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In this episode, Dr. Zach Baker and Dr. Corrie Jones talk through tips for getting the most out of attending a CEU course. They dive into:When you want to learn about a new topicChallenging yourself to reframe a topic in a new lightSeeing things from a new perspectiveThe benefit of networkingWays to prep for a courseLearning new things on familiar topicsHear about some strategies to ensure you're not just wasting your time and money, but instead, really using these courses as ways to grow either clinically or professionally!
One of the most powerful tools in the fight against climate change is the money sitting in investment portfolios - especially the trillions of dollars invested on behalf of public retirees. That's money that could continue to fund fossil fuel development, or help pay for climate solutions instead.New York City has implemented an ambitious Net Zero plan for its public pensions. That plan includes divesting from some fossil fuel companies and investing billions of dollars in climate solutions. One company benefiting from that investment is NineDot Energy. Wedged between an elementary school and a big box shopping center in the Northeast Bronx, NineDot Energy is operating a battery farm that the city's utility company, Con Ed, can call on to help relieve the grid when it gets overstressed. “The batteries hold a combined three megawatts of battery storage. That's enough to power about 3,000 New York City households for four hours on a hot summer day. Last summer, the battery farm was called half a dozen times, which was enough to reduce greenhouse gas emissions by a combined 24 metric tons. That's the equivalent of nine thousand car trips on the Cross Bronx Expressway.Currently, the city has the dirtiest energy grid in the state. More than 90% of its power comes from fossil fuels. NineDot Energy is still in growth mode, but battery farms like this could eventually help the grid transition to renewable sources, like wind and solar.“The sun only shines when nature tells it to; the wind only blows when nature tells it to, but people use electricity when they decide to,” explained Adam Cohen, co-founder of NineDot Energy. “A battery helps mediate that process. It pulls in the extra power when it's available, and then puts it back out when people call for it.” On a recent visit to the Bronx facility, 12-year-old Virtue Onoja showed off a mural she helped paint along with other students from the elementary school across the street, envisioning a future powered by cleaner energy.“One thing about me, I'm definitely an artist,” she said. “I drew a clear blue sky, no pollution, no nothing [and] beautiful yellow flowers and the sun.”There are also drawings of windmills and electric school buses. “There's still a lot of pollution, not just in the Bronx, but just in New York in general,” Onoja said. “All of this is the goal that we want to achieve.”This is an excerpt from the latest season of How We Survive. Listen to the full episode here.
One of the most powerful tools in the fight against climate change is the money sitting in investment portfolios - especially the trillions of dollars invested on behalf of public retirees. That's money that could continue to fund fossil fuel development, or help pay for climate solutions instead.New York City has implemented an ambitious Net Zero plan for its public pensions. That plan includes divesting from some fossil fuel companies and investing billions of dollars in climate solutions. One company benefiting from that investment is NineDot Energy. Wedged between an elementary school and a big box shopping center in the Northeast Bronx, NineDot Energy is operating a battery farm that the city's utility company, Con Ed, can call on to help relieve the grid when it gets overstressed. “The batteries hold a combined three megawatts of battery storage. That's enough to power about 3,000 New York City households for four hours on a hot summer day. Last summer, the battery farm was called half a dozen times, which was enough to reduce greenhouse gas emissions by a combined 24 metric tons. That's the equivalent of nine thousand car trips on the Cross Bronx Expressway.Currently, the city has the dirtiest energy grid in the state. More than 90% of its power comes from fossil fuels. NineDot Energy is still in growth mode, but battery farms like this could eventually help the grid transition to renewable sources, like wind and solar.“The sun only shines when nature tells it to; the wind only blows when nature tells it to, but people use electricity when they decide to,” explained Adam Cohen, co-founder of NineDot Energy. “A battery helps mediate that process. It pulls in the extra power when it's available, and then puts it back out when people call for it.” On a recent visit to the Bronx facility, 12-year-old Virtue Onoja showed off a mural she helped paint along with other students from the elementary school across the street, envisioning a future powered by cleaner energy.“One thing about me, I'm definitely an artist,” she said. “I drew a clear blue sky, no pollution, no nothing [and] beautiful yellow flowers and the sun.”There are also drawings of windmills and electric school buses. “There's still a lot of pollution, not just in the Bronx, but just in New York in general,” Onoja said. “All of this is the goal that we want to achieve.”This is an excerpt from the latest season of How We Survive. Listen to the full episode here.
This week in the studio, I'm joined by Dr. Nick Barringer—Army Ranger, performance nutrition expert, and one of the sharpest minds in military and metabolic health. Together, we cut through the noise around today's most controversial nutrition topics. If you've ever felt whiplash trying to make sense of conflicting headlines, this episode is your science-based compass.What's really going on with artificial sweeteners like sucralose and aspartame? Are seed oils toxic—or just misunderstood? And what's the actual science behind popular supplements like creatine, testosterone boosters and fat burners?Dr. Barringer brings two decades of elite military and research experience to help us separate hype from evidence—while sharing real-world tools that help people perform, think, and feel better.We cover:Whether sucralose and other artificial sweeteners damage DNA or gut healthWhat to actually worry about with food dyes Seed oils, inflammation, and what most people get wrong about themProtein and carb dosing for people over 40 (and how to think about fiber and fat)Why creatine is still the most underrated supplement for muscle and brain functionTactical hydration tips (and how sweat composition varies with diet)Hidden risks in testosterone boosters and “fat burners”Practical takeaways for elite performance, healthy aging, and being stronger at any ageWho is Dr. Nick Barringer?Nick Barringer, PhD, is a Nutritional Physiologist with deep experience in both applied and academic settings. He directed the U.S. Military-Baylor Graduate Program in Nutrition, taught at West Point, and was the first active-duty dietitian to graduate U.S. Army Ranger School and serve with the 75th Ranger Regiment. He holds a PhD in kinesiology from Texas A&M, and his research on tactical nutrition has been featured in outlets like Science Daily and Men's Journal.This episode is brought to you by: ARMRA - Use code DRLYON for 15% off your first order → tryarmra.com/DRLYON Manukora - Use code DRLYON for $25 off the Starter Kit → manukora.com/DRLYONOneSkin – Get 15% off with code DRLYON → OneSkin.coNed - 15% off with code DRLYON → helloned.com Find Nick Barringer at: LinkedIn - https://www.linkedin.com/in/nick-barringer-phd-rdn-cscs-cssd-5137789a/Instagram - https://www.instagram.com/nickbarringer.phd.rdn/Facebook - https://www.facebook.com/nickbarringer.phd.rdn/Find me at:Instagram: @drgabriellelyonTikTok: @drgabriellelyonFacebook: facebook.com/doctorgabriellelyonYouTube:youtube.com/@DrGabrielleLyonX (Twitter): x.com/drgabriellelyonApply to become a patient – https://drgabriellelyon.com/new-patient-inquiry/Join my weekly newsletter –
Queens Borough President Donovan Richards is urging Con Edison to reconsider its proposed rate hikes, warning they would burden working families. Meanwhile, police credit the quick thinking of children and first responders for saving lives during a stabbing in Brooklyn that injured four girls. Plus, a developer is proposing a casino next to the United Nations, complete with a Museum of Freedom and Democracy, as part of a bid for a state gaming license.
Con Edison is facing pushback for proposing a major rate hike, and lawmakers are questioning how the state approves those increases. Meanwhile, the city has started issuing fines to property owners who don't comply with the composting mandate, but NYCHA isn't following the rule yet. Officials say public housing compost collection won't begin until next year. Plus, New Jersey Senator Cory Booker breaks a Senate record with a 25-hour speech protesting President Trump's latest actions.
New York City officials say they're preparing for the end of a federal rent voucher program that currently helps more than 7,600 low-income households. The Trump administration says the program will run out of money next year. Meanwhile, Con Edison has agreed to pay $750,000 to settle a workplace discrimination case involving 17 women and people of color. Plus, the City Council is voting on bills to crack down on sidewalk sheds that linger for years, with the goal of improving public space and holding property owners accountable
Cathy Zoi is a clean energy veteran with a career spanning leadership roles across government, industry, and investment. Most recently, she served as CEO of EVgo from 2017 to 2023, taking the company public in 2020. EVgo is now one of the largest EV charging networks in the United States.Today, Cathy is deeply engaged in the energy and climate space. She serves on the board of directors for Con Edison, the major investor-owned utility serving the New York City metro area. She's also on the board of Apax, a British investment firm, and sits on the investment advisory committee for EQT, a Swedish global investment organization that recently acquired Scale Microgrids. Additionally, she's a board member at SPAN, an MCJ portfolio company, and at Soil Organic.Cathy's career started at the Environmental Protection Agency, followed by roles in the White House during the Clinton-Gore administration and the Department of Energy under Obama. She's worked at Silver Lake, founded a division of SunEdison focused on emerging markets, and helped lay the groundwork for Odyssey Energy Solutions, another MCJ portfolio company. Throughout our conversation, we explore her fascinating career journey, the lessons she's learned along the way, and her perspective on the future of clean energy.In this episode, we cover: [3:01] Cathy's early career at the EPA and the launch of Energy Star[9:15] Commercializing GHG reducers in Australia[11:59] Working with Al Gore's Alliance for Climate Protection[14:42] Serving as acting undersecretary in the Obama administration[18:06] Advisory roles on investment platforms[23:22] Experience at SunEdison and founding Odyssey Energy[27:29] Financial discipline and capital deployment at EVgo[32:06] The future of the EV charging business[36:14] Evolution of pricing models[39:18] Board work at Con Ed and risk management[43:19] What excites her most, including beneficial electrificationEpisode recorded on Feb 25, 2025 (Published on March 13, 2025) Enjoyed this episode? Please leave us a review! Share feedback or suggest future topics and guests at info@mcj.vc.Connect with MCJ:Cody Simms on LinkedInVisit mcj.vcSubscribe to the MCJ Newsletter*Editing and post-production work for this episode was provided by The Podcast Consultant
Billabong Fluid 2K Boardies Presents... An ATS Regular Episode spray of Smiiiiiiiiiiivlical proportions! Featuring: A deep dive into Caity Simmsie-brah's new film Blouse, a look at Jordy Smivvy's new clip Plus 27 and what's the go with the surfy crime spree affecting So Cal and East Coast Aus? There's the fattest c##nts to ever get coned, a classic Smivvy rant on the endless stitch-up of the system and the Swellians throw truth bombs directly into the mic for Ask us a Question. Get that up yas! Up... the financial revolution that's got young Aussie's backs! Takes 5 minutes to get on board. Fuck fees right off! SIGN UP HERE!See omnystudio.com/listener for privacy information.
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In 1931, George Metesky suffers a injury while working for Consolidated Edison power company in New York. George feels he is not properly compensated for years of trauma and recovery, and he wants vengeance against Con Ed. He begins a bombing campaign to push for justice against his enemies, and his devices mystify the NYPD. Join Black Barrel+ for ad-free episodes and bingeable seasons: blackbarrel.supportingcast.fm/join Apple users join Black Barrel+ for ad-free episodes, bingeable seasons and bonus episodes. Click the Black Barrel+ banner on Apple to get started with a 3-day free trial. On YouTube, subscribe to INFAMOUS+ for ad-free episodes and bingeable seasons: hit “Join” on the Legends YouTube homepage. For more details, please visit www.blackbarrelmedia.com. Our social media pages are: @blackbarrelmedia on Facebook and Instagram, and @bbarrelmedia on Twitter. Learn more about your ad choices. Visit megaphone.fm/adchoices
Why do we expect to be great business owners without any training at all? We don't think that way about our clinical skills.In fact, we all spent 7+ years in school, countless clinical con-ed hours and often hundreds of thousands of dollars to become good clinicians. And yet, most of us have never invested anything in ourselves as business owners. Yet we expect to have immediate success - no wonder 90% of us aren't happy with what we're making financially in business! There's a 'compound interest' in becoming a better business owner. A small improvement or investment now grows and grows over the years and decades we own our practice.If we develop a front desk script now, we might use it for thousands of patients. Our call logs, budget templates, 'last 5' for clinical buy-in - all of these skills or habits will last for years.These investments in the business will pay off over the life of your practice. Yet we don't approach business with the same dedication we do our clinical practice.As we said in a recent podcast 'sode, "If we invested 1% of the time and money in business ownership that we did to become great clinicians, 90% of us wouldn't be unhappy with what we make in the practice!Business Accelerator Program - Closes Friday!Registration for the January Cohort of the Accelerator Program closes on Friday (12/20)!! If you're a business owner looking to take things to the next level in 2025, make sure to check it out and get on the wait list here: www.pelvicptrising.com/acceleratorSee how business owners increased their revenue, boosted their confidence and reduced the overwhelm of building a business!About UsNicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health. PelvicSanity Physical Therapy (www.pelvicsanity.com) together in 2016. It grew quickly into one of the largest cash-based physical therapy practices in the country.Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes. Together, Jesse and Nicole have helped 600+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them! Get in Touch!Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!
Learn more about Forever Fierce HERE. To learn more about Gym Growth Blast Off, DM US. Here are 3 ways to get more BFU in your life: [NEW] Claim your FREE copy of Gym Marketing Secrets HERE Follow BFU on Instagram HERE Subscribe to MF's YouTube Channel HERE Are you a gym owner with 30+ clients per month looking to grow in the next 90 days? Then you might just be a few strategies away from adding $5k-$10k/month or more. Book your FREE Brainstorm Call HERE.
Ever wondered what it's like to have your peaceful day completely turned on its head by mischievous cats and mysterious noises? Jay and Beck share the hilariously chaotic antics of their cat companions, from Freddy's insatiable curiosity to Wolfie's demand for endless cuddles, life is never dull with these furballs around. But the adventure doesn't end there. Join us as we navigate a bizarre and unsettling experience at our local 7-Eleven, where a mysterious alarm shatters the tranquility of a simple errand. With Con Ed trucks swarming the neighborhood and the eerie noise following us home, theories run wild. Is it some kind of energy weapon? A secret Con Ed operation? Dive into our candid and humorous recounting of this perplexing situation, filled with suspense and our signature banter. Grab your drink of the day, get comfy, and prepare to laugh. Trust us, you won't want to miss this! Contains : *Adult Language *Adult Situations Thank you for listening, you Maniacs! If you like the podcast tell a friend. Please rate it 5 stars on Apple Podcasts and leave us a review. Follow us : Contact us : umbrellaholics@gmail.com Instagram@umbrellaholics Facebook@https://www.facebook.com/Umbrellaholics-110265711126471 Twitter@HolicsUmbrella Youtube@https://www.youtube.com/channel/UCguHLT224fCg9iCOasS8pjw Find us on all the major platforms!
Sign up for our upcoming free webinar with Kilo, Biggest Gym Marketing Mistakes [And How to Fix Them] HERE. To learn more about Tim's Summit, and to save money, use the code BFU HERE. Here are 3 ways to get more BFU in your life: [NEW] Claim your FREE copy of Gym Marketing Secrets HERE Follow BFU on Instagram HERE Subscribe to MF's YouTube Channel HERE Are you a gym owner with 30+ clients per month looking to grow in the next 90 days? Then you might just be a few strategies away from adding $5k-$10k/month or more. Book your FREE Brainstorm Call HERE.
In this conversation, Nick and Amanda discuss various topics including remembering names, receiving listener love, and Amanda's grievances with Con Ed. In this conversation, Amanda and Nick discuss the concept of 'all in' exercise culture and its potential harm to mental and physical health. They highlight the obsession with exercise and the inability to find balance in life. They emphasize the importance of having activities and hobbies outside of exercise, as well as the need for rest and flexibility in training. They also address the issue of comparing oneself to professionals and influencers on social media, and the dangers of addiction and dependency on exercise. Overall, they encourage listeners to prioritize their well-being and seek professional help if needed. ------------------------------- (00:00) Blooper and Remembering People's Names (06:38) Listener Review and Call for Questions (10:35) A Grievance with Con Ed (15:32) Introducing Special Guests (16:59) The Slippery Slope of 'All In' Mentality (35:01) Recognizing Harmful Exercise Behaviors (40:05) Promoting Balance and Flexibility ---------------------------------- Contact us and send questions for us to answer: Amanda - @amanda_katzz Nick - @nklastava Buy Me A Coffee Email - betweentwocoaches@gmail.com
Billabong and the Otis Carey West Up River Collection Presents… The bad news is Swellian Mascot Doinka just had his nuts cut off. The Good news is he's now getting coned 24/7 so he doesn't chew the stitches out of where his balls used to be. But who else is in the firing line for castration? Turns out the Mexican Pipeline, The Olympics at Chopes, the Challenger Series and plenty more are also in danger of losing their figs. Smiv and Deadly discuss why. UTFS!!See omnystudio.com/listener for privacy information.
Subbing in for Catalina this week is the pod's original co-host, Melissa. Dena talks about two TV shows TikTok made her watch: Owning Manhattan and America's Sweethearts: Dallas Cowboys Cheerleaders. Melissa's FYP is all about eyebrow blindness, featuring videos from @kellicali25, @stylebystacefizzy, @celebritymemoirbookclub, and @misscaramaria. Dena's FYP is focusing on the Olivia Culpo Wedding dress drama, with videos from @leggsssesquire and @fluentlyforward. We love a video from @durr.nick asking to read his birth chart. Apparently we are not the only ones who have no idea who John Summit is, thanks to @clairethescare. Jared Mccain Tok (@jaredmccain24) is a fun place to be. For Food Tok, we learn about Surfside Vodka from @mobibojoe and get a turtle chip and pickle sandwich update. Trending audio includes the song “Return to Innocence” by Enigma with a filter called “if I could fly” via CapCut. We like content from @mr.maxabillion, @unclepipes87, and @bethanderson1989. NYC Tok includes a funny video from @casstherockwillson about Con Ed. Check out all the videos we mention and more on our blog (2old4tiktok.com), Instagram (@2old4tiktokpod), and TikTok (@2old4tiktok_podcast).
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Advocating for the athletic training is as important now as it has ever been. There have been several avenues that people have worked through in order to get the word out about athletic training and what the profession can do. In this episode we got to talk with Ryan Stevens, the founder of cATalyzing Coaching Consulting where I focus on helping organizations enhance their employee experience, staff development, and collaboration to create awesome teams in the workplace. In this episode we discussed what Ryan sees as some of the ‘other' areas of athletic training that need to be addressed by the profession to help it keep growing and show how we can help a variety of people We also discuss the importance of ego and being able to check it at the door in order to learn from other professions and compliment each other. There are a lot of great ideas that people can focus on to try and help not only grow themselves but help the profession continue to advance. www.athletictrainingchat.com www.cliniallypressed.com SUBSCRIBE:https://www.youtube.com/channel/UCc3WyCs2lmnKK6shrL5A4hw?sub_confirmation=1 #ATchat #ATC #atimpact #at4all #boc #bocatc #athletictraining #athletictrainingchat #health #medicine #medical #medicalprofessional #professional #LAT #ATSarehealthcare #builtinsport #muellerready #complicatedsimple #professional #ConEd #professionaldevelopment #collaboration #interprofessional #intraprofessional #pt #chiro #physician --- Support this podcast: https://podcasters.spotify.com/pod/show/athletictrainingchat/support
Alan Fredendall // #LeadershipThursday // www.ptonice.com In today's episode of the PT on ICE Daily Show, ICE Chief Operating Officer Alan Fredendall discusses the current state of the insurance-based healthcare systems, alternative practice styles, and the "magic" behind building a sustainable practice. 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 INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. ALAN FREDENDALL All right, good morning, PT On ICE Daily Show. Happy Thursday morning, I hope your day 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 our Chief Operating Officer here at Ice, and the Division Leader in our Fitness Athlete Division. It is Thursday, it is Leadership Thursday, that means it is also Gut Check Thursday. This week's Gut Check Thursday is another qualifier workout, so it's on the more aggressive end. So we have every four minutes for four sets. You're basically going to go through one workout of the Hero Workout DT. You're going to do 12 deadlifts. You're going to go 9 hang cleans. The caveat this week is that they're hang squat cleans. So they're going to take longer to cycle and they're definitely going to take more out of your legs than the traditional power clean we find in DT. Then you're going to finish with six shoulder to overhead. So for most folks, that's going to be a push jerk. The weight there is 155-105 on the barbell. Ideally, we're finishing one round of that complex in about two minutes. And then in any remaining time in that four-minute window, we're doing as many wall balls as we can. Guys are going to throw a 20-pound ball to a 10-foot target. Ladies, a 14-pound ball to a 9-foot target. The goal of that workout is to get through the barbell and get to the wall balls and accrue some wall balls. Great scores are going to be really anything above 50 reps. Exceeding 100, making your way towards 150 is definitely going to be an exceptional score. Modify the weight on that barbell, modify the reps if you need to make sure that you get off the barbell in about two minutes and that you have time for wall balls. There is no rest between sets, so keep that in mind as well. You probably don't want to be doing wall balls right until the whistle and need to turn and pick up that barbell without a break. You're probably going to want to allow yourself maybe 15 to 20 seconds of rest on the last set of wall balls and then go and pick up that barbell when the clock beeps. So have fun with that one. That's from a qualifier workout for a really awesome competition we have here in Michigan out on the west coast of Michigan out near Grand Rapids called Fresh Coast Fit Fest. Really fun CrossFit workout two day event on the beach. So some of our teams here from our gym at CrossFit and Fenton are going to be doing that. So have fun with that qualifier workout. THE CURRENT STATE OF THE PT INDUSTRY Today what are we talking about? We are talking about cash-based practice, insurance-based practice, or maybe in between what we call a hybrid-based practice, where is the magic? So today I want to make a couple points. I want to really have a candid discussion on insurance and really the physical therapy profession in general. I want to talk about what it means to open a sustainable and ethical practice. I want to talk about the down-low with payment methods and payment amounts as far as how much we get paid. and I want to talk about the concept that I call the golden rule of private practice. So let's start with that discussion on insurance. So Kaiser Foundation back in 2022 published that about 95% of Americans have health insurance. Why do I bring that up? I bring that up because if you only get information from social media, which unfortunately many folks now do, you might have this perception that cash-based therapy, cash-based medicine in general, concierge medicine, has taken off and that if you still accept insurance, you are somehow maybe 100 years behind what's currently happening. and it could not be further from the truth. Most Americans, most consumers have insurance. Again, 95% of people. So certainly while folks are getting more used to maybe their high deductible plan and that they do probably need to pay out of pocket for some or maybe all of their health care, Certainly that's not the case for everybody. In this idea, this mantra on social media that Americans have just rebelled against health insurance and none of them have it anymore and everybody is totally willing to pay cash for everything and you can charge whatever you want is the name of the game could not be further from the truth. In fact, 33% of Americans have Blue Cross Blue Shield PPO insurance which means they carry pretty nice insurance that they probably pay a lot of money for. So I say all that to say this, we need to be realistic that most of us will probably come and go from this profession before we really see a significant shift in how patients interact with the healthcare system, most notably from how they pay for their healthcare. Why does that matter? And why is that unlikely to change? I think looking at the state of the economy in general, again, if you get a lot of your news from social media, you may believe that the economy is on the edge of being destroyed at any minute. But again, that could not be further from the truth. We dodged the depression that was forecasted. The economy is at an all-time high. And that is shown if we look at insurance company profits. So let's go down this list. I love to look at data like this. Blue Cross Blue Shield last year, $457 billion. Almost half a trillion dollars. UnitedHealthcare right behind them, $414 billion. Anthem Blue Cross Blue Shield, so kind of a conglomerate of a bunch of different state Blue Cross Blue Shield associations, $109 billion. Cigna, that's a private commercial insurance, $76 billion. Humana is another private insurer, $55 billion. If we look at just the five largest health insurance providers in the country, they comprise 5% of the country's total GDP. All of the money that we essentially generate and spend across the span of a year. We also need to recognize as we've talked on here before that by 2030, 70% of Americans will be Medicare eligible. So if anything, what we see over time is that more people are carrying insurance, more people have nicer insurance, whether they're paying for that themselves or whether they're just being provided nicer insurance through their employer and that more and more Americans are also going to be carrying Medicare insurance as they turn 65 or whatever that age becomes over the next couple years. So why are we unlikely to see a significant shift in payment methodology in physical therapy or in health care in general? Look at all of that money, right? If we include all the other health insurers, we're looking about one-tenth of all of our money coming and being generated by health insurance providers. If we include what's being spent on health care, both through insurance and through private pay, that is beginning to comprise almost a quarter of our economy. What does that translate to practically? What can we glean from that? It really says that the chief product that the United States produces is sick, injured people in pain, and that our primary export is dealing with the subsequent secondary issues that come with a sedentary lifestyle that produces really sick people. So I think we're really unlikely to see things shift because a lot of people are making a lot of money either being on the health insurance side of the equation or being on the health care system side of the equation. And I think we are living in denial if we don't think that those giant companies that are making half a trillion dollars a year aren't making sure that some of that money goes to lobbying members of Congress to make sure that there are laws that require health insurance to make sure that we build brand new headquarters buildings that employ a lot of people where case adjusters and claims adjusters and all these folks that run a health insurance company can work and that that company can say to the government, look how many jobs we're creating. And when you really see that these companies are starting to take in nearing a trillion dollars, you recognize how much money is truly in this system. INSURANCE IS WEIRD & NEEDS TO CHANGE That being said, we need to be honest that insurance is totally weird. Health insurance is so weird. It is the most inefficient, weird thing that we probably do, right? We're used to having auto insurance. If you've ever had to make an auto insurance claim, you would probably say that by comparison to health insurance, it was a pretty easy process, right? If you've ever wrecked your car, somebody came out and probably said, Oh dude, that car is wrecked. Yeah, we're going to get you a new car. So we'll do some paperwork. And then you'll get a check and you can go get a new car, right? I just had a windshield crack. It was really cold here in Michigan. It was negative 20 degrees. Made a call. Somebody came out and said, yep, dude, your windshield is indeed cracked to the point where it's probably dangerous for you to be driving. Drop your car off here and in an hour somebody will fix your windshield. We don't see that smooth process with healthcare. We see a really weird process filled with a lot of paperwork, a lot of limitations on access to service, and otherwise, the health insurance company trying to hold on to the money that they're getting from patients. It would be totally weird to have insurance in a lot of the other things we do, right? Imagine you need to get your hair cut. I need to get my hair cut really bad. Imagine I go to get a haircut and they tell me, hey, your haircut insurance will only pay to cut half of your head today. You'll have to wait six months, and they'll cut the other half of your head. How impractical would that be? Yet, that's how healthcare insurance functions. So we need to acknowledge the dichotomy here. There's a lot of money in this system. It's probably not changing anytime soon. That being said, it's very weird and inefficient, and it's not working for a lot of people. So that being said, if this is the current state of our healthcare system, and our industry is physical therapists, how do we navigate this? NAME THE ENEMY We navigate this by naming the enemy, right? Corporate physical therapy with hundreds or thousands of locations, employing thousands or tens of thousands of therapists, overbilling patients, seeing multiple patients an hour, driving up that revenue for both their businesses and the health insurance companies, and really delivering low-quality care. We will never win against those folks one-on-one. We'll never be able to go toe-to-toe with them. If you missed Virtual Ice on Tuesday with Jeff Moore, our CEO, you missed a really good discussion on effortless clinical practice. And he really touched on the idea of the solution to high volume, low quality is not to try even more volume with even less quality. That is a losing game. We can certainly try the same strategy to win. What's probably going to happen is that It's not going to last very long, you're probably going to burn yourself out, and you're just going to become another clinic that gets bought up by one of those big chains. So we need to name that enemy, we need to recognize what's being provided, and we need to begin to chip away at them. We need to hit them where it counts, which is to take their patients away from them. How do we do that? We need to fundamentally understand and recognize and be comfortable with what an hour of our time is worth. WHAT IS AN HOUR OF YOUR TIME WORTH? This is something I heard many, many years now, almost a decade ago now from Zach Long, of no matter what you're doing, you should know what an hour of your time is worth and you should be trying to get that. It doesn't matter if you're treating a patient, it doesn't matter if you're doing back-end work, It doesn't matter if you're doing marketing for your clinic, you should be getting relatively the same amount per hour, and you should have a really good understanding of what an hour of your time is worth. Building upon that is how we build a successful, sustainable practice. We just crossed the halfway point in our most recent cohort of Brick by Brick, our practice management course, and this is something I really hammer on people with how to establish your practice, that before you launch, before you start seeing patients, Now is the time to make sure that you set your practice up so that you have a successful, sustainable practice because that is the only way that we're going to chip away at all of these high volume, low quality establishments in a way that we might actually turn this ship around. What's not going to work is doing the same thing of seeing and taking insurance that does not pay well, seeing two, three, four people an hour and getting stuck in the same volume trap that all of these clinics are already stuck in. $40 a visit is profitable if you see four of those visits per hour, right? We can't get caught up trying to fight fire with fire here. We need to go a different route. We need five high-quality, independent, private practices around every chain clinic to provide really quality service to take those patients away over time from the chain clinic and drive them out. And we need to replicate that across the country. The worst possible outcome of fighting fire with fire is that after a couple years, you decide that you're done and you sell your practice to one of those corporate chains, right? You become the enemy. you turn your practice into another version of something that already exists, the volume goes up, the quality goes down, you just become another cog in the machine. That is the worst possible outcome if you do not think about starting your practice sustainably. How do we do that? PAYMENT METHOD: THE PATIENT'S PROBLEM My third point is that it comes down to payment method. We need to understand and recognize that Some people want to use our insurance, but that some insurance simply doesn't pay us a living wage such that we can pay ourselves what we think we're worth. We can pay the people who may work with us what they're worth, cover our expenses and still turn a profit. We need to really think about sustainability. That means that you probably should not accept every insurance possible and that depending on where you live and depending on what an hour of your time is worth, maybe no insurance is good enough for you. And that's also okay, right? Hence, cash-based physical therapy. And that for the majority of folks, the magic is going to probably lie somewhere in the middle. Taking a handful of insurances that let you reach a moderate amount of patients, and everybody else is going to have to pay cash. With that comes the hard truth that not every patient is going to be able to see us. And that at the end of the day, how a patient pays for their service, their physical therapy, is really their responsibility. There are certainly ways we can help. We can offer cheaper rates. We can offer pro bono. And that's a topic for a different day. But at the end of the day, how they pay needs to be in a form that is sustainable for us to take. And I don't think we consider that enough when we're about to launch a practice. I think we go full spectrum. How many people can we reach? Let's take every insurance. Doesn't matter how terrible it pays. Doesn't matter how much paperwork is involved with seeing those patients. Let's take it all and then we'll deal with it later. And then later becomes, I'm tired of doing this and I'm going to sell my clinic to one of the big chains. Again, the worst possible outcome. We need to recognize that if we accept more insurance and we provide lower quality, higher volume care, that we're going to have a minimal impact overall, not only on our patients' lives, but on the profession in general. PAYMENT AMOUNT: THE OWNER'S PROBLEM Looking at payment amount, we need to recognize that there's a natural give and take between employer and employed. And at the end of the day, for those folks in management positions or leadership positions, We need to recognize and truly embrace the idea that the staff physical therapist, the person who comes to work every day and treats patients, is our frontline worker, and that they need to be supported more so than anybody else. Far and away in our industry, far and away across healthcare, the people who see patients are often treated the worst. They are the people who have been told, guess what? There's no money for a raise this year. Guess what? We're taking away your Con Ed money. Guess what? We were going to give you an extra week of vacation. We can't afford that now, right? We continually strip money and benefits and autonomy away from our frontline workers and then we're totally shocked that they leave and open up their own practice, right? Attrition is one of the worst things that can happen to your clinic and we need to understand that while payment method is the patient's responsibility, Payment amount is the owner, the leader's responsibility of controlling what we get paid is ultimately, for me here at our clinic, my responsibility. I need to make sure that we take in enough money, that the frontline workers are supported, and whatever's left is for the ownership. And far too often in clinics, it is the other way around. If the insurances you take aren't paying you enough to take care of your people, you should probably stop taking that insurance. If the insurances you take require you to hire another staff member to do all of their authorizations and certifications, you should probably stop taking that insurance. And if working with an insurance company requires you to reduce your quality or increase your volume and become a detriment to the healthcare system instead of a positive influence, you should probably stop taking that insurance. THE GOLDEN RULE TO SUSTAINABLE PRACTICE The golden rule, my last point here, what do I think the golden rule is? Is that you should only work with organizations that value and reward high quality physical therapy that pay you at or above what your desired rate per hour is. Folks often ask us, hey Alan, hey Mitch, why do you guys take insurance? Well, we only take three of them. We take our Blue Cross Blue Shield state PPO. we take Medicare and TRICARE. Why? Because they don't have any documentation authorization requirements, they pay at or above our desired rate, and they have a really quick turnaround on payment, usually 48 hours for Medicare TRICARE and about 10 days total for Blue Cross, about five to seven business days. So we have relatively no turnaround on payment and it pays at or above what we want to get paid. And I don't think enough clinics appreciate how important that simple rule is. SUMMARY So I think, will things be fixed? Probably not anytime soon. We need to recognize that most Americans have insurance. They want to use insurance. Cash-based therapy is getting more popular, but is widely dependent on geographic area and local socioeconomics. We cannot fall into the traps on social media where we see all of these paid ads maybe from cash-based physical therapy owners that tell you you need to be 100% cash-based or you're behind the times. We need to have some sort of compromise as long as that compromise doesn't require us to sacrifice quality in order to obtain really good outcomes at a volume of patient care that is sustainable for our therapists and ourselves in a manner that rewards them for the work that we put in. We need to recognize how much money is in the health insurance and the healthcare industry, and how little of it those of us going to work every day and treating patients are actually seeing. I laugh every time somebody lets me know they just scored a sick $500 quarterly bonus for treating 80 patients a week. Because I know that clinic probably made hundreds of thousands of dollars off those patients that quarter, and the staff physical therapist got $500. Whoopee, that means nothing, right? We need to acknowledge that amount of money, excuse me, and we need to know that that is part of the reason why things may not be changing as quickly as we want them to change. If we're thinking about opening our own practice, we need to make sure we do the things necessary to make it sustainable. We need to take a really long, hard look at our local socioeconomics, our population, In Brick by Brick, we have people do a SWOT analysis, strengths, weaknesses, opportunities, and threats. And one of the things we encourage students to do is who are the biggest employers in your area and what insurance do they carry. If you work in a town where 80% of the people are employed by the same employer and they have Blue Cross Blue Shield PPO or it's a military base and they have TRICARE, it's probably in your best interest to take those insurances provided it pays you what you want and the documentation requirements are acceptable to you. If not, we need to also recognize it's okay to not take every insurance and that hybrid practice is probably long term the best solution moving forward until we can make significant changes in the insurance market or until we can shift enough folks over to the cash based side of healthcare practice. So cash-based, insurance-based, hybrid-based, where's the magic? Probably somewhere in the middle as with most things, right? And not or, but also recognizing that we're on the same team, right? If you are operating a cash-based practice, if you are operating insurance practice or hybrid practice, and you are providing really high quality care, you are doing your part to chip away at the problem. And if you're working for a company that is not doing that, or you are part of the management leadership team at a company that is not, you do need to acknowledge that you are providing a negative impact on the healthcare system. and you need to be understanding and recognizing of that fact. So, I love this topic. I think about this topic literally a thousand times a day. So I'd love to hear your discussion, your comments on this. Have fun with Gut Check Thursday. I hope you all have a fantastic weekend. If you're gonna be at Fitness Athlete Live this weekend with Mitch, Don, and Raleigh, have a great time. Have a fun Super Bowl. Go Chiefs. 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.
In this week's Security Sprint, Dave and Andy covered the following topics: In our warm start we address cyber threats from China and threats to the Water Sector, see quick hits for links. And we celebrate Pod friend Bridget Johnson on her new role. Main Topics: Cyber Warnings - BEC Evolving Threat Landscape: Crime, Confusion, Deepfakes, BEC, fake data breaches, fake political robocalls… Deepfake Scam Video Cost Company $26 Million, Hong Kong Police Says. Europcar says someone likely used ChatGPT to promote a fake data breach. OpenAI: Building an early warning system for LLM-aided biological threat creation FBI PSA: Scammers Use Couriers to Retrieve Cash and Precious Metals from Victims of Tech Support and Government Impersonation Scams Ransomware: Corvus: Q4 Ransomware Report: 2023 Ends as a Record-Breaking Year Ransomware Retrospective 2024: Unit 42 Leak Site Analysis. The year saw a 49% increase in victims reported by ransomware leak sites, with a total of 3,998 posts from various ransomware groups. The ransomware business is booming, even as enforcers shut down some major players; Palo Alto Networks' Unit 42 found a 49 percent bump in victims reported by ransomware leak sites in 2023 Quick Hits Brothers Charged After Seizure of Homemade Explosives, Ghost Guns in Their Astoria Apartment Queens bust: 2 brothers kept homemade explosive devices, 'hit list' in Astoria apartment, authorities allege. Investigators also recovered notebooks with hit lists that included police officers, politicians and celebrities, along with a scanner radio set to the frequency of the neighboring police precinct…The apartment is located right across from a Con Ed power facility. Cyber Threats to Critical Infrastructure and the United States Hearing Notice: The CCP Cyber Threat to the American Homeland and National Security Exclusive: US disabled Chinese hacking network targeting critical infrastructure FBI director to warn Congress of dangers Chinese hackers pose to American infrastructure, innovation Opening Statement by CISA Director Jen Easterly CISA: People's Republic of China Cyber Threat Water, Water, Everywhere! Announcement! WaterISAC is excited to announce that this Spring, it will be hosting H2OSecCon as a one-day virtual event on Thursday, May 23 from 11 AM - 5 PM ET! Sign Up For Updates Here! Securing Operational Technology: A Deep Dive into the Water Sector Environment, Manufacturing, and Critical Materials Subcommittee Hearing: "Ensuring the Cybersecurity of America's Drinking Water Systems" Chair Rodgers Opening Remarks on the Cybersecurity of America's Drinking Water System More Cyber. The U.S. economy is booming. So why are tech companies laying off workers? Statement From Secretary of Defense Lloyd J. Austin III on U.S. Strikes in Iraq and Syria Geo-politics. Sullivan: Middle East strikes "not the end" of U.S. drone attack response Houthis may sabotage western internet cables in Red Sea, Yemen telecoms firms warn Iran Says Yemen Strikes 'Contradict' US, UK Policy Hostages at Procter & Gamble plant outside Istanbul rescued after 9-hour ordeal US Senate Judiciary Committee Hearing: Big Tech and the Online Child Sexual Exploitation Crisis Senator to Big Tech: ‘Collectively, your platforms really suck at policing themselves' Ivanti Updates: Supplemental Direction V1: ED 24-01: Mitigate Ivanti Connect Secure and Ivanti Policy Secure Vulnerabilities CISA orders Ivanti devices targeted by Chinese hackers be disconnected QAnon-aligned son decapitates federal employee dad, shows off ‘traitor's' head in sick YouTube video Virtual Event: Preventing Mass Attacks In Our Communities. In this event, researchers from the US Secret Service National Threat Assessment Center discuss their findings on mass attacks perpetrated in public and semi-public spaces, including businesses, restaurants, bars, retail outlets, houses of worship, schools, open spaces and more. Click Here To Register.
This program will cover recent opinions of the Delaware courts on important aspects of M&A agreements, including remedies for damages based on “lost premiums” available to sellers and the parties capable of brining those claims and equitable limits on specific performance, as well as equitable and process considerations, including the standard of review applicable in controller buyouts as well as claims for aiding and abetting breach of fiduciary duty on the part of buyers. The program will address, among others, the Court of Chancery's opinion in Crispo v. Musk finally resolving Delaware's take on so-called “Con Ed provisions” as well as the opinions in Smart Local Unions and Councils Pension Fund v. BridgeBio Pharma, Inc., In re Columbia Pipeline Group, and 26 Capital Acquisition Corp. v. Tiger Resort Asia Ltd. Materials summarizing these and other opinions will be available. Questions? Inquiries about program materials? Contact Trenon Browne at tbrowne@bostonbar.org
Frank Morano discusses some of the hottest topics and gives his opinion. Frank talks about Andrew Cuomo's campaign balance going up and why and then Frank talks about Con Ed's rates going up. Frank talks about State budget negotiations that are about to start after her budget announcement yesterday and then Frank talks about Eric Adams and his budget. Learn more about your ad choices. Visit megaphone.fm/adchoices
Alle Infos zu ausgewählten Werbepartnern findest du hier. Das Buch zum Podcast? JETZT BESTELLEN. Lieber als Newsletter? Geht auch. Brandy-Produzenten haben ein China-Problem, Boeing hat ein MAX-Problem, Europa hat ein Inflationsproblem. Derweil hat Peloton eine TikTok-Lösung, Amer Sports eine IPO-Lösung und Fielmann ist eine Legende. Die älteste Firma an der New Yorker Börse, ein de facto Monopol und viel Dividende. Das ist Con Ed (WKN: 911563). Xiaomi (WKN: A2JNY1) will zum chinesischen Porsche werden. Die Strategie dafür: Land and Expand. Diesen Podcast vom 08.01.2024, 3:00 Uhr stellt dir die Podstars GmbH (Noah Leidinger) zur Verfügung. Learn more about your ad choices. Visit megaphone.fm/adchoices
This is the noon All Local for Wednesday, December 27, 2023
A sequel to one of our most popular 'sodes, we're tackling '$#it That Needs To Be Said' about business ownership. Bite-sized things we feel are extremely important, but haven't merited their own 'sode yet.They include: Business Ownership isn't for everyone. You won't necessarily make more money than you were making working somewhere else, and you definitely won't be working less (at least to start).You will be pushed out of your comfort zone. Business growth will require personal growthCareful who you take advice from. Don't listen to people who haven't been there, and develop your 'bullshit meter' for false claims and promisesThere's no 'magic formula' you need to find. There's no one 'right way' and no easy solutions to building a successful business.There's an inverse relationship between your time and finances. You'll have to balance your lifestyle with how much you work, depending on your goals.Bragging about revenue is BS. If you hear anyone talking about their 'six-figure', 'seven-figure' or 'multiple-______ figure business', ask them about their profit margin and what they actually take homeInsurance companies do shenanigans. Don't be surprised when they reject your patient's claims, and don't get involved if it's not part of your modelNo one is out to get you. We're always so worried about little details in our business - do your best, do the right things, and you'll (probably) be fineDon't hire just because you're busy. Growing beyond yourself is the largest decision you'll make in your business; don't make it lightlyMentorship is Con-Ed for Business. We've all spent years in school, hundreds of thousands in tuition, and more thousands in taking con-ed courses to help provide better patient care. And most of us haven't invested anything at all in becoming a business owner!Pelvic Business AcceleratorIf you're looking to take your pelvic rehab business to the next level in 2024, a new cohort of the Pelvic Business Accelerator starts in January of 2024. Registration opens next week! Check it out - www.pelvicptrising.com/acceleratorAbout UsNicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health. PelvicSanity Physical Therapy together in 2016. Together, Jesse and Nicole have helped 400+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them!Get in Touch!Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!
The All Local 4pm Update for Friday, December 15th, 2023
Many are of course wondering why the electricity briefly went out around the boroughs just before midnight last Thursday. Con Ed says a power surge took place at a DUMBO substation while a transmission line was being restored. Also, Mayor Adams' plan to curb spending on migrants is showing some gains -- at least on paper. The Independent Budget Office predicts the city will spend six to eight billion dollars on migrants' care the next two years, which is much less than the mayor's office estimate in August of nearly eleven billion. And the GOP has picked Nassau county legislator Mazi Pilip as their candidate to replace former congressman George Santos. Lastly, WNYC's Michael Hill speaks with the student journalists of Forest Hills High School in Queens behind the newly reformed student paper "The Beacon"
Wayne Cabot and Paul Murnane have the morning's top local stories from the WCBS newsroom.
Join the community waitlist Welcome to another episode of the Modern Pain Podcast. In this episode, Dr. Mark Kargela discusses the shortcomings of continuing education (Con Ed) in pain management and proposes solutions for clinicians.Key Topics:• Mismatch Between Con Ed and Clinical Practice: the environments of Con Ed courses often don't resemble real clinical settings, limiting their applicability in managing complex pain cases.• Isolation in Clinical Practice: Many clinicians find themselves isolated when applying modern pain science and techniques, lacking peer support and mentorship in their practices.• Logistical and Financial Challenges: Con Ed often imposes financial and lifestyle burdens on clinicians, making it difficult to integrate continuous learning into their lives.*********************************************************************
In this Thanksgiving edition, we reflect on the past year in wind energy. We're thankful for positive trends like capital changing hands, companies addressing the technician shortage, and growth of our podcast! The Uptime team sincerely appreciates the partnerships, experts, and audience feedback that have made this podcast possible. As we look ahead to next year, we invite you to continue engaging and let us know what topics you want us to cover. And most importantly, we're thankful that we can keep having insightful discussions about the wind industry! Sign up now for Uptime Tech News, our weekly email update on all things wind technology. This episode is sponsored by Weather Guard Lightning Tech. Learn more about Weather Guard's StrikeTape Wind Turbine LPS retrofit. Follow the show on Facebook, YouTube, Twitter, Linkedin and visit Weather Guard on the web. And subscribe to Rosemary Barnes' YouTube channel here. Have a question we can answer on the show? Email us! Pardalote Consulting - https://www.pardaloteconsulting.comWeather Guard Lightning Tech - www.weatherguardwind.comIntelstor - https://www.intelstor.com Allen Hall: Welcome to this special Uptime edition during Thanksgiving week. And Phil, Joel, and I, are going to reminisce about the past nine months and what's been happening for 10 months, 11 months, however long it's been. I guess we've been looking at it 11 months, going to what's been happening in wind. I think there's been a number of changes over the last six weeks that will have implications over the next couple of years. And. I know, Phil, we've been all going back and forth about where offshore wind is headed. I want to kick off first by looking back on onshore wind and let's say something positive here about what has been happening on onshore wind because there has been really good things happening. Philip Totaro: We're poised at this point of the year, we're poised to see, a, potentially a new installation record, in the United States this year, still to be determined whether or not, they're going to get there by the end of December. But, I think the certainty that has been provided by this extension of the production tax credit through the, Inflation Reduction Act has helped. The investment tax credit as well, and I think it's provided, a lot of people, even though they haven't released the full IRS guidance and everything yet. I think it's provided a lot of people some certainty. I think you're gonna see floodgates open when they do finally release this IRS guidance, but based on what everybody's anticipating, There's been, a lot of, companies getting back to business. if you remember this time last year, we were talking about how GE was going to shut down the factory and, everybody was financially insolvent. And, it was just terrible. And, now, things are actually on an upward trajectory. So I think you know, it's an industry getting back to business and, there's talk of new factories in the United States. The super secret Danish project in Colorado, economic, advisory council or whatever, announced. that their, LM was basically a contender for, for a factory potentially there. Yeah, I'm, optimistic about, onshore wind. I'm actually, surprisingly, I'm actually optimistic about offshore wind, because I think we've now, at this point, suffered through the last five months of nonsense, and, we actually have, something good on, on the horizon. Joel Saxum: There's a couple of... trends that I want to touch on if we're just talking about trends and things that have happened in the last year. One of them has been the large sums of capital changing hands. A lot of Duke Energy with their big sale of assets and you saw some Algonquin and Liberty Power and some of these other ones. And I think it was Con Ed got bought up and a lot of money being changed hands. And the reason that money's changing hands is because companies are basically divesting from older assets,
Dr. Christina Prevett // #LeadershipThursday // www.ptonice.com In today's episode of the PT on ICE Daily Show, ICE faculty member Christina Prevett emphasizes the crucial role of understanding statistics in making clinically relevant decisions. While staying up to date with the literature and being evidence-based are often emphasized in healthcare, Christina points out that it is not enough if one lacks the ability to comprehend the meaning of statistics and their application in a clinical setting. Christina acknowledges that interpreting statistics can be challenging, even for individuals with a PhD and experience in the field. This understanding leads the host to empathize with clinicians who may find statistics intimidating. It is recognized that being evidence-informed and evidence-based requires clinicians to possess the skills to understand and interpret the data they encounter. To make statistics more clinically relevant, Christina suggests utilizing systematic reviews and meta-analyses as tools for interpretation. Specifically, she delves into the interpretation of a forest plot, which graphically represents the results of a meta-analysis. By understanding how to interpret and analyze the data presented in systematic reviews and meta-analyses, clinicians can determine if the findings are significant enough to drive changes in their practice. Christina also highlights the importance of considering clinical relevance when interpreting statistical findings. The concept of the minimum clinically important difference (MCID) is introduced, which refers to the smallest change in an outcome measure that is considered clinically meaningful. An example is given of a statistically significant improvement in a timed up-and-go (TUG) test, but it is explained that it may not be clinically relevant if it does not meet the MCID for the TUG. 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 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 PREVETTGood morning everybody and welcome to the PT on ICE daily show. My name is Christina Prevett. I am one of the lead faculty in our geriatric and pelvic health divisions. So usually you're seeing me on Monday and Wednesday, but today I'm putting on my PhD research hat to talk a little bit about statistics, which I know sounds really boring, but I promise I'm gonna make it really exciting. But before we do that, we have a couple of courses that are coming up across our divisions. So MMOA is in Wappinger's Falls, NY this weekend. Extremity Management is on the road in Woodstock, Georgia. And Cervical Spine is heading to Bridgewater, Massachusetts. And so if you are looking to get in some Con Ed before the end of the year, we still have a couple of opportunities across all of our different divisions. And so I encourage you to go to ptinice.com and take a look at some of those opportunities. Okay, so a little bit about my kind of hat outside of working with ice is that I recently finished my PhD at McMaster University at the end of this year. I just announced that I'm doing a part-time postdoctoral fellowship at the University of Alberta looking at resistance training and its interaction with pregnancy and pelvic floor function. BUMPING INTO STATISTICS What that means is that I am bumping into statistics all the time. And I'm going to like kind of start this off and say, I've been asked to do some webinars and things around statistics for the ice crew for a while. And to be honest, it's been really intimidating for me to do that, despite the fact that, you know, I have a PhD and I'm interacting with this stuff all the time. Um, statistics is hard and, you know, discussing statistics in a way that makes sense is also challenging. And when I reflect on that and the fact that you know, I feel uncomfortable sometimes with interpretation and you know, I did a part-time PhD for seven years and I'm in a postdoctoral position. I recognize how challenging it can be for clinicians. And, you know, we get told all the time, like, you know, stay evidence-informed, like it's important to be evidence-based. It's important to stay up to date with the literature. But your ability to stay up to date with the literature is only as good as your capacity to understand what it is trying to tell you. And I mean that in the best way possible, that it is so tough for us to gain insights from what the statistics mean into what is clinically relevant for us to understand and be able to bring into our clinics. So today I'm trying to take our statistics and make them clinically relevant to you. SYSTEMATIC REVIEWS WITH META-ANALYSIS One of the first ways that I want to do that, and if you like this type of podcast please let me know, and I'll do more, is around the systematic review and meta-analysis and then trying to kind of deep dive into interpreting a forest plot. So when we're thinking about a systematic review, this is the highest level of evidence when we have a systematic review of intervention or prospective studies. When we take a systematic review, we ask a very specific question. And I'm going to use the example, I'm working on a systematic review right now on resistance training and pregnancy. And I'm going to take some of that to make this relevant to how this happens. This is where we're trying to get an idea of the state of the literature. So we use a PICO format, which is the population that we're trying to look at. So in this case, it's individuals who are pregnant. The intervention is what you are trying to see if there's a positive or negative benefit or whatever that exposure may be. And that for me is resistance training. The comparison group is to usual obstetrical care. And then the outcomes, we are looking at fetal delivery, pregnancy, and pelvic floor-related outcomes. So we're looking at the investigation of resistance training on incidents of gestational hypertension and preeclampsia, gestational diabetes, rights of cesarean section, the size of babies, and babies more likely to be too big or too small. What does their birth weight look like? How long are they pregnant? And then are they at increased risk for things like urinary incontinence, pelvic organ prolapse, diastasis recti, or pelvic girdle pain? So that's kind of the format of a systematic review we're trying to answer a very specific question. From there, we go to the literature and we want to make sure that we encompass as much literature as we can. in our search strategy. So that is usually why you'll see a list of PubMed and OVID, CINAHL, Sports Discus, like these types of different big searching platforms that are looked at. And then you're going to get a Prisma plot that you're going to see in the first figure. And that kind of describes a person's search strategy. So how many hits were given when this search was done? How many were excluded because of duplicates? How many were excluded from the title and abstract because they were done in rats instead of in humans? Or they were looking at an acute effect of resistance training versus being on a resistance training program like you're going to have a lot of those that are excluded. And then you're going to have kind of what is included in your systematic review, and then what is included in your meta-analysis if a meta-analysis is indicated or possible. When we're looking at a systematic review, we're looking at a qualitative synthesis. And what we mean by that is that we're trying to figure out, you know, where the state of the literature is. And when I'm reporting on something like the systematic review portion of a paper, You're seeing things like, you know, how many studies were done in resistance training in pregnancy? How long were those interventions? Were they done in the same cohort of individuals? What was, how many of them were statistically significant? What was the dosage of that intervention? Those are things that kind of come under the systematic review umbrella. But I would say really now the emphasis is being placed on the meta-analysis and that is the quantitative combination of these studies and that is what gives us this forest plot. So when we are going through and doing a meta-analysis, there are a couple of things that we need to make decisions on very early on. So the first thing is on a random or a fixed effects model. This is kind of getting into the weeds, but almost all papers are going to be a random effects model, which means that we're going to expect some variability in the population that we are working with, and we're going to account for that variability in the calculations that we're using for our forest plot. PRIORI SUBGROUP ANALYSES The second thing that we are looking at is a priori subgroup analysis. And so I'm going to use my research study to describe this. Before going into this meta-analysis and putting this forest plot together, we have to brainstorm around where possible sources of skew or bias would come into a forest plot. For example, in the resistance training intervention, it would be very different when we have resistance training in isolation versus resistance training as a component of a multi-component program. And so one of our subgroups analyses a priori we discussed was that we were going to subgroup studies that were only resistance training compared to our big meta-analysis, which included our resistance training in isolation or as a multi-pronged program. Another example in our systematic review is that some of our studies were on individuals with low risk at inception into the papers versus those that were brought into the study because they were diagnosed with a complication like gestational diabetes. we could think that the influence of resistance training on a person who has not been diagnosed with gestational diabetes versus those who have could be different. And so we did a secondary subgroup analysis where we looked at the differences between studies that looked at only individuals with gestational diabetes versus those that didn't. And so when you are looking at a forest plot, you will see the big analysis at the top, including all of the different studies. And then after that, you will see different subgroups where there's a repeater of what was in the main group, but it's a subsection of the included studies. And that's what we see. And then we try to see, you know, is resistance training and isolation positively associated with a benefit? versus multi-component or is there no difference and that gives us a lot of information too? So that's that subgroup analysis. Then you go into the results of the paper and there is a forest plot that is there and this forest plot has a bunch of different names of studies It has the total number of incidences and the weight. It has a confidence interval with a number around it. And then on the right-hand side, there's like dots with lots of lines and then a big thick dot at the bottom. I'm trying to explain this to our podcast listeners so that you can kind of understand. And I hope you're kind of thinking of a study in your mind that you have seen in the past. But we're going to kind of explain each of these different things. Okay, so when we're looking at what we are trying to find, it is going to depend if we are looking at a dichotomous variable like did gestational hypertension get diagnosed or not? And if it is a dichotomous variable, what we're looking at is an odds ratio with a 95% confidence interval. So if we are thinking that no difference between usual care and resistance training is one, then a reduction in risk for gestational hypertension with resistance training would be an odds ratio that is less than one. When it is less than one, it becomes statistically significant when the 95% confidence interval encompasses all numbers less than one. When the confidence interval, say for example, our odds ratio is 0.8, we can say that there is a 20% reduction in risk, because a one minus 0.8, of getting gestational hypertension because of resistance training. I'm making these numbers up. But that is only statistically significant if the confidence interval is 0.7 to 0.9. then we can say there's a statistically significant reduction in risk for gestational hypertension with resistance training in this systematic review of this meta-analysis. Where we cannot say it's statistically significant is if the odds ratio is 0.8 and the 95% confidence interval is 0.6 to 1.2. That crossing of one means that there is a higher likelihood that there is that variation is because of chance and not because of a true difference. And so what you see is that when you're looking at the odds ratio, the combination of all of those odds ratios from the individual studies are then pooled in that bolded line at the bottom of the forest plot to give us the confidence that we have based on all of the studies combined, that there is a true effect of resistance training in this example on gestational hypertension. I-SQUARED HETEROGENEITY The other kind of statistic that we're looking at is the I-squared statistic or the amount of heterogeneity. So when you're looking at that forest plot and you're seeing all the dots and those lines, the heterogeneity is basically saying how close are those dots? How much spread is there in those dots? And so if the heterogeneity is low, we can say that not only did we have a statistically significant result, but across all of the studies, we tended to see a trend in the same direction. So it allows us to have more strength and confidence in the results that we are getting. If we see a high amount of heterogeneity, so like there are some that are like really favoring control and saying that resistance training is bad for gestational hypertension, and then some are having really positive effects of gestational hypertension on resistance training, that I square statistic would be high, and then we would probably have to be doing more evaluation, and that's where we would rely really heavily on the subgroup and say, Well, is there certain subpopulations of this group that are skewing the data in one way or the other where their results may be different than the results of other individuals? And so that gives us a bit more information. So the odds ratio is when we're looking at the presence of an event and it's a binary variable of yes, this exposure exists or no, this exposure didn't. When we are looking at continuous variables, we are looking at like a time on an outcome measure, like the time to up and go, we are looking at a mean difference score between resistance training and a control. So the mean difference is going to be in the measurement of the outcome measure that we are looking at. So the target would be seconds. So then from the pool, it would be plus, Six seconds or mine I guess minus six seconds would be in favor of resistance training and that your tug score is six seconds less in a resistance training arm than a control arm or if it goes against resistance training it would be plus six and Again, we're looking at that 95% confidence interval. That average, that mean difference is also something that we would push against what our clinically relevant difference is. So we may see something that's statistically significant at a two-second improvement, but we know that the MCID for the TUG is four seconds. So while yes, it's statistically significant, it may not be a clinically relevant finding. So that's kind of where we build in clinical relevance. And then again, we look at that 95% confidence interval, see what that spread looks like, and look at that I squared statistic. Where it gets a little bit more complicated is when we have things that are measuring the same thing, but measuring it in a different way. So an example in the systematic review that I did on resistance training and lower extremity strength is that there are a lot of different ways for us to measure lower extremity strength. Some people may use an estimated one rep max, and Some people may use a five-time sit-to-stand as a conduit for functional strength training. Some people may use a dynamometer for knee extensor strength. There's a lot of different ways for us to do that. We can still do a meta-analysis on this, but what we have to do is transform all of those variables into one type of measure. And that's when we would see something called a standardized mean difference, an SMD. And in that SMD, we're essentially taking the impacts of all these different types of measurements that are telling us the same information and putting it into an effect size. And so the effect size gives us the amount of confidence that we can see in the influence of the intervention resistance training on the outcome of lower extremity strength. So an effect size using Cohen's d statistic would be that less than 2 is no effect, 2 to 5 is a moderate or minimal effect, 5 to 0.8 is a moderate effect, and 0.8 and above is a large effect. And so in my systematic review on lower extremity strength and resistance training in individuals with mobility disability, we saw a standardized mean difference of 3, which means that we can be really confident there was a large influence of resistance training on the development of lower extremity strength. So kind of pulling this all together, I know I threw a lot at you. When you were looking at the forest plot, you were looking at trends in the data that are pooling all of the different intervention studies, looking at the same construct and looking at the same outcome. When we are looking at the odds ratio, this is a binary variable. There's going to be a 95% confidence interval. And the pooled odds ratio that we look at with respect to making decisions is that bolded number at the bottom. Our I-squared statistic gives us an idea of the spread of the data and the results that we see. When we are looking at continuous variables, you're going to see either a mean difference or a standardized mean difference. The mean difference is reported in the measurement of the outcome measure that we're talking about. So it could be seconds, it could be points. A standardized mean difference is an effect size where we are transforming multiple different outcome measures into one output that's pooling these things together, but we have to do it in a standardized metric that looks at the magnitude of the effect of that outcome. So how do we think about this clinically? Well, the first thing is that we need to understand where these effect sizes are and if they are significant. And then we have to put it through the filter of, is this clinically relevant? When we have something that isn't statistically significant, the next thing to do is go into the methods and say, you know, was this dose appropriate? Was this done in the way that I would do this? And can I be confident that the interaction between what I would do in the clinic and what was done in these studies is significant enough for me to drive changes in my practice? All right, I hope you found that helpful. I'm at 18 minutes, I knew I would. But if you have any other questions about statistics and how to interpret them, please let me know. It's really important that we know how to understand the data that we're being presented with because that's how we're gonna change our clinical decisions based on what we are seeing. All right, have a wonderful afternoon, everyone. I promise hopefully I didn't stress your brain out by talking about math too much and hopefully, this was helpful and we can do it again sometime. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.
Dr. Dustin Jones // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult division leader Dustin Jones discusses the difference between sarcopenia (the loss of muscle mass) and potentiapenia (the loss of muscular power). Dustin reminds listeners that performing functional outcome measures & then creating a treatment plan based on functional deficits uncovered during assessment is the most important thing in ensuring patients receive the individualized care they need: "Assess, don't assume." Dustin also discusses the utility of using functional outcomes to assess & track progress so that insurers like Medicare will continue to pay for treatment. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 - DUSTIN JONES All right, welcome y'all. This is the PT on ICE Daily Show brought to you by the Institute of Clinical Excellence. My name is Dustin Jones, one of the lead faculty within the older adult division as we call MMOA. We're going to talk today about a really interesting topic. We're going to name the enemy and that is potentiopenia. We're going to name the enemy particularly when we're working with older adults and that is potentiopenia. This is brought to you by a listener question, a commentary that they wrote and I want to dive into the topic of power, strength, Sarcopenia as well. What should we really be focusing on? How can we screen? Before we get into the goods, I want to mention about some upcoming MMOA live courses. MMOA live is a part of the cert MMOA curriculum. Part of that curriculum is a live course. Also our MMOA level one online course, which was formerly called MMOA essential foundations. And then MMOA Level 2, which was formerly called Advanced Concepts. You complete all three, you get your cert MMOA. We have three upcoming weekends where you can go to that live course. We're gonna have Annapolis, Maryland and Central South Carolina. This upcoming weekend, November 11th, we're gonna be in Wappinger's Falls, New York. And then right before Thanksgiving, November 18th, that weekend, we're gonna be in Westmont, Illinois. So if you are looking to get some Con Ed before the end of the year, be sure to check us out. PTOnIce.com is where you can find all that. POTENTIAPENIA All right, so naming the enemy, potentiopenia. So this is a term you probably have never heard about because it's not been coined, it's not been researched, it's not been agreed upon in literature. This is a word that was made up by Dr. Ronald Michalak. So Dr. Michalak is an orthopedic surgeon that's been practicing for roughly 20 plus years that has quitting his surgical practice to go back and pursue his PhD in Rehabilitation Science. Dr. Michalak is an avid listener to the PT on ICE Daily Show, so I want to take the time to shout out to him, but also for all of y'all that listen to this show that aren't our typical physical therapy crowd, right? The OTs, the speech-language pathologists, the other healthcare providers. I know we have some PAs, some NPs in here, but we're really grateful for y'all tuning in because we're starting to see we have a fitness-forward army clinicians that are trying to solve the same problems. This is one example. So Dr. Mitchell like you know 20 plus years doing orthopedic surgery you start to see some patterns right? You start to see the issues with focusing on the tissue, right? Of focusing on, oh, that bone-on-bone, we should probably just go ahead and replace that whole joint, and that will solve all your problems, right? There's some issues to that, that when we focus so much on the anatomy, the structure, that we apply surgical interventions to non-surgical problems, that creates issues, right? And so over his career, he started to see, man, the biggest issue is not the quote-unquote bone-on-bone, it's the fact that these folks are deconditioned, they're weak, they're not able to do the things that they want to do and it leaves them susceptible to some of these medical situations that I'm often performing surgery on. What can I do to prevent them from even having surgery? And so we started to dig into the research and science and what he has come to the conclusion of is we are really missing the boat to where we're focusing on the wrong things and what we need to focus on particularly with this population is their lack of power. hence the term potentiopenia, the lack of muscular power. So, I want to give some context for this discussion because I think it's really interesting of how much progress has been made in this area, particularly in geriatrics and geriatric rehabilitation. SARCOPENIA So, sarcopenia, you've heard us talk about this so many times on the PT on ICE Daily Show. If you've taken any of the MMOA courses, you've heard this term. Sarcopenia was first coined in 1989 by Dr. Rosenberg, and at the time, the definition, the accepted definition of sarcopenia was age-related loss of muscle mass. That we thought, oh man, these folks are losing muscle mass, therefore, they are losing their strength, they are losing their ability to do what they need to do. This is a big issue. It's age-related, but we may be able to do something about it. As this was studied more and more, and just this whole concept, was being critically you know thought about that the term of sarcopenia or the definition of sarcopenia was missing a little bit right because you can have someone that is losing muscle mass but may still be really strong or you may have someone that does have a good bit of muscle mass that is rather weak or they're not able to produce their force quickly aka they have low power So, in 2008, Dr. Clark really started to push against this definition of sarcopenia and say, hey, this isn't the issue. The issue is the lack of strength, the age-related loss of muscular strength. And he coined the term dynopenia. That was a back and forth, back and forth. And now in terms of the term of sarcopenia, what we're seeing is that it's starting to incorporate some of the things that Dr. Clark really was pushing for. And now you're often going to see sarcopenia defined as the age-related loss of muscle mass and strength. That's what we speak to in the MMA course. And so a lot of the screens that you're seeing of being able to identify folks that have sarcopenia are mass related screens of actually measuring muscle mass and having cutoffs based on certain age groups and so on and so forth. But then there's also functional measures, right? Gait speed is one, grip strength is another one, the SPPB, the short physical performance battery test can indicate that someone is at risk of sarcopenia. Sarcopenia has changed a ton over the past few decades. Now, what's interesting is that the amount of research, which is so massive in this particular topic, that we have really good evidence to show, man, if this person scores below one meter per second, for example, on the gait speed, that this individual is at risk of sarcopenia, also a host of negative health outcomes. It's very predictive. We have a lot of data to show that poor performance on some of these outcome measures is a big issue and very predictive and warrants medical treatment or physical therapy, if you will, or occupational therapy, some of these rehabilitation-based services. Now, here's the issue. Here's what I think Dr. Michalak is going towards, is a lot of these screens that have been used to say, hey, this person has sarcopenia, age-related muscle mass and strength, that these screens may not actually be measuring what we think, right? If you think about gait speed, normal gait speed, for example, is that a measure of strength? Not really, right? Is it a measure of, let's say, power, the ability to produce that strength quickly? Potentially, right? Definitely, if it's a fast gait speed, or if we're looking at gait speed reserve, the difference between max gait speed and normal gait speed. Think about the 30 second sit to stand test, where we're standing up and sitting down 30 times. Is that a measure of strength? You can make a strong argument that, no, not necessarily, but it's more of a measure of how people can use that strength quickly to perform that transfer. Same thing could be said for the five times sit to stand. And so these outcome measures that are often tied to quote-unquote sarcopenia, the age-related loss of muscle mass and strength, isn't really measuring that. We can say that those tests are very predictive of some of these negative health outcomes. That's not what we're talking about. What we're talking about is do these tests actually measure, indicate what they're saying that they measure, right? Now, here's the, I think the important part about this is that if I am performing a five-time sit-to-stand test or a 30-second sit-to-stand test and think that, oh, this indicates that this person has impaired lower extremity strength and I focus on strength-based interventions, right, I'm just worried about getting them stronger, not necessarily trying to help them get stronger, produce force quicker, aka power. THE NEGLECT OF POWER-BASED TRAINING And so what Dr. Michalak is really proposing is that our focus on age-related loss of muscle mass and strength, the focus on strength has resulted in the neglect of power-based training. We need to really think differently about these terms and ultimately what they result in. I think we should have a new term, potentiapenia. That was his argument. This is all in a beautiful commentary that I loved reading that I'm going to link in the notes. So here's our take on this. I agree that… we have really dropped the ball on power-based training, right? That we often neglect that in this population for many reasons. One is just we haven't named the enemy as one. Two is that we often have ageist assumptions about what people can handle, right? That, oh, that's too intense for them or they will get hurt. It's not as well studied as strength-based training. There's a lot of reasons that go into that, but I do agree that we have really dropped the ball there. A new term, creating a new term, and everything that's associated with that, I don't know if that's the answer, but I do think we need to continue to be critical of the term sarcopenia and what that actually represents. It's already changed to age-related loss of muscle mass and strength, which is lovely, and I would love to see that conversation continue to include power as well. Clinically, here's what I think is really important for us when we think about some of these deficits that folks are undergoing and we're throwing around some of these terms. STRENGTH VS. POWER TRAINING I think the big thing that needs to be focused is we're diving into the weeds of strength versus power and you know reps and sets and volume and all that type of stuff that when first one is when we're working with individuals that are relatively sedentary or inactive and Movement is king. I don't care what they do. The fact that they are moving is ultimately important, right? We got to get people moving first and we need to be less picky of what that looks like, especially with sedentary and active individuals. That's the first thing. The second thing is we need to really think about our assessments and challenge our assumptions with this. This is why in our courses we always say assessments over assumptions. It's very easy for us as clinicians, when you're doing an assessment, you're doing the five-time sit-to-stand test, 30-second sit-to-stand test, to assume, oh, this person needs to do more lower extremity-based strength training, right? That's a very common thing for us to correlate. Now, that test may not be and probably isn't testing pure strength, right? There's other ways to do that. One rep max testing, estimated one rep max testing. We can use dynamometry as well. There's other methods to test strength. These functional and very practical outcome measures may be more a testament to someone's power ability. So when we use these tests, particularly the 30 seconds sit to stand, five times sit to stand, I think is a great example. that we need to be thinking probably about strength training, but we also need to be thinking about power training. Can they produce that force quickly? Because it ultimately is an indicator of power, the ability to produce that force quickly and do that transfer. So what your outcome measures tell you, we need to be very careful of how that informs the intervention, right? And ultimately what we're often going to find, I think this is not an or conversation, strength training or power training, in the realm of ice, you will hear this so often, it is and not or, right? Probably both, strength and power, we can do both. In reality, when we do get people stronger, you often see, especially in folks that are untrained, you are gonna see an improvement in power production. You could do specific power training, where you're doing force movements quickly, you're probably using lighter loads, and you're probably gonna see an improvement in strength, right? That's gonna happen with a lot of untrained individuals. But I think in the context of rehab, in the context especially of One Rep Max Living, that we probably want to do both. Heavy loads are really good. Heavy loads provide an amazing stimulus to promote muscle mass, our strength, but also the strength of our bones, also our soft tissue remodeling. It makes us more resilient individuals. But fast loads are really good too, right? They give us that type 2 muscle fiber stimulation to prevent some of that preferential decline. in those fibers. That quick speed is so practical for so many things that we do in the real world and also in high-risk situations. It's an and conversation. We want to do both. Now, Dr. Mitchell, I had two specific questions that I also wanted to hit on. Could referrals be written or phrased better from the physician end to encourage PTs to try to help get these individuals moving toward fitness? Now, I want everyone to listen here, and by and large, the PT on ICE Daily shows largely physical therapists, physical therapy assistants. Think about what this physician just asked. This physician is basically saying, where are my fitness forward clinicians, right? Where are my fitness forward clinicians? Where are the people that I can trust with my patients? I love this question. I think from our angle, from kind of the rehab fitness side of things, Let it be known. What are you about? Lock arms, lock shields with us, the ICE tribe, the ones that are really pushing this fitness forward message because there are healthcare providers looking for you. Now, Dr. Mitchell, from the physician's standpoint, I do think it is helpful to make it clear as a physician that you have that fitness forward approach. And oftentimes, we don't see that on referrals, right? It's the diagnosis and treat, which you love as a PT, to be honest, but if you do run a 30 second sit to stand and acknowledge that it is under or below a particular cutoff let it be known and let it be known what you are thinking about that it is a potential loss of power production potential right and let the PT do the job of assessing to determine is this a bigger power issue or a bigger issue of just producing force of strength. FUNCTION-FORWARD HEALTHCARE PROVIDERS But let it be known, I love it whenever I see another healthcare provider perform some type of screen, like a 30 second sit to stand, a timed up and go is another one, that tells me that this is a function focused healthcare provider. And we're speaking the same language, especially when we're coming from the MLA tribe. We speak function, we speak that fitness forward mindset, include some of that information and that's really going to get the point across particularly to the fitness for clinicians. I would also say Dr. Michalak is go to PTOnIce.com, look at the find an ice clinician map and build relationships with that person that is local. The second question that he asked was, are there any insights into Medicare billing or reimbursement that would allow them to do so and actually get paid for their expertise? So the question here is mainly looking at, he's interacted with some PTs where he sent the referral that was not pain based, where these clinicians said, I can't get this covered, right? I treat pain, I get paid to treat pain. That is not correct, right? So you can definitely get reimbursed to have the fitness forward approach when you use appropriate outcome measures. When you can demonstrate medical necessity through the performance of these validated outcome measures that we cover extensively in our MMOA level one online course, and a little bit as well in our MOA live course, when we're using those outcome measures to demonstrate, hey, this person has a score, which based on the literature is showing that they are at a higher risk of whatever, negative health outcome, usually it's a fall, that that warrants your services. It is medically necessary. So we can have fitness-forward physical therapy. This is what we often see in the context of home health. We treat more function than pain in the context of home health. Outpatient, not so much. It's more of a pain driver, but you can still have a fitness-forward approach in the context of outpatient. These outcome measures are absolutely key because they demonstrate medical necessity. Multiple outcome measures I should say great conversation. So what I want y'all to do if you like this topic I want you to come to Instagram and I'm gonna drop a couple links. You could also send me a direct message At Dustin Jones dot DPT and I'll send you the links as well because it's a really great conversation. I think by and large Yes, we need to get people stronger We're already really pushing forward with that and I love that but we may need to take it to the next level of power based training In terms of a new name, potentiopenia, I don't know. I'll let the really smart people debate that and discuss that, but I'm going to keep pushing the message that we need to build people's resilience. We need to end one rep max living and really show that people may be quote unquote old, but not weak. Also that they may be quote unquote old and not slow. Y'all have a good rest of your Wednesday. I'll talk to you soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.
In this Philly classic auto showroom episode, Mental has a boring drink at an interesting bar, Chrissy mishandles scissors, Chris gets all pixelated. Really, we do our typical pre NHMS show, join us for track info and our track walk to remember where the track goes. Track map - https://sccnh.org/event/autocross-magicross-nhms-road-course/ Get on track - South side of central garages. Get checked, left onto pit lane, turn one (during race this is check). Coned path through turn 2, follow the wall around 2 (tight), enter onto straight (watch for stalled cars on track) stay left of blend line. Turn 3 Hard right onto road course.Stay left, Good straight line braking before (2nd or 3rd). Folks will still try to go 3 and 4 wide. Gators offer no grip here, apex is the 2nd to last blue gator, track out is the start of the gators on the opposite side. Look for a line that drive a line that allows you to go to power early and hard. (traction?). Flag station on the outside. Turn 4 Flag station on right, usually black flag, Eyes up the hill out of 3, maintain the momentum from 3 and add some. Suspension is compressed and you should be able to put some power down. Great place to out motor less HP cars. Turn 5 blind crest setting up for the downhill section, find a visual, carrying speed, brake very late, stay right, stay high when track is clear, dive into bowl. Turn 6 the bowl. Hard turn in late, slow wheel unwind, lines up to apex of 7 (stay out of gravel), if you have to turn in twice you did it wrong. Stay on the line, give up a pass to maintain momentum Turn 7 feedback is how much steering input you use. 1 is ideal. Track narrows, good pass station Turn 8 Tree house flag station, Can go 2/3 wide, but sort before 9 Turn 9 Late-apex hard right downhill. Usually covered in gravel after race starts. Earlier apex, ensure you are straight along zebra strip jersey barrier, keep left, unloaded suspension Turn 10 Avoid the turtle, it will flip your car. Flag is behind the wall on the NASCAR side. Don't get close to very late apex. Bumpy, elevation change, different age asphalt & crowned section. Widens for a very short bit. watch 4 spins outs & accidents Turn 11 Be single file. Giant wheel crushing pothole on right. Don't push wide Turn 12 Setup for straight. Pit entry on left, avoid wall, watch big curb on entry (left) Turn 1 – 2 coming off the straight, brake late, stay high, brake on banking turn on banking, follow candy stipes into 1 Defensive, tuck in and get close to corner station No track out for 1 & 1a. Expect to get passed by fast cars. Watch for dive bombers. Will gather debris (especially in rain) Turn 2a back onto NASCAR. Fairly late apex onto NASCAR surface. Use the banking, get on the gas, track out about 2/3rds up, flag station on inside that people miss. 2024 Lemons Schedule! https://24hoursoflemons.com/schedule/ 1979 RX7 ITA car on Racing Junk https://www.racingjunk.com/improved-touring/184491663/1979-mazda-rx-7-it7-ita-stu-stl-ep.html?category_id=4&np_offset=5 Boring BMW V8 Swap on Racing Junk https://www.racingjunk.com/24-hours-of-lemons-cars-and-equipment-for-sale/184490697/1985-bmw-e30-with-v8-swap-24-hours-of-lemons.html?category_id=4&np_offset=109#1 Mutt Cutts replica is a Dumb and Dumber fan's dream van - Hagerty Media https://www.hagerty.com/media/car-profiles/mutt-cutts-replica-is-a-dumb-and-dumber-fans-dream-van/ Buy the Dumb and Dumber Van Here! https://carsandbids.com/auctions/KdlmZzzp/1993-ford-e-150?utm_source=pd&utm_medium=email&utm_campaign=n California Cruising Bans Overturned (motorious.com) https://www.motorious.com/articles/news/california-cruising-bans-overturned/ Mazda Issue C&D for Developer making his CX-9 More Useful thedrive.com/news/mazda-slaps-developer-with-cease-and-desist-for-diy-smart-home-integration?utm_term=The Drive_Wire_10.23.23&utm_campaign=The Drive_Wire_Actives_Dynamic&utm_source=Sailthru&utm_medium=email https://mfbc.us/m/yp26k6j - E1R Bingo Card
Dr. Zac Morgan // #ClinicalTuesday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Spine Division division leader Zac Morgan discusses the importance of working with patients to dispel negatives beliefs & fear concerning movement aggravating symptoms. Zac describes different strategies to discuss with patients how not moving after surgery or while in pain is probably the riskiest decision. Take a listen or check out the episode transcription below. If you're looking to learn more about our Lumbar Spine Management course 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 - ZAC MORGAN Good morning PT on Ice Daily Show crew. I'm Zac Morgan, so I'm lead faculty with the spine division. I teach lumbar and cervical spine management, so you can find me on the road doing those things. Shout out to that crew in Hartford, Connecticut or Waterford, Connecticut this last week. We had a good time learning about cervical spine over there in Waterford. Few more courses on that note coming up this year that if you're trying to jump into either cervical or lumbar, just wanted to point you in the direction of. So November 11th and 12th, we'll be back in that Northeast region up in Bridgewater, Massachusetts for cervical spine. December 2nd and 3rd, Hendersonville, Tennessee for cervical spine. And then if neither one of those work for you, the next chance will be at the turn of the year on February 3rd and 4th over in Wichita, Kansas. If you're looking for lumbar spine management, we've got three different courses this year that are all still have tickets available. Frederick, Maryland, that's next week or this upcoming weekend, October 21st and 22nd. Then we've got November 4th and 5th. That'll be over in Fort Worth, Texas. And then lastly, Charlotte, North Carolina on December 2nd and 3rd. So still several Good offerings if you're looking for cervical or lumbar spine management. We've already got quite a few booked for next year as well, so if this year the calendar doesn't work out or if the Con Ed budget resets at the beginning of the year, Take a look at the 2024 course offerings as well and more to book there. 01:36 - CATASTROPHIZING REST So team, this morning I wanted to talk to you all a little bit about rest and why I think we need to catastrophize rest. I think we need to make a bigger deal out of it when our clients come in and we find out that they've been resting. So let me talk a little bit about this. I've been chewing on this idea for a while and I think it's important for us to sort of understand that when someone's in pain, their risk meter is broken. Like they don't have the ability to conceptualize what's actually risky for them often when they're in pain. And so let me unpack what I mean with maybe a clinical scenario that we're all really familiar with. Let's think about something like a knee replacement. I think most of us in our career will interact with patients who have had a knee replacement. Usually we have interacted with those people on the days right after they have had a knee replacement or maybe you're the one that's getting them out of the bed in the hospital and you're the first person that's getting that person moving. I think we understand the risks to this person pretty well, and as a profession, we respond to them pretty well. We understand what this person's actual risk is when it comes to the knee replacement, and their risk would be being too sedentary or resting too much. And what would come alongside of that risk would be a lot of problems that we'll cover in a bit. You think about what that person's concerned about when you talk to that person in the subjective exam on day one, or maybe you just went into their hospital room and you're talking to them. That person's usually concerned about things that are unwarranted. They're worried that their knee is gonna pop out when you start to flex it. The first time you have that person do active range of motion, that person's like, oh my gosh, is my knee gonna fly out? Is the implement actually gonna pop out? They're worried about things like that, but we as PTs, we know that's not very common. We tend to mobilize knees really early and get them moving really, really rapidly and get as much range of motion as possible as quickly as possible in something like a knee replacement because we know that it's crucial that that happens at short term. So a large part of our job early on in managing this person who has just had a knee replacement is convincing them that their risk meter is off. Again, they're afraid to move. They walked through the door that day with a lot of blood in their amygdala. They were very concerned. They were worried, what if something's going wrong? I didn't know it was going to hurt this bad. I didn't think it was going to be quite like this. And they have typically not been moving as a response to all that pain. 03:22 - CONVINCING PATIENTS TO MOVE And our job is to help them understand that, hey, if you don't move, that's where the risk lives. The risk lives in being sedentary after a knee replacement. Like what's actually risky is if we don't move, the blood will pool, right? And we will wind up with things like a blood clot. Very risky. If a blood clot ends up dislodging and we end up with a pulmonary embolism, that's life-threatening. So that's real risk. That's something that we have to help those people understand is like, hey, if you're too still, we could wind up with something like a blood clot. And maybe we don't fear-monger that to patients, but we do help them understand that risk. You think about some of the other risks that that person has if they don't get moving. What about long-term mobility? If a knee replacement patient does not get their knee moving, you think about what that person's long-term mobility is gonna look like, and it's gonna be quite poor. That first 12 weeks after knee replacement is the most important time for us to restore full extension and get as close to full flexion as we can. We're really trying hard to push range of motion early because we know that person's long-term risk is having a stiff knee. and then not being able to participate in some of their ADLs because of the immobility in their knee. We get the risk so we help unfold that to the people in front of us. I mean the last big ones that happen if someone rests are things like atrophy or loss of cardiovascular endurance and we know this happens very very rapidly. when someone's on bed rest, when someone's immobilized, when somebody's truly sedentary or even sedated, things like that. We know the body responds and we see wasting of all those systems. The same thing's happening if someone doesn't move when they've had knee replacement. maybe not as rapidly as true rest, but we know that they're losing muscle mass, we know their muscle girth is going down, we know their endurance is getting worse. All of these things are truly risky for that person. And for that reason, I think we as PTs do a really good job of helping that person understand, hey, I know it hurts, but the risk of you moving through pain is much less than the risk of you not moving through pain. So I need you to move. And I think we do a really good job with patients like knee replacement patients or patients with a knee replacement. I think we do a really good job with those folks, getting them moving, even though it hurts, getting them back to their ADLs, getting them progressively loaded back to where they're out of sort of disability. I want to shift gears now. And I want to talk a little bit more about my expertise area, which is cervical spine and lumbar spine. So patients with neck pain and patients with back pain. That's typically who I'm seeing the most of in the clinic these days. And I think our response to these folks is a bit different than it is with the knee replacement patients, which is sort of understandable, because with a knee replacement, you understand exactly what happened to that person, where with back pain and neck pain, we never know what the tissue driving their symptom is. 06:57 - FEAR & OUTCOMES WITH BACK PAIN But I think we often respond with fear, and I think that influences the person's outcome. So let me unpack what I mean. So when someone acutely strains their back, they do something, they were lifting their kid and something happens and now their back is really strained and they're in high, high levels of pain and usually high levels of disability as well. Like a lot of patients will tell me, Zach, I can't even tie my shoes. I have to have my wife help me tie my shoes. I can't get my pants on. I can't get on and off the toilet. The activities of daily living are really influenced by these high pain levels. And a lot of these people, when you start to talk to them, they're terrified to move. Especially a forward bending, but really just to A lot of people in general with acute back pain, they're so scared to move their back around. And they're afraid that what will happen if they move their back around, is that they'll worsen their scenario. They're concerned that if they move too much, and maybe some of this is valid, but if they move too much, they'll worsen whatever's wrong with their back, and then they'll have long-term problems. But team, as you're hearing that unfold, you and I both know that's not the case, right? Like it's actually the people who choose not to move who usually wind up with worse recurrence of their back pain. It's why, I mean, you look at the Olivera study in 2018, where they compared all the lumbar clinical practice guidelines around the globe that they could get their hands on. And there's really only two things, all CPGs, not profession specific, um, not region specific, just all the CPGs that they looked at in that study, they agreed on two things. One of them, don't image. The second one, get moving, right? Don't rest, some sort of exercise. We know people with back pain need to get moving. It is clear, no one argues about that anymore. There's no studies, no big studies that have looked into, hey, rest is actually the successful recipe for back pain. It's not that. We gotta get them moving. But I think sometimes we let our fear of allowing that person to move hold them back. But we need to conceptualize those risk factors. Like you think about what it was like for your knee replacement patient. Maybe we don't have the same concern of like a blood clot or an infection, but think about this person's other risks. 06:57 - THE IMPORTANCE OF MOVEMENT Like, what about long-term mobility? If someone doesn't restore their ability to forward bend, they often end up with a loss of long-term lumbar flexion. And how does that usually wind up? Maybe sometimes they're fine and they're asymptomatic throughout the rest of their life, but often when I see recurrent back pain patients, They have had episodes throughout life and they've chosen to avoid a certain range of motion and part of our job is to do some graded exposure back to that to help them conceptualize the risk. To help them realize actually being still is where the risk is. We've got to get moving. You think about atrophy. You think about what happens to that person's muscular system. If they have severe back pain and they're not doing the things that they normally do, perhaps they're laying in bed a little bit more, sometimes they're laying on the couch a bit more, a lot of times their spouse is helping them out, their partner is helping them out with a lot of their ADLs. Team, when people have acute back pain, they often get very still because their fear level is really high, and part of our job is to help them understand that where their head is at, what they're concerned about, is actually much less risky than being still right now. Being still is where the risk lies. If we don't get back to movement, you're going to lose that long-term mobility. You're going to lose a lot of your muscular system. You're going to end up losing quite a bit of your cardiovascular endurance. That's where the risk lies. Because what do we all know about people who tend to lose muscle mass, who tend to lose cardiovascular endurance? Most of those people will struggle to get that back. And I think the longer they live, the more challenging that climb back to fitness is going to be. So our older adult clients are definitely in this boat. We've got to keep these people moving. We've got to get them afraid of resting. That's where the fear should be because what happens when you rest is the long-term stuff. That's what causes recurrent back pain. If a person hurts their back and they're now afraid to move in that range of motion and they don't restore capacity, whether that's cardiovascular capacity or the actual strength of the tissues because of fear, now that area is more fragile. It's more susceptible to injury. They're usually careful with that area and being careful with that area often is not a solution for getting rid of a recurrent back pain. As a matter of fact, we want to move more towards things like graded exposure, graded exercise, building that engine, building the tissues, how robust that underlying tissue is. That comes with movement. It doesn't come with rest. So team, I think just putting this whole thing into perspective, what I want to get across this morning is that when someone comes in to see you in pain, their brain is not in the right decision making area to understand risk. Their amygdala has all the blood in it. They're really concerned. they don't know if they're going to be okay. It is our job to use our prefrontal cortex because we can use that in that state because we're not anxious because we see this all the time. We use our prefrontal cortex to say, you know what, actually we need to develop a plan that gets you back to X, Y, and Z. And that's what we do with rehab. And that's how we try to bring down that recurrence, is we avoid all these catastrophes that happen when people sort of follow their natural instinct, which is to rest. So that's all I've got for you this morning. I want us all catastrophizing rest a lot more on our patients, helping them understand that that is not necessarily the safe choice. A lot of times people's risk meter is broken there and it's actually the unsafe choice. So let's catastrophize rest, get out there this Tuesday team, meet us on the road if you're looking for anything. Please feel free if you want to have a big conversation here, jot it into the thread and I'll be on here all day answering any questions. Thanks team. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.
In January, Illinois' largest utility released ComEd 2030 – their roadmap for providing clean power for more than 4 million customers. For CEO Gil Quiniones and the company, that means hitting big marks like enabling almost 2 million EVs by 2030, $1 billion in energy assistance for customers, integrating DERs, and procuring more clean power.If done right, ComEd's path would be a big win for the state's clean energy goals, and energy equity in the region.Before joining the utility in 2021, Gil tackled problems of energy and sustainability in another major American city, New York. He served as a part of Mayor Bloomberg's administration working on clean energy and climate policy, and held roles at ConEd and New York Power Authority.Now he's spearheading Chicago's energy transition, with an emphasis on equity for the city's underserved communities.This week, Brad speaks with Gil Quiniones, CEO of ComEd, about taking into account customer affordability and equity as they move ahead with their low-carbon plan.This podcast is produced by GridX. GridX is the Enterprise Rate Platform that modern utilities rely on to usher in our clean energy future.
Dr. Joe Hanisko // #FitnessAthleteFriday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Fitness Athlete lead faculty Joe Hanisko stresses the need to maximize preparation and recovery for a successful competition. He emphasizes the importance of preparing for the week before the competition, the competition day itself, and even the week after the competition. Joe encourages individuals to focus on their game plan, proper nutrition (including carbs, protein, and electrolytes), fluids, and electrolytes. Additionally, He highlights the importance of keeping the body moving between events to avoid stiffness and stagnation. The ability to warm up, maintain a good heart rate, and perform at a fast 100% effort is crucial for success. On the day of the competition, Joe advises sticking to one's game plan and not letting others dictate it. He mentions that CrossFit is about being able to adapt on the fly, but it's important to trust one's strategy and see where it takes them. Joe also emphasizes the importance of nutrition during competition day, stating that eating is necessary and what one eats matters. He provides the example of an elite athlete who consumed multiple Snickers bars for fast carb and glucose intake to replenish muscles, but notes that this strategy may not be applicable to everyone. After the competition, Joe discusses the importance of the follow-up week. He suggests focusing on recovery during this time and allowing the nervous system to recover and do what it needs to do. He highlights the significance of giving oneself time to recover, as it is an important part of the overall competition process. Overall, the episode emphasizes the importance of preparation, execution, and recovery in the context of a competition. It highlights the need to have a game plan, trust one's strategy, focus on proper nutrition, and prioritize recovery to maximize success. Take a listen to the episode or read the episode transcription below. If you're looking to learn from our Clinical Management of the Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO Hey everybody, welcome to today's episode of the PT on ICE Daily Show. Before we get started with today's episode, I just want to take a moment and talk about our show's sponsor, Jane. If you don't know about Jane, Jane is an all-in-one practice management software that offers a fully integrated payment solution called Jane Payments. Although the world of payment processing can be complex, Jane Payments was built to help make things as simple as possible to help you get paid. And it's very easy to get started. Here's how you can get started. Go on over to jane.app.payments and book a one-on-one demo with a member of Jane's support team. This can give you a better sense of how Jane Payments can integrate with your practice by seeing some popular features in action. Once you know you're ready to get started, you can sign up for Jane. If you're following on the podcast, you can use the code ICEPT1MO for a one month grace period while you get settled with your new account. Once you're in your new Jane account, you can flip the switch for Jane Payments at any time. Ideally, as soon as you get started, you can take advantage of Jane's time and money saving features. It only takes a few minutes and you can start processing online payments right away. Jane's promise to you is transparent rates and unlimited support from a team that truly cares. Find out more at jane.app.physicaltherapy. Thanks, everybody. Enjoy today's episode of the PT on ICE Daily Show. 01:26 JOE HANISKO Good morning, everybody. It's PT on Ice, daily show live. It's Friday, I would say September 22nd, getting close to October already. It is Fitness Athlete Friday. I'm Joe Hanisko. I'll be your host today. One of the lead faculty of the clinical management of the Fitness Athlete crew. Today we want to chat about competition. So CrossFit competition prep 101. Just the basics. We get either personally ourselves or some of our clients who are signing up for local or online competitions and we want to make sure that we're preparing them and that they understand what their expectations are for getting into that competition. the week before, the actual date of, and then even that week after, like making sure they maximize their preparation and their recovery for a successful event, especially when really all that we typically have to see in comparison is these elite athletes who are going to be doing things similarly, but also different because of the amount of training they've put in and just the fortitude that they've built up in terms of an athlete and the resilience that they've earned in an athlete. We'll talk about that CrossFit Competition Prep 101. Before we get going, I want to make a couple of call outs to the CMFA Live agenda that's coming up for the rest of the year. Both of our Essentials and Advanced Concepts course took off online in the last week or so. So those are going to be going through until the end of the year and we'll get those going again at the beginning of 2024. But in terms of live courses, we have a handful coming up in the next few months to close out the year. So if you're looking to get into any Con Ed courses, we are going to be in California. Washington, Alabama, the state of Texas, down in Florida, New Orleans, and Colorado, all before Christmas. So from now until Christmas, we have six or seven CMFA Live courses that will be out there. So grab a seat if you're looking for that. Hop on to theptnis.com and you can find all of our courses there. All right, CrossFit Competition Prep 101. 03:45 PREPPING FOR COMPETITION WEEK Let's talk about the week of. So you're going into this weekend of competition. What do we do that week before? I would say that at this point, We're not talking about the prior weeks and months of training. That's a whole other conversation. But at this point, whatever you've done to earn your right to sign up for this competition, you've done it, you've earned it. You can't really gain a whole lot more in one week of training, but you can lose a lot in that one week. So we want to make sure that we take that week leading into competition pretty seriously. If we're assuming maybe competition day is on Saturday, which is most common for a lot of local events, I would say that those first two to three days of that week, Monday, Tuesday, Wednesday, per se, I would focus on training as normal. Keep things consistent. If you guys have specialized programming through your gym and or you're using some sort of online platform like Mayhem, Days one, two, and three can stay pretty consistent. We don't have to change a whole lot about that. It allows us to stay moving, feel good, test some things out, and it's not until day four and day five that we really start to maybe change some things there. Day four, I would say, is a great opportunity to just take a complete rest day, figure out how the body is feeling, let things calm down. Maybe we focus on just a nice walk outside, maybe we do some mobility work and some soft tissue work to kind of prep the body but I'm cool with day four-ish in that time frame being a complete rest day if that works out into your calendar. It gives us time for the body recover for the nervous system to recover and then it gets us to day five the day before competition. I would suggest that the day before competition you don't do absolute rest. I think it's kind of nice to low level prime the body for movement especially when you're about to do something at a pretty high intensity the following day. So this could be super easy, like moderate EMOM style work, where you're doing a lot of body weight or simple movements. This could be just a zone two kind of monostructural day where we hop on the erg, sorry about that light there, hop on the erg, get some of our heart rate into that zone two level and just do a nice 20, 30, 40 minute cruise control type of workout. But I like the idea of the day before competition, moving the body and taking that rest day, maybe a day or two before competition. opposed to resting right up until that point there. So in terms of our basic agenda, days 1, 2, and 3, you can stay pretty consistent. Day 4-ish, probably 3 or 4-ish, we're going to take a complete rest day and let the body completely recover, maybe focus on soft tissue mobility. And then day 5, we want something smooth and easy, get the body feeling good. If you have any you know problem areas we're doing a little bit of accessory work to tune those up but we're not hitting a hardcore CrossFit style event the day before that competition. A couple other things that I would maybe not do in that week before is I would not go above 75 80 percent of your maximum volume in terms of load so if your programming calls for deadlifts, squats, whatever it might be, some heavy loaded exercise, no matter what, keep that in that moderate, upper moderate range there. I feel like being in that 60, 65, 70, maybe 75% range at the most gives you an opportunity to load those tissues, feel like you're getting something out of it, but also not blasting the nervous system. Our nervous system is probably one of the most undervalued parts of our recovery because it's hard to sometimes assess until you go and perform. But when the nervous system is down, our actual performance will be down as well too. And typically what drops the nervous system is high volume training and high loaded training because we only have so much of the tank to give before we need to recover. So I would avoid hitting heavy, heavy weightlifting the week of. Keep those 75-ish percent or lower. That being said, too, another thing I've seen a lot and had a lot of education on is if your event calls for some sort of weightlifting complex, like a hang snatch to overhead squat to hang snatch complex, I'm just making something up, don't go out and test that thing at max capacity over and over and over again. One of the biggest flaws that I see with our novice CrossFit athletes is that it's something new. It's like, oh, I haven't done this exact complex. I don't know exactly what it's going to feel like. Well, go and test it at that 50%, 60%, 70% maybe. but I see so many people the week or two prior doing it three or four times and what they're doing is depleting their nervous system and when it matters on that Saturday when competition is there, you may in fact lose some by having tested that so often before. So I would, I'm not saying don't trial it to see what it feels like, but I'm saying you should have a good understanding now with all the training you've done before to earn your right to be in that competition, roughly what your capabilities are, and then testing that complex at lower to moderate weights will give you a little bit of an insight to where you think you can be, but you are not going to get stronger by practicing that over and over again in a week or two before that event. So get familiar, but don't blast yourself with those complexes. Yeah, and then the other thing I was gonna say is just don't, in terms of testing, going a little farther, don't test all those workouts that you're about to do at max capacity multiple times either. I'm on board for learning, for strategizing with team, if you have a team event, I think that is great, but do those several weeks in advance. Don't go and blast your body the week of testing an event that you're probably gonna do because that's where we'll see decreased performance and potentially injury risk that will increase when we're doing that stuff there so recap of the week of the week of you're going to train as usual for the most part days one two and three Day three and or four, we're going to take a rest day and let that body completely recover. Just focus on mobility, recovery style stuff. Day five, we want to move a little bit. Lightweights, bodyweight style exercises, throw that into an EMOM format. Get yourself on a ERG machine and do some zone two monostructural work. We want to avoid max effort loads throughout the week to keep our nervous system healthy. We don't want to test everything over and over again. Save yourself for Saturday. You will not lose by not training, but you can lose by overtraining in that week before. All right, so now you're in the day of. Day of competition. This looks a little bit different to everybody, but a few little pointers that I have, some of them will be obvious, but just reminders, is that just stick to your game plan. Hopefully you've thought your process through and trust it. You know yourself as an athlete, your team hopefully has connected, or your training partners, and you know each other fairly well. Don't let other people dictate your plan. Stick to your plan. CrossFit's all about being able to adapt on the fly, which you will have to do sometimes, but don't go in constantly thinking that you have to change your strategy. Trust your strategy and see where things take you. 10:37 NUTRITION ON COMPETITION DAY In terms of nutrition during competition day, I feel like we need to be eating. I think that's an obvious thing to say, but what we eat matters. We see people, Matt Frazier was a good example, who would just slam multiple Snickers bars in a day of competition because he was looking for fast carb glucose intake to replenish those muscles. It's actually not a terrible strategy, but we're not Matt Fraser either. There's got to be probably some moderation to that. I do believe having easily digestible carbohydrates, which may include some sugar and that's fine. A couple little gummy worms here or there, some fruit, maybe some of those protein bars or energy bars that have some carb in it, built in it. things that taste good and that are easy for you to digest are probably best. We need carbs to replenish our muscular glycogen system and just our overall metabolic system. I think getting some protein in is fair, but we don't need to heavily douse protein. We don't need to be eating like multiple burgers that will sluggishly kind of slow you down. So lean proteins, beef jerky, a little bit of pulled chicken, something like that can be a fairly easy type of protein to digest. And then I would say a third thing being fluids and electrolytes. So this is where getting salt waters of some kind, like a element for an example, or your own homemade version of that, getting that electrolyte balance into our body is crucial. You're going to be pumping fluids out, And you can get really scientific with this and weigh yourself before and after an event like some of these higher level athletes do. But I don't think that we have to be at that level. But do replenish your fluids. Be drinking water. Get some sort of electrolyte back into that system. And I think these are going to be two really crucial things in terms of adjusting fluids that are important there. Some of these sports drinks, just read the back. Get smart with these guys. Like read the back of some of these labels and you'll realize that you could make yourself a way better balanced electrolyte style drink than the marketed ones that have virtually nothing inside of them. So get online. figure out how you could dose in some table salt with some other electrolytes and just make something that is gonna help you retain fluids, especially if you're doing this in a hot, humid environment where you know you're gonna be sweating a lot. And then I think the other thing in between events is don't just sit and do absolutely nothing. Take some time, five, 10, 15, 20 minutes at the most to recover and chill, but as you're leading up into that hour before your next event, try to move. walk around, hop on a bike if they have one. This is where I will actually, in some circumstances, support things, simple things like massage guns. There is some anecdotal and potentially actual structural evidence that would say that the vibration and impulse is a good way to just kind of prep that nervous system and keep those tissues a little bit more aware of what they're about to be doing. I'm game for it. Whatever you gotta do to stay agile and feeling like you're at your best is what we need to be focusing on there. So day of, stick to your game plan, proper nutrition, including carbs and protein predominantly, and then electrolytes is big as well, fluids and electrolytes, and then find some way to keep that body moving in between events that you're not stiff, stagnant, going in. The ability to warm up, keep your heart rate at a good level, and then hit a fast 100% effort event is crucial to success. We don't wanna be going in cold. Even if you're feeling a little tired, you gotta find a way to keep that heart rate moving. 14:17 TAKING REST AFTER COMPETITION All right, final thing is our final prep, I should say follow-up week, the week after your event. So you've done your week before, you've completed your event, congratulations. Sunday, Monday, Tuesday, leading into the next week, what do we do? Be okay, I'm gonna say this again, be okay taking more than one day of rest. I have an event coming up this weekend that has for sure three main events that all are at least 18 to 20 plus minutes in domain plus five like mini events. And then if you are lucky and fortunate enough to earn your right into the championship event, that would be four main events. So four main events plus five mini events. I don't train for that. Nope, not many novice athletes do. Elite athletes, yes, they are prepping with four to six hours of training on average per day in a week. We don't do that. Not many of us are doing that. So if we are going to go out and sell our soul in this event on a weekend, be okay taking Sunday, Monday, and maybe Tuesday and doing little to no major physical activity. It doesn't mean you have to be a couch potato. Maybe you are again going for hikes, walks, little bike rides, whatever it might be. Find some enjoyable sport that you like, like golf to get out and just stay active. I'm not asking you to be lazy, but I'm asking you to respect the amount of volume that goes into some of these CrossFit events. I see a lot of people who go and smash it on Saturday and then are at the gym on Sunday working out or Monday doing a, you know, high level, uh, online programming that is consisting of two plus hours of training. to each their own at the end of the day, but it's okay, I'm giving you permission to let your body recover. At the end of the day, for me, I'm reminding myself that this is not about today and tomorrow, this is about 20, 30, and 40 years from now. I am building my fitness to be a better, older adult. So be okay taking some time off. Use the next week to just sort of assess the body. Did anything tweak? Are you sore? Are you stiff? Focus on those areas. This is where getting your clients maybe back into your clinic that following week and just prepare for that. Say, hey Johnny, I know you got an event coming up on Saturday. Why don't we make sure that we have a day to meet on that following week just so we can talk about how it went and be sure that we're doing some good recovery things and I can help you better game plan that following week as well if I can see you early on that week. So take time to assess the body. And I would suggest again, similar to the week before, keeping loads in that 75, 80% or lower before we get back on track with your normal training. Just allow again that nervous system to recover and do what it needs to do, so. Hopefully that was helpful, guys. Again, either for yourself or for clients that you're having, but I love the fact that people are dedicating themselves to fitness and that they're willing to put their body, their soul, their personalities, their mentalities, their identities on the line and go sell it on a weekend or online competition. We are training for a purpose. We have short-term goals. We can go test those out. We have long-term goals. All this is leading to that direction. So preparing yourself for that competition is really important. Executing on the day of is really important and making sure you give yourself time to recover afterwards is also important. Hopefully it's helpful. If you have any questions, comment on the videos. Otherwise, take a look online and see if you have any interest in getting into our CMFA live courses coming up across the country. They are filling up. So let's get on those and enjoy the end of our year together. I will talk to you later. Have a great weekend. 17:46 OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.
If you listen to essentially any piece of contemporary music, you're likely—more than likely—to hear the influence of Bob Moog. Moog invented the first modular synthesizer, a device for creating electronic sound simultaneously more powerful and more accessible than anything that had come before. Initially adopted by the avant-garde, Moogs were quickly scooped up by the elite of rock and pop, laying a heavy sonic signature on the 1970s—and pretty much much everything that has come since. Think...Floyd. Think Stevie. To learn more, we talked to Albert Glinsky, the author of “Switched On: Bob Moog and the Synthesizer Revolution,” the definitive biography of the man behind the tones. And the story? It's wild. Featured topics include: home-grown Theremins, electronics stolen from Con-Ed, Japanese industrial conglomerates, hippy rip-off albums about the zodiac, open-faced breadboards, John Cage & Co, and the determinative power of the keyboard. How an inveterate tinkerer, ensconced in upstate New York, remade the world. Subscribe to our newsletter! Follow us on Twitter! Music - Panic Girl - "Washed Ashore"
Hosts STEPHEN SCARLATA (producer, Jodorowsky's Dune) and JOSH MILLER (writer, Sonic The Hedgehog, Violent Night) explore the unmade career of writer/director BENDAVID GRABINSKI ("Scott Pilgrim Takes Off"; Nickelodeon's "Are You Afraid of the Dark?" reboot). Surviving the Hollywood system is often funny, frustrating and ultimately inspiring. In this episode we discuss the never-realized projects The How-To Guide for Saving the World, Con Ed, Whiplash, Archer & Armstrong and more! Part 1 of 2 episodes. Get BONUS content on Patreon! https://www.patreon.com/BestMoviesNeverMade/about Theme music by Brian J Casey Follow us on Twitter: @NeverMadeFilm and Instagram: Best Movies Never Made.
Service on the 1,2 and 3 subway lines are back up and running, after a water main break disrupted the morning commute for more than 300,000 New Yorkers. Plus, WNYC's Sean Carlson talks with Laurie Wheelock, executive director of the Public Utility Law Project of New York, about ConEd's recent rate hikes. And finally, WNYC's Precious Fondren goes shopping at Find Me Now's sample sale and learns more about the trendy clothing brand and their hardcore fans.
Get up and get informed! Here's all the local news you need to start your day: Con Ed and city officials urge New Yorkers to conserve energy during peak hours amidst a heat wave. Also, a landlords' group sues Jersey City over new legislation providing low-income tenants with free legal counsel in housing court. Meanwhile, the Bowery Residents Committee lands a $103-million contract to aid subway homeless, despite past performance issues.
On this day in 1977, a citywide power outage created total chaos in New York City.See omnystudio.com/listener for privacy information.
Working for Con Ed never looked so cool. On today's episode we're diving into Iraq metaphors, Mike's shitty crowd work, gay Elsa, and monster anatomy! Next week, The Haunted Mansion! Befriend us: Pod: @thetoniawards on Instagram Jake: @jakeheverhart on Instagram, @therealjakobeem on Twitter Sam: @samanthprosser on Instagram, @samanthprosser on Twitter Connor: @connor_kwiecien on Instagram Shea: @justsheavassar on Instagram, @shea_vassar on Twitter
And we’re back! It’s been over a month since we did a Q&A episode, so I knew I needed to get one in sooner than later. This week, we’ve got a ton of fun topics to discuss. For starers, how do you determine your own weaknesses and plan your continuing education? How do you help […] The post May Q&A: Movement Models, Con Ed and Augmented Eccentrics appeared first on Robertson Training Systems.
We have been trying to get Miranda to come sit on our couch for some time now. She's been a listener for a while, engages with us behind the scenes and gives her two cents about our episodes, has attended the Canadian Massage Conference with us, taken ConEd classes, and hangs with us at our free networking events. It took so long because despite Miranda having many opinions, she's quite introverted and deals with social anxiety. She finally agreed to come by and talk shop with us. Listen to Miranda's story, a little about her struggles with social anxiety, her journey through school and self- employment, and some real stories of dealing with clients who cross boundaries. 2rmtsandamic.com | conedinstitute.com | massagetherapymedia.com
True Creeps: True Crime, Ghost Stories, Cryptids, Horrors in History & Spooky Stories
Join us as we defuse the details of the Mad Bomber that tormented New York City for over a decade and a half with over 30 bombs. We'll discuss his motives, his explosive attempts to make his former employer listen him, and how he was apprehended.Join our Facebook group here: https://www.facebook.com/groups/449439969638764https://www.patreon.com/truecreepshttps://theweirdemporium.net/pages/true-creeps-podcast-merchwww.truecreeps.comHave an episode idea or a question about a case? Submit them here: https://www.truecreeps.com/ideasandquestionsTwitter @truecreepsInstagram @truecreepspodFacebook.com/truecreepspodEmail us at truecreepspod@gmail.comUnmasking the Mad BomberCon Edison celebrating 200 years of powering the cityConsolidated Edison Company of New York, Inc. | Encyclopedia.comAbout Con Edison & Our Services | Con EdisonAbout Con Edison & Our Services | Con EdisonHistory of Con EdisonMicrosoft Word - Scolari_v_ConEd.docNY Harlem Explosion & Con Edison Training Errors | Daniella Levi LawAcevedo v. Consolidated Edison Co. of New York, Inc., 189 A.D.2d 497 | Casetext Search + Citator$2,600,000 Settlement for Local 3 Electrician in Con Edison LawsuitWorker Is Electrocuted at Con Edison Plant - The New York TimesConsolidated Edison Manager Burned in Manhole ExplosionDr. James A. Brussel, Criminologist, Is Dead - The New York TimesA 16-Year Hunt For New York's 'Mad Bomber' : NPRThe Mad Bomber: Origins of Criminal Profiling – StMU Research ScholarsGeorge Metesky | American terrorist | Britannica
Why is Jessie's bill so high!? She's adulting today trying to figure out Con Ed and recently decided she's throwing a Halloween party. Chris is moving through a rough patch in life, why doesn't fall ever go his way? Send him some support! Jessie tries to invite him to pumpkin carving, and a discussion about invites ensues. We end on an improv scene to lighten it up before we send off. Patreon? There's tons more content for you there.
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