working on some strength because they're doing bigger clearances. We may put a step up in that obstacle course and then we're working on reactive control to the side that they're experiencing difficulties. So when we kind of take a step back, when we slot in what we see into this framework, it can be really helpful. So to bring this full circle, we want to think about balance intensity just like anything else. It's just like aerobic training. It's just like resistance training, but we cannot get good outcomes with bad data. So how do we do this? Our subjective, we need to dial in on mechanisms and risk factors. We need to be asking questions. If we do not have the answers to those questions, we're going to rely on the evidence of where older adults in different settings tend to fall. Then we're going to use outcome measures and we're going to select the outcome measures, if we can, based on our setting, that are going to give us the information we need to see where those thresholds are. From there, we're going to drive ourselves right into intervention based on where those deficits lie. And we're going to get to an intensity where individuals are either weary, we're pushing into potentially some low-grade pain, or they are self-reporting high amounts of fatigue or nervousness. 17:31 PROGRESSIVE OVERLOAD & FEAR So we may be doing some graded exposure into fear. And that is a form of progressive overload, especially in the geriatric space where fear of falling is a big risk vector for future falls. So kind of bringing this full circle, here is the framework for you when you have a person coming in who is having falls or is worried about their balance. And it'll allow you to really dial in your interventions. Let me know if you have any other questions. What are your thoughts on this? I would love to have a dialogue. If you are interested in learning more about some of this research, we just put that 2023 paper into MMOA Digest. So every two weeks there is a research email that we send out that allows you to stay up to date with the evidence. We put all of our new courses on there, so definitely go to ptnice.com slash resources and sign up for Digest. If you are not on Hump Day Hustling, please make sure you do that too. That is all different types of research from all of our divisions. Have a wonderful Wednesday. Bye everyone. 18:34 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 are 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 ptonice.com. While you are there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top 5 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.

Jason Khalipa is a 2008 CrossFit World Champion, Jiu-Jitsu purple belt, and the owner of NCFIT. On this episode, Jason discusses how his daughter's illness led him to start training Jiu-Jitsu, what he looks for in a Jiu-Jitsu gym, his main motivation for training, the impact of learning a new skill, how he mixes Crossfit with Jiu-Jitsu training, what type of training is most beneficial for Jiu-Jitsu, what lesson from CrossFit carried over most into Jiu-Jitsu, the best exercises for Jiu-Jitsu, what got him into CrossFit and how he was able to win in 2008, how exercise helped Jason deal with tough life situations, the "AMRAP" mentality, how Jason and his family dealt with and overcame his daughter's illness, the idea of “make to give” for your business, the importance of physical activity to deal with stress, how Jason has adjusted his training as he has gotten older, whether Jason prefers Gi or No-Gi training, how his Jiu-Jitsu has evolved, how to become a better training partner, how to “level up” the quality of Jiu-Jitsu gyms, and how to build a successful business. To support Jason and his family's charity check out https://www.avaskitchen.org/ Jason's gym: https://www.nc.fit/ Jason's Instagram: @jasonkhalipa Thanks to the podcast sponsors: Charlotte's Web CBD. Head over to https://bit.ly/38FnyUv and use the promo code Chewjitsu20 to get 20% off of your total purchase. Epic Roll BJJ. Check out https://www.epicrollbjj.com and use the promo code Chewjitsu to get 15% off of your total purchase. Ten Thousand. Check out https://www.tenthousand.cc/ and use the promo code Chewjitsu to upgrade your training gear and get 15% off of your total purchase. Check out podcast exclusives including conversations with guests, Q&A sessions, and tons more at https://patreon.com/thechewjitsupodcast

Music by: Crazy Town - "Butterfly" 

Jason is an American former Crossfit Games athlete, who made 8 consecutive appearances and the games and is known for his win as the 2008 CrossFit Games champions and other notable finishes in second place in 2013 and third place in 2014. He also won the Spirit of the Games award in 2009, which is an award given to the CrossFit gamesathlete who exemplifies extraordinary character and inspires those watching to face their biggest challenges with resilience, grace, and kindness. In 2016, Jason's daughter Ava was diagnosed with Luekemia which led him to stepping away from competing in the games. Since his days competing in the CrossFit Games, Jason has spent his professional time building his fitness business, NCFit Gyms and the NCFit Collective. He is also the host of his own wildly popular podcast call Effort Over Everything. Jason is also known for the book he wrote titled "As Many Reps as Possible." This book serves as a framework to being more present, living more intentionally, and accomplishing more in life. Not in a hypothetical, mushy way, but in a practical, real way. "As Many Reps as Possible" or "AMRAP" in the CrossFit community is an approach I've adopted in my own life and in today's conversation we talk a lot about how to apply this framework in our roles as leaders of our families. Jason is a hyper present, hyper focused guy, and after speaking with him, its no surprise to me that he was able earn the fittest man on earth while also accomplishing what he's accomplished in business so far all while keeping his family as his number one priority. Above it all, Jason is an incredible man, husband, and father.Discussion PointsJason talks about his childhoodHow Jason got into fitnessFamily support in starting his first Crossfit gymTeaching our kids to chase their dreamsFostering our kids interestsOptimizing timeStepping away from CrossfitJason reflects on his daughter battling leukemiaThe importance of communicationThe importance of date nightPerspective changes after daughter's battle with leukemiaPerspective from real pain and sufferingThe AMRAP Mentality framework for lifeFinding your whyMicro checkinsFocus on what you can controlHard workChanging gearsDetrimental impacts of social mediaMacro check insWhat Jason struggles withWhat Jason wants his kids to remember about himLinksnc.fit@jasonkhalipa on Instagram

Are you feeling unmotivated & overwhelmed when it comes to exercise? Do you want to get back into an exercise schedule without slipping back into old toxic patterns? Or maybe you're a brand new beginner looking to simply get started! On today's episode, Jessi provides us with simple tips that we can implement this week to reignite a healthy relationship with movement. Remember, diet culture doesn't own a game plan or fitness! If you're not signed up for Jessi's VIP list yet head to www.jessijean.com/vip — there will be a PDF print out of a simple AMRAP sesh to dip your toes back into movement! Here is the link to the lights I use in my little movement area in my home! Are you ready to end the fight with food once and for all? Book your free strategy call to see if The Food Freedom Online Program is a good fit for you: www.foodfreedomonlineprogram.com